Comments Document

Please support proposition HB1512- Currently there are roughly 20 states in the US that allow Medicaid billing for complex rehab technology (custom manual and power chairs) in skilled nursing facilities; including Texas and Mississippi. These states already see the cost benefits of wound and fall prevention that custom wheelchairs support in addition to the reduced burden on facility staff. When a manual wheelchair that is non custom is provided, the chair is not configured optimally for independent and safe propulsion leaving the wheelchair user to require staff to move them throughout the facility, pressure manage them to avoid wounds, and contribute to falls in the facility. The average cost to treat a pressure wound is $70,000 and these occur in nursing facilities at a rate of 24% (National Pressure Ulcer Advisory Panel). Proposition 1512 supports value based care through preventative measures to reduce preventable comorbidities while enhancing quality of life for residents of nursing facilities.

RE: HB 2274 (2023) Dear Mr. Chair and Committee members: I am opposed to HB 2274 I have been teaching outpatient lab medicine to medical students, nurse practitioner students, nurse practitioners, physicians in training since 1995. 1. Pharmacists are less trained in this area of medicine. They do not have the time to fill medication, refill medication plus provides vaccinations is well documented by many news articles and personal observations. 2. Diagnosing a strept throat requires a good history and physical exam plus testing if indicated based on evidence-based medicine criteria. If a patient has a sore throat, there are many causes besides strept such as infectious mononucleosis (enlarged spleen in a student athlete can be disastrous) or peritonsillar abscess (which can be life threating if not diagnosed and treated with antibiotics and surgery). Pharmacists do not have adequate training in this area. 3. Pharmacists do not have access to patient’s recent lab tests regarding their kidney function. Many medications require this information before prescribing the correct dose and dosing. 4. It would make more sense, if the burden of dispensing medication in a physicians’ office, was markedly reduced Regarding pharmacists testing urines for bladder infections (UTI) and kidney infections, I have many concerns. 1. Are they going to collect a fresh clean catch specimen on site or are patients going to bring in an old specimen? The older the specimen and not refrigerated the more likely the specimen will be false positive. 2. If it is male patient are the pharmacists going to do the necessary prostate exam? 3. If a patient has a bad reaction to their treatment, can they access the pharmacist after hours? 4. If the urine specimen is dilated since a patient is drinking lots of fluids can result in a false negative test? 5. Urethritis has similar symptoms as a bladder infection. Many of these patients have sexually transmitted diseases such as chlamydia which does not respond to most typical antibiotics for UTI. 6. I frequently see patients who are dehydrated with urinary burning and bladder spasms/frequency who are not infected but treated for UTIs at urgent care sites. 7. In this state we have a major problem with increasing antibiotic resistance. I worry antibiotics will be overprescribed. Are pharmacists aware of the latest antibiogram for their area. Bactrim does not work well for many common E. coli infections in our area. Cipro has lost its usefulness now. 8. Are pharmacists going to recognize any other abnormalities on a urine dipstick? Will they miss bladder cancers, kidney cancer or glomerulonephritis? 9. If there is blood on the dipstick, are they going to spin down the urine and look at it under the microscope to confirm it is blood, hemolysis, or myoglobin? Thank you for your support in opposing this bill. Sincerely yours, Roger A. Hofford, M.D. FAAFP, CPE Roanoke, VA Past President, Virginia Academy of Family Physicians Associate Professor, Family Medicine, Virginia Tech Carilion School of Medicine Clinical Professor, Family Medicine, Virginia College of Osteopathic Medicine Clinical Professor, Family Medicine and Population Health, Virginia Commonwealth University

HB 1764 I am opposed to HB 1764 as original submitted for the following reasons: 1. Proposed Section E requests practice agreements be eliminated. I disagree. A practice agreement is a job description between a physician assistant and the supervising physicians. I do not know many employed people do not have a job description. It is good that these agreements be reviewed and updated every two years to be sure everyone is on the same page regarding responsibilities. 2. Paragraph 54.1-2952 regarding proposed physician entering a patient care team is voluntary is fantasy unless “no compete and nondisclosure clauses” are removed from physician contracts removed. Hospitals will have major leverage over the physician otherwise. 3. Keep the ratio of physician supervision at no more than six physician assistant and nurse practitioners for all hospital physicians. In graduate medical education the Accreditation Council of Graduate Medical Education does not allow a faculty member to supervise more than 4 residents/fellows at a time to ensure patient safety. In the hospital setting many of the supervising physicians (hospitalists) are recent resident graduates who are uncomfortable supervising more than four individuals at a time. Supervising six is stretching their comfort level regarding patient safety. Supervising more than six individuals is stressful and creates moral distress since patient safety is at risk,

I signed up to comment (if needed). the facilitator of the chat asked me to identify myself but my chat is disabled. My email is jae.benz@dbhds.virginia.gov from DBHDS and my phone number is 804-432-3326 if anyone is able to assist. thank you.

This is a comment on HB1946. My name is Einar Ingvarsson and I work as Director of Training and Research at the Virginia Institute of Autism (VIA). We employ around 40 licensed behavior analysts, and typically hire new ones at least quarterly. We provide services throughout the commonwealth, including Charlottesville, Roanoke, Lexington, Lynchburg, and surrounding areas. As things stand now, we would not consider hiring licensed behavior analysts unless they also have a certification from the BACB. The BACB is currently the only certifying agency for behavior analysts that meets the quality criteria that we are looking for, such as the amount and quality of supervised experience, being incorporated as a non-profit, having course sequences verified by an independent agency (Association for Behavior Analysis International), and including competencies on behavior in general (i.e., not specific to a particular diagnostic category). Therefore, VIA strongly supports HB1946, as it would ensure that those that obtain licensure as behavior analysts have been certified by an agency that meets these and other minimum requirements.

Virginia families have benefited greatly from the Autism Insurance legislation we carefully crafted over the past 15 years in Virginia. Quality of care and quality of the services are critical for our loved ones with Autism. This bill to fix the loophole between the statue and regulation is critical to insure we provide services from professionals that meet our Virginia standards. I ask for your assistance in passing this bill as written, Its good for Virginia and it is good for our families who have loved ones with an Autism diagnosis. Thank you, Mark Llobell Virginia Autism Foundation Founder

The Virginia Autism Project and the Virginia Autism Advocacy Alliance support HB1946 which will provide the necessary guides for the profession. Please Vote YES on HB1946.

Too expensive and time consuming. Pharmacists are too far and in between and this is just more busywork for them. Not all techs could do this also and they're hard to find also.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

HB 2276 Immunization; immunization of children against COVID-19 Informed consent is the basis of medical ethics. Parents should make decisions regarding the health and wellbeing of their children. COVID-19 vaccines do not prevent viral transmission so there is no justification for requiring these vaccines as a requirement for school attendance. This bill specifies that parents shall not be required to immunize their children against COVID-19 in the same manner current Virginia law allows them to determine whether to give them the Haemophilus Influenzae Type b vaccine. In 2020, when the legislature considered and passed HB 1090, which dealt with the manner in which future childhood vaccines would be considered, legislators and their experts confirmed the legislature’s support for keeping parents in charge of their child’s vaccination schedule. In 2021, the Virginia Department of Health proposed a regulation requiring the COVID-19 vaccine as a requirement for school attendance. More than 15,000 Virginians commented on the regulation, with overwhelming opposition (93%) to mandating the shot. Medical professionals around the world are in agreement that there is no scientific rationale for continuing any COVID-19 mandates in 2023 and beyond. HB 2280 Parental consent to surgical and medical treatment of certain minors This bill requires parents and guardians to consent to medical interventions concerning their children, including vaccination. It is important to amend current law to make it clear that parents are in control and make medical decisions for their children. Several cities have attempted to pass orders and laws that allow children as young as 11 years of age to consent to vaccination without parental knowledge! Please do not let this happen in Virginia. Please support this bill to send a clear message that in Virginia, parents are in control and they decide what medical interventions their children receive.

Dear Committee Members, Many years ago, my husband and I had notarized certificates of religious exemption provided by the HEAV expressing that the administration of immunizing agents conflicts with our children's/our religious tenets and practices. The documents say we "understand, that in the occurrence of an outbreak, potential epidemic or epidemic of a vaccine-preventable disease, the State Health Commissioner may order our children's exclusion from school, for our children's/our own protection until the danger has passed." This law, HB2306, "exempts a person, including a parent or guardian on behalf of a child, who objects to administration of a vaccine on religious grounds from mandatory immunization requirements issued by the Commissioner of Health during an epidemic." Epidemics don't change our religious convictions. We believe that our bodies are the temples of the Holy Spirit based upon the Word of God and therefore, we must choose what goes into them. We believe vaccines should never be forced on anyone because they can and do cause injury and death. We urge you to support HB 2306 for our religious freedom as well as for medical freedom to protect those of us who suffer a greater threat from the injection than from an epidemic. Thank you for your consideration.

I am asking you to support HB 2306. Religious freedom and medical freedom are human rights. We should be allowed to exercise these rights when and if we choose not to take a vaccine. Injections should never be forced on any person. Public health emergencies should not be used as reasons to take away these basic rights. During the COVID situation and continuing even now, people have been denied these basic rights. This bill would protect our freedom to exercise those rights. Please support this bill. Thank you, Susan Franz

Dear Delegate, I am contacting you to request your support for Delegate Freitas' House Bill 2306, which will be considered tomorrow, Tuesday January 24th. This bill ensures that Virginian's religious beliefs are held sacred and will be honored when choosing to reject any vaccination for themselves or their child. Vaccines can and do cause injury and death and should never be forced on anyone. Religious and medical freedom are basic human rights and should never be denied even in the case of an epidemic. Please pass this important bill that provides all Virginians the freedom to make medical decisions based on their religious practices and beliefs. Thank you.

I support this bill. Medical freedom is our fundamental right. Our country is not even recognizable. The government has no right to require any medical procedure against my will!

Comments Document

On behalf of the Virginia members and supporters of Americans United for Separation of Church and State, we oppose HB 2306, which would allow people to take religious exemptions from vaccination requirements during an epidemic, exactly when vaccines are most important to protect public health. The First Amendment to the U.S. Constitution does not require—and in fact prohibits—granting a religious exemption like the one in this bill. I therefore urge you to oppose HB 2306.

I support this bill so physical therapists can better serve their patients' recovery processes.

Comments Document

This bill gives Physical therapists the freedom to treat what we are trained to treat. This eliminates unnecessary follow up trips to MDs (who are already booked out months). Physical therapy is a doctorate level profession. We are trained to treat musculoskeletal issues. This bill will save money and increase efficiency with healthcare.