Legislature(2007 - 2008)BUTROVICH 205
02/20/2008 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB245 | |
| Proposed Amendments | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| = | SB 245 | ||
SB 245-HEALTH CARE: PLAN/COMMISSION/FACILITIES
CHAIR DAVIS announced consideration of SB 245.
1:38:10 PM
UNIDENTIFIED SPEAKER said the federal government recognizes it
is reasonable that not all the expense be paid by the group's
physicians and allows partnering with a hospital for
radiologist/physician offices. Because of the long-standing
relationship between radiologists and hospitals, they are
natural partners in this type of venture and the partnership
provides physician office access to sophisticated information
technology systems which benefit patients by providing
communication between facilities. The most vocal opponent of
this exemption is the representative of the country's largest
publicly traded hospital corporation, and it is understandable
why they would like the state to cripple their competition. It
is impossible to see how giving them a monopoly as providers of
these scans benefits the patients of the state or the state
itself. One of the earlier provisions in the bill would protect
facilities in smaller communities, and competition that would
skim off revenues produced by imaging procedures could
jeopardize the continued existence of these small, critical
facilities. Facilities in boroughs with a population greater
than 60,000 do not need this type of protection from
competition.
He summarized by saying that, as a radiologist operating a small
business, he spent considerable time and money bringing
equipment and physicians to the State of Alaska and its'
patients and would like to see an end to the legal quagmire
caused by lack of a definition of a physician's office in the
existing Certificate of Need law. The language in the committee
substitute adopts a definition that is both a compromise and
consistent with federal regulations.
1:40:46 PM
PAUL FUHS, Lobbyist, Alaska Open Imaging Center, LLC (AOIC)
outlined the legal problems that have resulted from lack of
definition. After HB 511 was passed, it did not define
"independent diagnostic testing facility," but did not eliminate
the physician's exemption either and that is where the confusion
lies. AOIC opened an office in Fairbanks that was declared a
"physician's office" by the centers for Medicaid and Medicare
and was determined by the commissioner to be a legal operation.
When they opened another facility in MatSu, a suit was filed in
Fairbanks claiming that they were an Independent Diagnostic
Testing Facility (IDTF). The judge ruled that, because there
were no definitions in statute and they did own imaging
equipment, they were an IDTF and ordered the facility in
Fairbanks to close. When an orthopedist in Juneau was allowed to
open an MRI facility, they transferred ownership completely to
the physicians and reopened in Fairbanks, but that could still
be appealed. After that, a hospital filed another suit against
the facility in MatSu because it was not 100 percent physician
owned, even though there is no regulation that requires it to
be. The administrative law judge closed the MatSu facility
despite two letters from the commissioner supporting the
legality of the operation.
This has completely destabilized investment in this area, which
is adversely impacting patients because people are buying the
oldest equipment available in order to stay below the threshold
of $1.2 million in equipment so they don't need to get a CON.
He said AOIC had always argued for removal of CON in the mature
medical markets; but stressed that the legislature must clear up
these definitions and end this legal limbo.
1:44:29 PM
ROD BETIT, CEO, President, Alaska State Hospital and Nursing
Home Association, testified in support of the new language in
this committee substitute and encouraged the committee to adopt
the CS.
SENATOR THOMAS questioned the issue of costs and what drives
them, and how, from a hospital's point of view at least, removal
of the CON would increase costs. He understood that removing
imaging or other services from hospitals would decrease revenues
and the loss would be spread over the entire operation, but
statistics show that daily hospital charges have doubled or
tripled from 1992 to 2006. If the CON was holding costs down,
then removing it would be a major concern; but if competition
might help [to control costs] he would certainly be in favor of
it.
1:48:19 PM
MR. BETIT said he had price comparisons in Fairbanks for those
services inside and outside the hospital and, in all cases,
Fairbanks Memorial was lower than what the competitors were
charging. He believed if they had that data for the entire
state, it would help them understand whether increased
competition actually produced lower costs for consumers. He did
not feel they could really answer that question until the
information became available for everyone, not just hospitals.
That information in combination with the Community Benefit
Report should provide a much clearer picture. He noted that the
Community Benefit Report in the members' packets was their first
attempt to capture the amount hospitals statewide were absorbing
in unreimbursed expenses.
1:50:19 PM
DR. ARTHUR MANNING, was very much opposed to the CON. He said
the cost of a procedure he had performed at Providence the
previous summer was $56,622.71. A week before the following
Christmas, he had that same procedure performed at the Pioneer
Peak Center for $10,913.00. In addition, there was no operating
suite available that week at either Providence or Regional
hospitals and a doctor who worked there said if you came in with
a broken femur you could expect to wait until the following day
to get it set. He wondered where the 50% excess in operating
capacity claimed by those hospitals might be. He also disagreed
with testimony presented the day before to the House of
Representatives that there was a shortage of nurses. He observed
that there were plenty of nurses in Fairbanks but, like his
neighbor Cathy Sullivan, they were working in other fields
because they could make more than what the hospitals were
paying. In closing, he alleged that many of the administrators
"down there" were not being truthful.
1:53:05 PM
DR. BOB BRIDGES, Owner, Aurora Diagnostic Imaging Center (ADIC),
supported the repeal of CON and the provisions in SB 245, and
applauded the legislature for the definitions that were included
in HB 345. He stated that physicians also absorb a lot of
unreimbursed expenses; he takes care of charity cases as well as
Medicaid and Medicare patients. He liked the idea of posting
prices and the quality of care that goes along with that online
so people could shop around, but cautioned that the costs posted
should allow for a realistic comparison, noting that hospitals
break out costs while his billings are all-inclusive.
CHAIR DAVIS thanked Dr. Bridges for his testimony and for taking
Medicaid and Medicare patients. She assured him she had not
heard anyone say that only the hospitals provide uncompensated
care.
1:55:37 PM
SENATOR THOMAS said he understood that 80 percent of doctors in
Fairbanks and many in the Anchorage area, were not taking
Medicare. He commented that when he looked at the huge increases
in charges per adjusted patient day over a 14 year period, it
caused him to wonder whether competition would actually reduce
prices, and asked Dr. Bridges if he felt he would continue to
take Medicare and Medicaid patients.
DR. BRIDGES responded that he could not, in good conscience,
turn people away; he donated a pet scan each month to
Alzheimer's patients and was a member of Access Anchorage, which
provides services to those who cannot not afford to pay for
them. He added that, as one of the original WAMI medical
students he felt he owed the people of Alaska for his education
and was looking forward to paying it back.
1:59:00 PM
JILL THORVALD echoed Dr Bridges' comments regarding charity
cases. She stated that she is the Executive Director of a
medical clinic in Fairbanks that wrote off in excess of $100,000
during the prior year because they treated everyone, regardless
of their ability to pay. She further attested that they were one
of the only providers locally that would take Medicaid and their
doctors were on call with the hospital 24 hours a day, 365 days
per year.
SENATOR THOMAS commented that Fairbanks Memorial Hospital built
a wonderful extension to their facility. It is an expensive
operation to run and has to be manned 24 hours a day, 7 days a
week. He asserted that no one else provided that level of care
for serious accident victims and asked whether or not she agreed
that if the CON were repealed, an expansion like that would
receive less emphasis in the hospital's list of priorities based
on their bottom line, thus reducing access to life-saving care
for people injured in serious accidents.
MS. THORVALD replied that, in her personal opinion, the
emergency room's bottom line profit would not be affected at all
by loss of the CON. As a matter of fact, she felt repealing the
CON could enhance the operation as it would free more doctors to
rotate through those calls, which would mean a wider choice of
specialties and better rested doctors.
SENATOR ELTON guessed that the emergency room at the Fairbanks
hospital was not a profit center so there wouldn't be community
competition with the emergency room. He was concerned that the
hospitals would continue to provide services that do not provide
profit, while the profitable services leave the hospital.
2:03:28 PM
SENATOR ELTON asked if he had misunderstood her answer.
MS. THORVALD responded that he did pose a good point however, if
the CON went away making this a more attractive community to
other providers, it would enhance other departments in the
hospital that are profitable.
2:04:53 PM
CORONE STURM supported SB 245, specifically repeal of the CON.
She acknowledged that they have a wonderful hospital that is a
valuable resource to the community, but stressed that the
doctors are also important, and they were leaving "in droves"
because it was no longer profitable for them to practice here.
She said she had been listening to testimony on these bills for
a couple of weeks and had heard a lot of hospital
representatives present their positions; she exhorted the
committee members to listen to their constituents, to people
whose medical bills are skyrocketing and have had to leave town
or the state to get care. She said she heard testimony the day
before in a House committee meeting from people who were turned
away for care and who couldn't see their own providers because
they did not have privileges at the hospital. And for those who
could get care, the cost was very high. She attested that
competition was recognized in health care as vital in a
community of their size to prevent a monopoly.
She encouraged the committee to move forward with SB 245 saying
that, unless they create a more conducive environment, they will
continue to lose quality providers.
2:07:53 PM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services (DHSS) made herself available for questions.
SENATOR DYSON confirmed that Commissioner Jackson was working
from version /L and asked her to turn to page 5, line 24. He
said he would like the state to encourage people to take
responsibility for their own health care and was looking for a
place to insert that. He assumed that if the bill passed, her
department would promulgate regulations to implement it, but
wondered whether the bill should be amended to place more
responsibility on the individual.
COMMISSIONER JACKSON assured Senator Dyson that promoting
personal responsibility was at the core of the bill. She asked
whether he was asking for more specific verbiage in that portion
of the bill.
SENATOR DYSON suggested that after the "and" they insert the
words "health care" and "healthy living." He wanted to be sure
that would not be counter to her intentions or the governor's.
COMMISSIONER JACKSON concurred with Senator Dyson's suggestion.
SENATOR DYSON then directed the commissioner's attention to page
7, line 20 [21] regarding hospital ratings. He proposed that, in
addition to "infections and mortality" they should also be
logging medical accidents.
2:11:25 PM
COMMISSIONER JACKSON invited their chief medical officer to
address the question.
2:11:44 PM
JAY BUTLER, Chief Medical Officer, Department of Health and
Social Services (DHSS) agreed that Senator Dyson raised a very
good point. An example of the type of things that could be
included there and were currently being collected was falls, an
important and completely preventable cause of injury. He felt
this could be coordinated with the movement by Centers for
Medicare & Medicaid Services (CMS) to stop Medicaid
reimbursement for medical errors.
SENATOR DYSON asked if Mr. Butler was suggesting that they add
"accidents and medical errors."
MR. BUTLER said the question was whether to specify it in the
bill or defer to the commission to define that level of detail.
He did agree that, in terms of the types of things that could be
reported, it fit very well with the goal of letting people know
how safe a given health care facility might be.
SENATOR DYSON felt that, because they had already listed
infections, it might make sense to complete the list.
CHAIR DAVIS interrupted to clarify with Commissioner Jackson
that the commission could specify that level of detail without
including it in the statute.
MR. BUTLER said that would be his recommendation.
SENATOR DYSON moved on to page 8, line 21 and asked whether
everything listed under mandatory reporting would be on the
website.
MR. JACKSON answered that all of it could eventually be on the
website. He was concerned that the mandatory reporting
requirements were very ambitious and he was not sure how much of
it was feasible in the short-term. He understood that the goal
of the statute was to create the authority to collect the
information.
COMMISSIONER JACKSON added that with the new effective date of
July 1, 2009 it might not be possible to get all of the listed
components on the web that quickly.
SENATOR DYSON clarified that he was not talking about the
implementation; he wanted to know whether the bill specified
that the data gathered through mandatory reporting would be made
available to the public online.
MR. BUTLER responded he was not able to provide a legal
interpretation.
SENATOR DYSON asked if it was the administration's intention to
make that information available.
2:15:36 PM
CHAIR DAVIS interposed that Senator Dyson was getting ahead of
them and she would like him to hold his question until they were
ready to consider amendments.
SENATOR DYSON explained that, before he could craft an amendment
he needed to know if one was necessary.
COMMISSIONER JACKSON said it was the administration's intention
to make that information available online.
SENATOR DYSON asked for clarification on line 21, "information
on costs to the consumer." He wanted to be sure this meant the
public would know the cost of that service for all consumers.
COMMISSIONER JACKSON advised that their attorney was making
careful notes on this.
SENATOR DYSON said, if they did not amend it, he wanted the
intention of the legislature to be clear on the record with
regard to this language.
2:18:10 PM
SENATOR ELTON said he wanted to go a step further than
clarifying their intent; he wanted it to be a component of law
that the information collected would be made available to the
public.
2:19:19 PM
Stacie Kraly, Chief Assistant Attorney General, Department of
Law said part of the problem is that the bill is full of
"shalls" and "mays" and "must" and those sorts of things, so
they need to do a careful review of the health information
portion of this to ensure that all of the provisions are
mandatory; that there is a mandatory obligation to disseminate
the information to the public.
She continued that it was the administration's intent and they
would have to be careful that any amendments did not unwittingly
make it more discretionary. She pointed to page 6, line 23 "the
department shall establish and maintain an information database"
and said it flows back to the mandatory reporting provisions,
which also include "shall" language.
CHAIR DAVIS asked if she felt comfortable with the current
verbiage.
MS. KRALY revealed that there was a proposed change to page 6,
line 30, which would change the "must" to a "may" and would turn
the mandatory language into a discretionary issue about what
should be included on the website. Otherwise, most of the other
language in the provision related to article 2 of the bill was
mandatory, not discretionary.
SENATOR THOMAS said it appeared to him that most unhealthy
lifestyles are developed early in life and he questioned the
absence of any mention of early intervention in the schools. He
also noted that the bill had grown far beyond the Certificate of
Need issue.
COMMISSIONER JACKSON assured Senator Thomas that they did not
mean to leave out what he recognized as a very important
component, which is the time kids are in school, but she did not
have the power to mandate in the schools, the school districts
or the Department of Education (DOE). She offered to include
language that would have DHSS work with DOE and provide them
with the same kinds of information included in the other
bulleted numbers: body mass index, diet and nutrition, exercise
etc.
Regarding Senator Thomas' comment about the CON being a long way
from the other two sections of the bill, she respectfully
disagreed. She believed they were creating more effective ways
to address access to care, quality of care, and cost of care.
2:26:47 PM
CHAIR DAVIS reminded the committee this was the third hearing on
the bill and they had a number of amendments before them, which
she felt they should consider before drawing up another
committee substitute. She realized that the most controversial
part of the bill was repeal of the CON and advised DHSS that it
was time to state their position on the current CS.
2:29:39 PM
COMMISSIONER JACKSON pointed out that the changes in section 4
caused the department some concern; not all of the issues would
be resolved in terms of Certificate of Need litigation with
those changes.
SENATOR ELTON interrupted to suggest that people following the
proceedings might not know how the changes in section 4 affected
the Certificate of Need program, and asked the chair to allow
Commissioner Jackson to talk briefly about what the new CON
program would be.
COMMISSIONER JACKSON summarized that section 4 in that version
added definition language around some of the independent
diagnostic testing facilities, but was concerned that it did not
include the ambulatory surgery centers and felt they should
consider adding that.
CHAIR DAVIS said she had used the language from HB 345 for this
section and if the Commissioner felt amendments were needed, she
would like the department to get them to her.
COMMISSIONER JACKSON said she would be happy to do that.
SENATOR ELTON summarized the changes: The bill evolved from the
original governor's bill that would have eliminated the
Certificate of Need program, to a Committee Substitute that
would change the CON so that diagnostic imaging equipment would
be exempted [from the program] in communities with a population
of 60,000 or more, provided that it is at least 50 percent owned
by state licensed physicians.
2:35:05 PM
CHAIR DAVIS thanked Senator Elton for the summary and confirmed
that this CS was not asking for repeal of the CON and she did
not think the committee would go back to version A and push for
repeal. She hoped that the language in the current CS would
still resolve most of the litigation issues surrounding the CON.
COMMISSIONER JACKSON deferred to their attorney to speak to the
legal issues.
2:37:01 PM
CHAIR DAVIS asked Ms. Kraly to speak to whether this CS would
resolve some of the legal issues facing the department without
repealing the CON.
MS. KRALY responded that inclusion of the SB 245 exemption for
diagnostic imaging facilities would resolve a majority of the
current law suits, as well as a pending application for two
facilities in the Anchorage area. It would not resolve all of
the issues.
2:39:02 PM
SENATOR DYSON said he had asked Ms. Kraly earlier what "cash"
meant in the context used on page 7, line 17. She said that is
what the patient/client would pay, as opposed to a third-party
payor. He wanted to confirm the "negotiated price" as used on
that line means the actual, total price for the procedure.
2:41:00 PM
MS. KRALY admitted that the pricing structure for health care
reimbursement is very complex, and Senator Dyson raised an
interesting and appropriate question as to the differences
between various pricing methods. She stressed that they would
need to be careful to be comprehensive enough in their language
to include the entire range of associated costs, and thought
they may need to include an additional phrase to make sure they
were including not only the negotiated price between an
insurance company and a facility, but what the actual cost was.
SENATOR DYSON cautioned that providers often give misleading
information and he was not sure "cost" was the right word. He
was looking for the totality of the value that transfers from
the payor to the payee.
MS. KRALY agreed.
CHAIR DAVIS chided that, if they would begin going through the
amendments they had before them, they would get to the issues
they were discussing.
2:43:51 PM
EVELYN MOON said she wanted the CON to go away because it would
lower the cost of procedures and make them more available
locally.
CHAIR DAVIS recognized SENATOR HUGGINS.
2:45:44 PM
JOANNE SMITH, Wasilla, said she had worked in the health care
field all of her life and felt strongly that CON laws should be
repealed . When the laws were repealed in Texas, she observed
that it did not appear to create any difficulty to the hospital
in which she worked and, as a matter of fact, it improved
efficiency. She stated that Alaska has on of the highest cost
and lowest quality health care systems in the United States and
if they removed the current monopoly it would improve the
quality of care, increase the number of physicians who want to
work in Alaska thereby increasing construction and revenues
throughout the state, resulting in better services at a lower
price.
2:47:47 PM
CHAIR DAVIS proposed going through the amendments for the
working draft, version L
DON BURRELL, Legislative Aid to Senator Bettye Davis, read the
amendments.
^Proposed Amendments
Page 4, line 8 [Sec. 18.09.010, Paragraph (2)] would
be replaced by "to improve the department's plan for
who shall report data, what data will be required,
when each facility type will be required to begin
reporting, and the reporting system to be imposed."
SENATOR DYSON said he had no problem with the content.
MR. BURRELL continued.
Page.4, line 12 [Sec. 19.09.020]: Delete number (1),
"the state officer assigned the duties of medical
director for the department."
SENATOR ELTON said his understanding was that the medical
director is also a Centers for Disease Control and Prevention
(CDC) officer, and wondered why they would delete a CDC officer
from the commission.
CHAIR DAVIS said they had changed all of that section, replacing
many of them with persons appointed by the governor.
SENATOR ELTON said he would mull that over.
MR. BURRELL continued with Amendments.
Page.4, line 14: Delete "Department of Administration"
and replace it with "Governor." Make this number (1).
Page 4, line 15: Delete "commissioner of
administration" and replace it with "Governor."
Page 4, line 16: Delete number (3), "one member
representing the Department of Commerce, Community,
and Economic Development, appointed by the
commissioner of commerce, community, and economic
development."
MR. BURRELL commented that with these amendments they were
changing the makeup of the health care commission.
Page 4, line 21: Delete "six public members" and
replace it with "three public members." Make this
number (2).
Page 4, line 23: Insert number (3) "three health care
providers, representing hospitals, physicians and
mental health."
Replace "(6)" with "(3)."
Delete "one member of the House of Representatives"
and replace it with "two members of the House of
Representatives."
Page 4, line 25: Replace "(7)" with "(4)."
Delete "one member of the Senate" and replace it with
"two members of the Senate."
SENATOR DYSON said he would like to hear from whomever proposed
the changes what the philosophical base is for this change in
direction, and to hear the administration's comments on it.
CHAIR DAVIS said the administration might not be prepared to
comment as they had just received the proposed amendments.
2:56:31 PM
She said she brought this forward in order to bring more health
care professionals to the commission than the language in
version A provided.
SENATOR DYSON commended Senator Davis for her efforts to balance
the commission, but encourage caution to ensure that it would
not be over-balanced with people who have a "dog in the fight"
and a profit motive. He also struggled with how to attract
really informed, experienced consumers who don't have a specific
"axe to grind."
MR. BURRELL continued:
Page 4, line 27: Insert "(6) one member representing
Alaska Tribal Health care System."
Insert "(7) one member representing health care
insurance."
Delete (8)
Page 4, line 28: Delete the word "department's" and
replace it with "Governor's."
Page 4, line 31: Delete "three", replace with "five".
Page 5 Line 6: Insert immediately after executive
director, "with appropriate health care policy
experience,"
3:00:57 PM
SENATOR DYSON interjected a proposed amendment to Page 5, Line
24.
Insert after "and", "health care and".
SENATOR ELTON expressed concern that the commission would employ
an executive director. He felt the chain of command would be
fuzzy if the commission hired the executive director but the
department provided the staff.
CHAIR DAVIS felt this could be handled within the existing
language.
MR. BURRELL
Page 5, Line 26: Insert after reducing, "rate of
growth in health care costs for all residents of the
state" ...
Page 5, Line 27: Delete "below the national average",
replace with "make health care more affordable;"
Page 5, Line 28: Delete "ensuring", replace with
"improving"
Page 5, Line 31: Delete "ensuring, replace with
"improving"
Page 6, Lines 19 and 20: Delete "facilities", replace
with "services, price and quality"
Delete "of health care services of health care
facilities in the state; and", replace with "in making
health care decisions; and"
Page 6, Line 24: Delete "all"
The phrase would now read "establish and maintain an
information database on the Internet of information
about health care facilities" ...
Page 6, Line 26: Delete "facilities, replace with
"services"
3:04:23 PM
SENATOR ELTON asked if the word "all" was deleted because
some health care facilities are not under the state's
purview.
CHAIR DAVIS explained that was part of their reasoning.
MR. BURRELL
Page 6, Line 30: Delete "must", replace with "may"
CHAIR DAVIS noted that the committee had already heard from
Ms. Kraly that this change could be a problem, and
suggested they bypass this amendment until they received a
decision from the Department of Law.
MR. BURRELL continued on page 7, line 4 which read "(A) health
care located in the state;"
Page 7, Line 4: Insert "care" after health and before
facilities.
Page 7, Line 14: Delete "(3)a list of the 100 most
commonly prescribed medications in the state and the
source and price, updated monthly, of the
medications;".
SENATOR DYSON asked Chair Davis why she was deleting that.
CHAIR DAVIS said she felt it was confusing and that it would be
difficult to identify the most commonly prescribed medications.
She proposed to let the department address it.
SENATOR DYSON responded that the medical industry could handle
that fairly well and it would be very valuable information to
consumers.
SENATOR ELTON thought this was one of the elements of the
original bill because the presentation from Florida did provide
this information.
MR. BURRELL went on to line 26.
Page 7, Lines 26 and 27: Delete "(7) a list of
procedures approved by state agencies for emergency
response and treatment;"
SENATOR DYSON asked why.
MR. BURRELL said number (7) was a little ambiguous; they needed
to clarify what "emergency response and treatment" really meant.
SENATOR DYSON said that is the department's role and he would be
glad to hear from them.
3:10:52 PM
He added that line 17 should be amended to define price more
precisely.
Page 7, Line 26, insert after "infections" "medical
errors and accidents".
MR. BURRELL moved to page 8, line 6 to insert a new number 11.
Insert new number (11) which will read, "a list of
physicians that accept new Medicare clients."
Move the current (11) down and replace "(11)" with
"(12)".
SENATOR DYSON asked to amend line 20.
Insert after "AS 18.09.110:" "this data shall be
posted on the department website" and on line 21,
after "consumer" add "and all other consumers"
MR. BURRELL read their amendment to line 21.
Page 8, Line 21: Insert after "health care services"
"which include facility and physician components of
care."
A five year sunset section for the Alaska State Health Care
Commission would be added for June 30, 2013, in reference to
mandatory reporting.
Page 11: Add an effective date of July 1, 2009 for
Sec. 18.09.120 which begins on page 8, line 17.
Page 11: Section 4 which begins on page 3, line 18
would take effect immediately.
3:15:28 PM
SENATOR ELTON reasoned that a previous presenter testified there
was a lot of work involved in this mandate and a starting date
of July 1, 2009 for reporting might be too aggressive. He wanted
to hear from the department regarding the effective dates.
SENATOR DYSON said he was impressed by the presentation the
committee heard on brain injuries among returning veterans; he
asked Senator Huggins to think about including a member of the
veterans' or military health providers on the commission.
CHAIR DAVIS asked Senator Dyson to get that to her office so it
could be included in the new committee substitute. She held SB
245 in committee.
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