The Senate Committee on Health & Human Services met on March 31 to take up a number of bills. In order, this report covers SB 1616 (Bettencourt), SB 984 (Schwertner), SB 1195 (Paxton), SB 640 (Menendez), SB 437 (Blanco), and SB 968 (Kolkhorst).
This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.
SB 1616 (Bettencourt) Relating to powers and duties of governmental entities during a public health disaster; providing civil penalties.
- Many political subdivisions of the state had different views on how to handle pandemic than what the state did
- County judge in my district is not allowing in person attendance, strict workplace capacity
- Defines disaster for local emergency management & sets pandemic above it; puts this in hands of state
- Removes criminal penalties for violation of local pandemic orders, replaces them with civil penalties
Shelby Sterling, Texas Public Policy Foundation – For
- Broad, but temporary power granted under public health emergency, some orders promulgated under this were inconsistent with state orders and possibly unconstitutional
- SB 1616 clarifies public health emergency and removes criminal penalty; ensures there is a statewide response to pandemics
- Many political subdivisions have overstepped their authority
- Would restore local disaster declaration law to original intent, was supposed to apply to natural disasters like hurricanes
- Seliger – How many died in TX as a result of COVID?
- I think it was very high
- Seliger – If that many people died in a hurricane or tornado it would be a disaster
- Yes
- Buckingham – With you on regulations and what we experienced last year; however, do you have concerns that this would be taking tools out of the toolbox for something like Ebola?
- I think that this provides one solution & ensures state response
- Tools are available for the local health authority through the Health & Safety Code
SB 1616 left pending, public testimony to be taken later
SB 984 (Schwertner) Relating to public health disaster and public health emergency preparedness and response, including the operation of the Task Force on Infectious Disease Preparedness and Response.
- CS laid out
- Ensures Texas is better prepared to respond to public health emergencies; needed clear data
- Tasks DSHS with establishing reserves of PPE, requires Infectious Disease Task Force to meet once per year, epidemiologist to be included in Task Force membership, requires RACs to collect deidentified data from hospitals in TSA
- Data reporting provision is not intended to do anything else but give state most basic level of insight, plan to work with HHSC on this
- CS adds Nelson amendment
- Schwertner – Certainly issues with PPE, collecting & assimilating info, whoever can do this the fastest and most accurately is what we need to do
- Kolkhorst – Sen. Campbell, Sen. Schwertner, Sen. Miles, and myself were on a work group over the summer, many ideas come from this work group
Eric Epley, Southwest Texas RAC – For
- Provides overview of RAC creation & operations
- RACs have several large trauma, cardiac & stroke data initiatives, want to leverage this in pandemic response as well
- RACs helped distribute PPE across the state, collected data alongside state & federal efforts; need to unify data at the lowest level
- Need to do aggregate reporting & prevent hospital shopping
- Data needs to be collected at RACs due to local interest
- Buckingham – Different diseases require different PPE, how do you determine?
- Have levels of PPE depending on contagion, infectious disease response unit was built after Ebola and have a cache of high response
- COVID needed a little bit less, but have kept caches up, has been tough to rotate
- Buckingham – Expensive, sitting on things you can’t let sit for 10 years
- Ideally if we had an MOU with each major system and one large expense, then keep rotation through normal course of order
- Buckingham – One issue is PPE is manufactured overseas, similar to generation we may need to ensure manufacture within the state
- Kolkhorst – Reads statement from TDEM Chief Nim Kidd in support of Epley
SB 984 left pending, public testimony to be taken later
SB 1195 (Paxton) Relating to the right of certain hospital patients to designate an essential caregiver for in-person visitation.
- CS laid out
- SB 25 proposed this for LTC, SB 1159 applies to hospital patients
- For minors, both parents or conservators are able to be in the room at the same time
- CS adds sections to parallel SB 25, establishes patient right to visitation every day, 7 day limitation, alternative caregivers can be immediately designated if one is restricted, safety protocols cannot be more stringent than staff protocols
SB 1195 left pending, public testimony to be taken later
SB 640 (Menendez) Relating to a study on the interoperability needs and technology readiness of behavioral health service providers in this state.
- CS laid out
- Data is not fully shared electronically between behavioral health providers; telehealth is challenging if data and consent cannot be shared easily
- SB 640 will help state understand issues on interoperability and gaps in readiness for behavioral health
- CS clarifies that HHSC will conduct study, not eHAC
Christine Bryan, Clarity Child Guidance Center, Texas Hospital Association – For
- Was a federal incentive program for EMR 10 years ago, mental health is probably 10 years behind other health care sectors
- Will help determine what the tech capability is of the behavioral health landscape
- Clarity has a EMR system, but unlikely to have any psychiatric or mental health history from other providers
- Two new directed payment programs will begin asking if we’re sharing with Health Information Exchange, EMR is necessary for this
- Will help prep to be able to utilize federal funds in the future and avoid quality penalties
SB 640 left pending, public testimony to be taken later
SB 437 (Blanco) Relating to the state reserve of personal protective equipment for health care workers and essential personnel.
- CS laid out
- CS requires state to establish and maintain a 60-day stockpile, TDEM to consider amount & type of PPE, length of time to store, and process for restocking
- Requires TDEM to establish advisory committee for recommendations in rulemaking
- CS moves PPE stockpile from DSHS to TDEM, time limit down to 60 days from 90 days, adds Homecare rep to advisory committee, includes electric & gas employees to definition of essential personnel, and Nelson amendment
- Hall – Where would the PPE be physically stored?
- Question TDEM would answer
- Hall – Heard Chief Kidd’s talk about strategic warehouses around the state with plan to refresh; does this bill fit with what Chief Kidd was discussing?
- It does, have been working with TDEM on this bill
- Part of the move from 90 days to 60 days to match FEMA reimbursement schedule
Cindy Zolnierek, Texas Nurses Association – For
- PPE essential for defense against infectious disease, masking and PPE is crucial for those needing to work in tight spaces who can’t distance
- For COVID, PPE supply was woefully inadequate & drastic measures like reusing masks were needed
- Nurses felt abandoned and experienced moral distress, no caregiver should be placed in this situation
SB 437 left pending, public testimony to be taken later
SB 968 (Kolkhorst) Relating to public health disaster and public health emergency preparedness and response; providing a civil penalty.
- CS laid out
- Broad bill defining healthcare powers currently not defined in law, attempted by Sen. Schwertner after the Ebola outbreak; need to balance between government and governed
- Requires TDEM to enter into priority contracts with PPE suppliers, modernizes and limits definition of public health disaster, defines public health emergency, requires health facilities to maintain minimum PPE, describes DSHS’ duty as lead health agency during disaster, removes DSHS broad authority to impose control measure and defines limited authority, requires reporting of cycle threshold values, establishes legislative oversight over public health disaster orders, restricts public health emergency to 30 days, allows DSHS to seek civil penalty for failure to report, establishes office of Chief State Epidemiologist
- CS removes preparedness planning with other state agencies section, directs Preparedness Coordinating Council to make recommendations for preparedness planning, clarifies that TDEM shall contract for PPE, aligns definitions of public health disaster and public health emergency, restricts DSHS’ ability to declare disaster to 30 days & extended by legislature, adds Nelson amendment, clarifies that TMB is not granted rulemaking authority, directs Chief State Epidemiologist to report to SOC
- Saw many issues with who was in charge, PPE management and distribution, etc.
- Also had issues with Ebola where DSHS wasn’t able to declare disaster
- Removes DSHS to issue control orders broadly, defines specific control order ability, requires comprehensive review of COVID response by the Preparedness Planning Council
- Attempt to give agency enough tools with continued input from the legislature
Chief Nim Kidd, TDEM – Resource
- Perry – Do you currently have a plan or do you need guidance on PPE stockpiling?
- I think we’re close to the same understanding, have a lot of PPE in inventory
- Don’t own climate controlled storage PPE is sitting in now
- PPE will have a shelf life because private sector is back up, but still have 40 locations around the state
- Locations under lease will need to re-sign or move
- We do have a plan to put 8 warehouses around the state, not all the same size and not all stocking the same items; would like to keep PPE, meals, and water
- Need venue, utilize PPE to start stockpile, and to figure out distribution
- Perry – this issue is put to bed as long as we can move forward, I think it is the right plan to move forward with a local perspective
- Perry – Logistically all we need to figure out warehouse storage, we have gotten to the point if we can figure out funding
- Buckingham – Do you need state to tell you PPE needs, or do you have this covered in your plan?
- Would love for local providers to tell me what PPE they need, would rather be in a position to communicate with providers on what PPE they have
- Will need to distribute PPE again, difficult to know what’s needed with provider info
- Missing cell of people with global supply chain outlook
- Buckingham – Needs fluctuate, PPE needed for diseases differs; difficult to figure out what PPE would be needed, I think we have more of a responsibility to ensure things are manufactured here
- Buckingham – Would you be a retailer of PPE?
- Would prefer not, would prefer to work with entities; could possibly use state health systems, work with daily users of PPE
- Perry – This was a health issue, also highlights importance of water and other supplies
- Seliger – The way TDEM handled PPE was exceptional; have you spoken with hospitals about getting PPE from you
- Have had conversations, highlights MRE stockpile that rotates as ordered
- 60 day burn rate helped informed numbers needed for PPE
- Kolkhorst – If you’re looking at the state from a company perspective, what is TDEM’s role?
- Likely COO for disaster response, commissioner of health should be Chief Medical Officer
- Kolkhorst – Logistics-wise you have the ability to move PPE, SB 968 attempt is to clarify that DSHS serves in the primary public health role & TDEM is response; still needs some work
- Perry – Is it your professional opinion that there is a shelf-life on PPE?
- A lot of people put shelf-life on things due to safety, sometimes do this to make you buy more
- Brought in scientists to look at PPE and ensure it was safe and effective
- Saw a lot of materials used in PPE break down, will always be a concern for providers
- Campbell – Things like q-tips and tongue depressors don’t have an expiration
SB 968 left pending, public testimony to be taken later
Senate HHS reconvened after the floor to take testimony on pending bills
SB 437 (Blanco) – Relating to the state reserve of personal protective equipment for health care workers and essential personnel.
Kevin Warren, Texas Healthcare Association – For
- Early shortages in PPE and changes in guidance
- Went through 89,000 masks, 66,000 face shields, 18,000 boxes of gloves, and 97,000 gowns on a daily basis in long term care facilities
- The reserve should be a backstop
- Early prioritization was focused on the surge in hospitals
Diana Martinez, Texas Assisted Living Association – For
- Had to purchase homemade masks and make homemade hand sanitizer at first, purchased masks from China
- Texas needs to follow Louisiana’s example in supply
- First set of masks were found to be fake, lucky to get one case of gloves when ordering 2-3
- Purchased masks from China, KN 95 unavailable at the time
Chloe Goodman, Worker’s Defense Action Fund – For
- Offers legal services to low wage workers
- Construction workers not provided with PPE and other hygiene products
- Outbreaks on construction sites were common early on
Rene Lara, Legislative Director for Texas AFL CIO – For
- Bill establishes a stockpile of PPE
- Represents meat packing companies, some shut down in the country
- Hoarding was major issue in the supply chain
- A stockpile known to exist will lessen hoarding if made widely known it exists
SB 437 left Pending
SB 1195 (Paxton) – Relating to the right of certain hospital patients to designate an essential caregiver for in-person visitation.
Meagan Corser, Texas Homeschool Coalition – Neutral
- Provision that allows parental access to children in hospital
- Language allows hospitals to deny access for any court order regarding access, which occurs often on both sides in divorce cases, doesn’t want this excuse to be used
Sheila Hemphill, Texas Right to Know – For
- Inability to reach loved ones in ICU has affected many
SB 1195 left Pending