Public Comments for 02/06/2024 Health and Human Services
HB278 - State plan for medical assistance services; fertility preservation treatments, etc.
Good Afternoon, On behalf of the Virginia Association of Hematologists and Oncologists (VAHO) and the Association for Clinical Oncology (ASCO), I have attached a letter of support for HB 278.
My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!
HB313 - State Inspector General, Office of the; investigations of abuse/neglect at state psychiatric hosp.
HB 50 support. Currently Hiram Davis medical center Petersburg serves psychiatric and violent individuals in the same building as intellectual disabilities. Please prevent harm to defenseless Cognitive impaired. I have witnessed armed guards and sharing same hallways as intellectual disabilities populations. HB313, request amend to include Hiram Davis medical center and Sevtc Chesapeake Training Center. Equal protection and investigations for individuals with intellectual disabilities. HB 515 Oppose. Violates Olmsted Supreme Court case federal law protects choice by guardian. Lack of due process timeframe for Medicaid and Medicare recipientsm Individuals with profound intellectual disabilities cannot make their own decisions. Mental health discharges intended but remains Linked in the code section. See Olmsted and ADA federal laws. I'm a legal guardian for son Taylor Bryant at Hiram Davis medical center after displaced from CVTC. Vote No.
HB342 - Naloxone or other opioid antagonists; possession by state agencies, guidelines for private employer.
On behalf of SAARA of Virginia we endorse Del. Hope's bill on Naloxone or other opioid antagonists onto its next stages. Thank you.
Michael Sizemore, Advocacy Manager of SAARA
Attached please find a letter from the National Safety Council (NSC) urging your support of HB 342, which would require state buildings to have opioid overdose reversal medications on site and train state employees on its use. This legislation is lifesaving and will help keep Virginians safe in the workplace.
HB426 - Professional counselors; Board of Counseling to recognize NCE as a valid examination for licensure.
It is my belief that this bill is writing a wrong. AS A VETERAN I have seen the shortage of qualified individuals in the mental health field and find it unbelievable that it was ever made so difficult to maintain competent licensed individuals from doing a job they have successfully done for years because of a test require by none credentialed bureaucrats. TWENTY TWO a day killing themselves because they can't get the help they need....I personally experienced this shortage. You like to complicate things...these individuals should have been grandfathered in to start with.
HB434 - Inpatient/residential subst. use disorder trtmt.; facilities to prepare & record discharge plan.
My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!
Attached, please find written testimony on behalf of the Pyramid Healthcare, Inc. family of companies in opposition to HB 434, which would require that any residential substance use disorder treatment facility licensed by DBHDS must prepare and record a certified discharge plan upon a patient’s discharge or withdrawal from the facility. While we provide discharge-planning services for our clients and believe this is crucial to ensuring long-term recovery, we oppose the bill as written. To be clear, discharge planning is essential to ensuring our patients are able to sustain long-term recovery. Currently, we provide discharge planning services for our clients; however, the language of the legislation duplicates existing safeguards, puts additional administrative burden on providers, and invites punishment to high-quality providers serving vulnerable patient populations. As part of our existing agreements with regulators, accreditors, and payers, we regularly undergo various audits throughout the year of our processes, procedures, and documentation for our clients, including related to discharge planning. As such, creating additional layers of administrative requirements related to discharge planning are unnecessary duplications of existing procedures.
HB453 - Kinship foster care; barrier crimes.
HB499 - Medicaid waivers; program rule modifications.
I'm here today to speak on HB499, which is very specific to Consumer-Directed Medicaid Waiver Services, more specifically, Routine Visits. During the pandemic, providers were afforded the flexibility to conduct their visits using telehealth methods. Those flexibilities ended in January 2023. We see the person receiving services in person to develop their plan of care and provide training and we would be seeing them in person every 6-months. This Bill would allow CD Providers to see the person for Routine visits in between those 6-month reassessments using HIPAA compliant video methods instead of physically in-person. This would reduce some of the cost to the providers by removing the mileage component, it would be less invasive for the families, and with the rise of respiratory infections like COVID, Flu, RSV, etc., it would keep this vulnerable population more safe if we are not physically in their home as often. Since we are not asking for an increase in the quantity of visits with this Bill, there would be no cost to the state to implement this change. I would encourage you to support this Bill as written and would be happy to entertain any questions you have.
HB503 - Credentialed addiction treatment professionals; definition to include licensed behavior analysts.
HB515 - State hospitals; discharge of individuals.
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Hi I am writing to you on behalf of The Well Connection UK, a media and publishing company. We could easily get virginia.gov featured in various publications such as magazines, online blogs and news sites. This would undoubtedly help virginia.gov with publicity, reputation, domain authority and organic search engine rankings. We have a wide range of options including completely free collaborations, sponsored posts, guest posts and banner ads. If this sounds of interest, please reach out to the senior business development manager, Anita at info@thewellconnection.co.uk and whatsapp +447395206515 (GMT) Kind regards Clifton Junior Outreach Assistant
Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
I am a legal guardian and the President of CVTC Families and Friends . I oppose HB515 as written, although Delegate Hope's Legislative Aide has informed me that there will be an amended version. The unamended version conflicts with a number of state and federal laws and regulations and the Supreme Court's Olmstead ruling. Furthermore, forced discharges from training centers would also violate the state's settlement agreement with the DOJ, which is still in force. (From Judge Gibney's final ruling on the settlement: “no resident of a Training Center shall be discharged from a Training Center to a setting other than a Training Center if he or his Authorized Representative chooses to continue receiving services in a Training Center.”) Furthermore, the Virginia Code definition of "guardian" states that guardians are responsible for making residential decisions. A number of individuals were forcibly removed from CVTC's nursing facility to Hiram Davis Medical Center, and they may also be at risk, absent a language amendment, as Hiram Davis is associated with, and is on the grounds of, Central State Hospital. Please amend the bill's language to specifically exclude training centers and Hiram Davis Medical center, or oppose the bill.
HB 50 support. Currently Hiram Davis medical center Petersburg serves psychiatric and violent individuals in the same building as intellectual disabilities. Please prevent harm to defenseless Cognitive impaired. I have witnessed armed guards and sharing same hallways as intellectual disabilities populations. HB313, request amend to include Hiram Davis medical center and Sevtc Chesapeake Training Center. Equal protection and investigations for individuals with intellectual disabilities. HB 515 Oppose. Violates Olmsted Supreme Court case federal law protects choice by guardian. Lack of due process timeframe for Medicaid and Medicare recipientsm Individuals with profound intellectual disabilities cannot make their own decisions. Mental health discharges intended but remains Linked in the code section. See Olmsted and ADA federal laws. I'm a legal guardian for son Taylor Bryant at Hiram Davis medical center after displaced from CVTC. Vote No.
HB 515 This proposed change is apparently intended to permit DBHD bureaucrats to discharge patients with 15 days’ notice and without parental consent. Parental consent for Medicaid patients is required in the earlier language of section 3.C. This creates an ambiguity through which the Department can act until a court issues an injunction, which is not likely to happen in 15 days. There is no other reasonable explanation for this proposed change. It is my opinion that this is a sneaky bureaucrat-generated attempt to create a loophole to remove the powerful guardian consent limitation on their personal power. Most of the patients in State hospitals and training centers are of color (including my daughter). This amendment is clearly targeted at empowering the Department bureaucrats to discharge most of them on very short notice and over the objections of their families and guardians. The proposed change contradicts the long-existing language at lines 25-27. That right is protected by US Supreme Court case Olmstead v. L.C. (and settlement we had with Commonwealth in United States Court Western District of Virginia; attached.). This is bill is extreme and inhumane and negatively targets minority disabled population.
HB577 - Slot-retention requests; Developmental Disability waiver slots, sunset date.
HB594 - State plan for medical assistance services; payment for certified community health workers.
We are need in our communities
We Need Your Support! We were taught that doing small things in a great way is as important as doing great things. However, this isn't always true. Community Health Workers play an essential role in various communities across the state. They perform admirable work, whether it's addressing small, medium, or large tasks. Unfortunately, these positions are at risk of being defunded or disappearing in the next few months. This situation will impact vulnerable people in the communities that really need them (CHWs) the most. One potential solution to this problem is identifying sustainable reimbursement mechanisms that can support and expand the CHW workforce.
My name is Tameca Day and I am an active member of my city and state. It is apparent that our city needs more help in multiple areas and that these issues need immediate attention. As a member of the CHW community it is my understanding that we can greatly assist in small ways that make a huge impact. To continuosly push these efforts we will need to procure and maintain funding to protect our vision. This idea is not an individual security. This mission will continue to rest on the shoulders of those providing and those who seek assistance from trusted liasons where they reside. My hopes are that we can put aside differences and uplift RVA.
I support the organization that is doing all this so that our voice is heard since as health promoters we need a lot of support.
Health promoters need to be given greater support to take care of our community with more resources such as: medical insurance, more health supplies, support for the language barrier
I am the husband of CHW member who give their all to the community with action from going to Door to Door, having social gatherings to inform the community of change to come and how resident can improve and become more successful engaged with their own communities. I have witness with my own eyes the effort and success that CHW have provided for families in need as well as health awareness they provide for resident who may have never knew about so many resources that help in their personal lives. With being in house I am able to see the day to day action of a CHW who put there community first with early morning and late night commitment to helping individuals as well as their families during crisis times including the joyous times once a goal is completed through celebration of a job well done. Back during Covid outbreak it was very challenging time for CHW because they were the liaison between the hospital/ clinic to inform the community about vaccines and Information that was urgently needed on how to treat symptoms, as well how protect against different variants. So being just the husband of the CHW I feel happy for be part of a on growing team who love the their community and willing to go above and beyond to help the residents in it. I believe it in the blood sweat and tears of CHW who want to make there community a better place for all. Just like my great aunt Geraldine Evans in the 90s who took it apon her self to advocate to have a traffic light and crosswalk provided for children crossing the street to achieve their education in school safely. Her name is still labeled and posted on the corner of Muary st and 16th st in Blackwell community with her action she has been titled as The The Mother of Blackwell community. To me that’s the true definition of a CHW at their best . CHWs always be the one of the key pillars of a community. Thank You Dominique Jackson
Mi nombre es José Roberto Sosa soy del area de Williamsburg y soy Promotor de Salud, yo estoy a favor de esta ley, por que e notado los cambios y las diferencias cuando los promotores de salud ayudan a la comunidad.
Dear Delegate Sickles, My name is Jackie Green-August, and I am a certified community health worker in Southside, Virginia (Piedmont Region). I became a CHW because I live in a rural community of 15,535 individuals who rely on three physician practices, several dentists, no specialists, one supercenter, one grocery store, and 11 dollar stores to keep my community healthy. A few years ago, when I learned our county was at the top of the list for the prevalence of Diabetes, I decided I needed to educate people about how to maintain optimal health. Today, I provide a food distribution that feeds 400 people and teach Diabetes Lifestyle Change classes. In small rural communities like mine, the community health workers provide routine check-ins between doctor visits. As a CHW, I offer blood pressure and weight checks, health screenings, food, free fitness classes, SNAP and Medicaid application assistance, and doula services. I connect patients to telehealth, transportation, free clinic visits, and legal aid. I am also a CHW mentor, ambassador, and supervisor, teaching others how to improve their communities through outreach and education. You must hear my story to understand the importance of community health workers and our vital roles in the health and well-being of our families, friends, and neighbors. As CHWs, we request recognition for our work and value. Please amend the state plan for medical assistance services to include a provision for payment for services provided by certified community health workers. Thank you for this opportunity to comment on HB594 and explain its importance.
HB606 - Clinical social workers; licensure examination alternative.
I would like to submit my overwhelming support for HB606, paving an alternative pathway to a License in Clinical Social Work (LCSW). I am currently an LCSW and also provide clinical supervision for those who have a Master's in Social Work and seek licensure. The current LCSW exam creates a significant barrier for social workers who are in critical need with the behavioral health crisis. ASWB (Association of Social Work Boards) recently released a study showing how mostly Black, Latine, and Indigenous individuals are unable to pass the exam which provides limitations on growth within our field and services provided for our communities. Another major barrier is the cost associated. Social Workers can spend up to $5,000 on obtaining study material and attempts to pass the exam. Having an alternative pathway will assist social workers in focusing more on our practice and continuing to serve our communities whether that is in hospitals, shelters, community organizing and private practice. As Social Workers we are embedded in society yet rarely acknowledged and seen for the incredible amount of work and advocacy we provide as we navigate significant societal barriers. Passing HB606 will continue this work and encourage individuals to join our field to address Virginia's on-going behavioral health crisis.
Vote yes on HB606!
As an LCSW, I ask you to vote for HB 606!
I am writing in support for HB606 due to being an up and coming social worker currently in supervision. I believe this option would assist with the disparities in the behavioral health workforce and allow social workers to have other options to stay in this field. I also believe that individuals that have currently taken the exam with failed attempts should have a grandfather clause to assist them with licensure. The ASWB is not benefiting the social workers either by making individuals continuously pay to take this exam which is causing individuals to have more debt and increasing burnout due to having to gain more employment (like second jobs) to make ends meet.
I’m a BSW, MSW, QMHP-A, social worker with over ten years of experience. I will never become licensed or pay to sit for an exam. Our current process of licensing is exclusionary and limiting. Please allow social workers more ways to advance themselves and their careers.
Vote yes on HB606!
Vote yes on HB 606 to create an equitable path to social work licensure.
Vote YES on HB 606!
Vote yes on HB 606!
Vote yes! Virginia needs more licensed clinical social workers and more LCSWs of color!
I am asking for you to pass this bill for both moral and practical reasons. It has been established by the ASWB's own data that the test is biased toward the beliefs and approaches of white social workers. The numbers are appalling. I know social workers I went to school with who are excellent, who have helped so many people, but cannot pass that test. It's unacceptable that they would be paid less and not get the opportunity for promotion. I definitely have concerns about quality control of clinical social workers but that test does not predict how much someone can help a client, it just measures whether you know how to answer the way the test wants you to answer. Having more supervision, which actually requires being observed and given feedback about how you help those clients is much more helpful. Lastly, people who are in acute crisis or a moment of being ready to make a change are having to wait months and months to see a therapist. We need more licensed therapists to help more people.
Vote yes HB 606
My name is Kim Young, I am a resident of Richmond, Va and I am a Licensed Clinical Social Worker (LCSW) in Virginia, and I am asking you to support HB606 (Price) which aims to strengthen the behavioral health workforce by increasing pathways to becoming a Licensed Clinical Social Worker (LCSW). Passing HB606 would direct the Board of Social Work to implement an alternative requirement to the Association of Social Work Boards (ASWB) exam. Virginia is experiencing a behavioral health workforce shortage and the Virginia Health Workforce Development Authority (VHWDA) released a recent and here are a few highlights: Behavioral health workers are challenged by low pay. High education cost, and work environments rife with high administrative burden, high caseloads, and at times violence.. Virginia’s own regulations and tedious administrative burden restrict those entering the field causing burnout and turnover.It is difficult to attract students to the behavioral health profession due to steep clinical hours requirements, the cost of obtaining hours, and licensure requirements..Virginia is ranked 12th in the nation for population but 37th for the number of licensed social workers specializing in mental health care. The legislature should direct the Board of Social Work to implement an alternate path to licensure that does not require an exam. In the absence of ASWB’s foundationally flawed and biased exams, social work licensure would be earned primarily through degree completion and accruing supervised clinical hours. The option to sit for the licensure at 3,000 supervised experience hours will still exist but the alternative path will allow someone to elect to complete an additional 1,500 supervised experience hours to become a Licensed Clinical Social Worker (LCSW) in lieu of the exam. Additionally, implementing a grandfathering process that allows those who have already been working towards licensure to apply their supervised experience hours towards the alternative non-exam licensure path.
I submit a responsive yes for this. In my as quality assurance in a state agency I notice how imperative it is to get well trained clinical staff. If I'm not mistaken Virginia ranks very low in terms of the number of qualified staff or qualified clinical operators we have. If excluding the inequity of charging more money to retake tests, there is still the responsibility to ensure that Virginians have access to these clinical providers. Removing barriers that hinder qualified people from receiving certifications or easily retesting seems the easiest way to increase the number of professionals it is evident that we need.
YES to HB606. Virginia is experiencing a behavioral health workforce crisis. There is a high demand for licensed mental health professionals and an insufficient workforce to respond to these needs. Part of this issue is the inaccessibility of the exam required for Licensed Clinical Social Workers (LCSW). The National Association of Social Workers has acknowledged that the current exam is being disproportionately failed by Black, Brown, and English Language Learner (ELL) testers. The licensing exam is only offered in English, despite the rapidly growing Latine and diverse immigrant population and the high demands for bilingual therapists. Virginia residents deserve mental health professionals that look, live, and sound like all Virginians. The high cost of becoming licensed (registering and paying for supervision, buying study materials) and possibly even failing the exam can be upwards of $5000, in addition to the cost of getting a Master of Social Work degree. Passing HB606 would help address the critical behavioral health workforce needs that Virginia is experiencing, and would be a pathway to a more diverse, inclusive, sustainable, and accessible mental health workforce. YES to HB606!
Vote yes to HB606 for alternative pathway to licensure for social workers. No standardized test should be an indicator to the skills that a social worker portrays. This pathway will also strengthen the behavioral health workforce and allow social workers to stay in this profession instead of finding a new career. As a social worker currently in the field and working towards licensure, this exam has caused me a lot of agony and distress currently I am not able to move in my career due to failed examination attempts. I am asking for everyone to vote yes to this bill, as it will help all current social workers, up and coming social workers continue to make valuable change in this world.
vote YES
vote YES reduce the racist barriers to licensure and join the national movement against the test.
vote YES reduce the racist barriers to licensure and join the national movement against the test.
vote YES
YES. Increase pathways to licensure through WORK experience AS a supervised social worker, is a better indicator of qualification to be a social worker
YES. Allow further access to licensure outside of standardized testing that evidence and data shows disproportionately keeps out BIPOC social workers from earning higher paid positions and licensure
HB608 - Temporary detention; certified evaluators, report.
We do NOT want privates to be able to complete TDO evaluations! This will destroy all the work we have done to keep people OUT of the hospital. I have worked in a CSB most of my 32 year career.
Strongly oppose!!
I stand opposed to HB608.
Strongly opposed to this. We work diligently to provide services in the least restrictive environment. As a result, we have significantly decreased our TDO rate in our area. If this were to pass for a pilot, undoubtedly other providers would begin to seek the same privileges to TDO individuals. We feel that it would ultimately reverse the work that we have done and this would not be in the best interest of the individuals we serve.
I stand opposed to HB608 for the reasons stated in the other comments of opposition.
Greetings and thank you for considering my comments. I would oppose this legislation that would allow for prescreening evaluations to be completed by private agency personnel even under a pilot program such as what is proposed. One of the foundational components of the TDO process is that the evaluation is completed by an unbiased professional, one that is not connected to the ED that the individual presents in or to the hospital to which they are placed. This provides a protective factor for the individuals that we serve to help ensure that they are evaluated objectively and their best interests are pursued. The CSB is required to see all individuals who present for evaluation and there is a concern that this program could result in hospitals choosing who they see and who they refer to the CSB for evaluation based on payor source. Changing this process would also allow a private entity to have a direct route to the state hospital system in a time where we as CSBs are being encouraged to do everything possible to minimize admissions to those facilities. My belief and I believe as history as shown, there will be an increase in state bed utilization as a result of this in a time where we already are experiencing bed shortages due to high levels of forensic TDOs, staffing shortages, etc. There has also been the statement made that the magistrate is one who determines the TDO and while they may issue that TDO order, that decision is based upon the information provided by the evaluator and recommendations for placement facility. In summary, I do not feel that this is a solution to the bed shortage that we have. Our CSB has been able to add many components of the crisis continuum including a Crisis Receiving Center, 23 hour program, mobile crisis team, care centers in each of our hub areas that are walk-in, one of which is open 24/7 (the others are open 7 days a week, 12 hours per day), Partial Hospitalization Program in each of those locations, expanding our youth CSU by four beds, expanding our adult CSU to 16 beds in the next couple of years, and a host of other services that support individuals in crisis. We have seen our TDO rates drop significantly over the past few years as we have rolled out these services and we continue to see a decline for this current fiscal year. As an alternative to the proposed legislation, I encourage you to explore ways to support programs such as the ones that we have implemented that are proactive in preventing individuals from presenting in the EDs for evaluation and actively work to keep individuals in our communities, in their homes, and with their families and support systems.
Strongly opposed.
Strongly opposed !!!
Strongly oppose
Greetings Health and Human Resources Subcommittee members, As the Executive Director for District 19 Community Services Board (CSB) I am concerned about the impact this bill and a similar senate bill will have on catchment areas across the state. D19 CSB catchment area includes the cities and counties of Colonial Heights, Emporia, Hopewell, Petersburg, Dinwiddie, Greensville, Prince George, Surry, and Sussex, respectively. Currently CSBs/BHAs are designated by the Code of Virginia as the single point of entry into the publicly funded system and this legislation provides a bypass for private hospitals. As currently written, the legislation is silent on whether these facilities will be required to conduct EVERY evaluation or if they will still rely on the CSB system. Ultimately If these bills pass, private hospitals will be able to evaluate only those individuals they want to evaluate and send those whom they do not want in their facilities to state hospitals. This includes the ability to admit to their facilities only those with insurance and send anyone who is uninsured or underinsured to the state hospital. Virginia’s CSB/BHA public safety net has been established to treat all regardless of insurance coverage or ability to pay. This allows for the civil commitment process as established by the Code of Virginia to be accomplished without the prospect of monetary gain but with the individuals rights and due process at the fore. CSBs/BHAs work closely with private hospital systems, law enforcement, local judicial systems, and community stakeholder’s to ensure that Virginia’s most vulnerable citizens have the treatment needed from the initial notification of a crisis, during the civil commitment process, coordination of TDO placement and care while waiting for a bed (private or public), participation in the commitment hearings, and all of the ancillary tasks related to aftercare and liaison services to successfully assist individuals who are subject to this process with transitioning back to the community. In closing, having more individuals complete evaluations will not address the bed crisis issues, ER boarding, or the burden on law enforcement to maintain individuals while they are waiting on a bed. Continued effort to build out Virginia’s Crisis system and diversion to lower levels of care, and prevention efforts at the community level will decrease reliance on emergency treatment for those in of behavioral health services. Please see the attachment for specific examples regarding why this bill should be opposed. Respectfully, Terrelle Stewart, LPC, CPSC Executive Director District 19 Community Services Board
I strongly oppose HB 608. I would like to refer the reader to review the comments in item # 11 of the attached Department of Planning and Budget 2024 Session Fiscal Impact Statement, which are also listed below: "According to DBHDS, prior to legislative changes several decades ago, the practice of non-CSB designated clinicians conducting emergency evaluations was permitted. Multiple criticisms of the commitment process emerged during this time period, including inadequate screening that resulted in numerous TDOs and admissions to state hospitals and a lack of community services and supports to prevent unnecessary hospitalization. At the time, the law mandated examination by an independent physician or a psychologist. Subsequently, a series of studies was conducted by the Institute of Law, Psychiatry and Public Policy (ILPPP) at the University of Virginia in 1988, DBHDS in 1990, and the Joint Legislative Audit and Review Committee (JLARC) in 1994. After the JLARC study, the General Assembly required that in all cases, only an evaluation conducted by a community services board (CSB) could lead to the issuance of a TDO and required the CSB to determine the place of hospitalization. The requirement was designed to ensure consideration of less restrictive interventions and avoid unnecessary TDOs."
Strongly Oppose
Opposition to HB608 Temporary detention; certified evaluators, report. HB608 Financial Impact Statement itself addresses many concerns Fiscal Impact Statement o Pilot for One Provider carries a fiscal impact to the Commonwealth o Indicates that the addition of non-CSB evaluators into the behavioral health care system “adds additional. administrative burden” to ensure that non-CSB evaluators are consistent in evaluation protocols across the civil commitment process o States if enacted, DBHDS anticipates an increase in the # of individuals who are evaluated and admitted to a state hospital, leading to increased census pressures throughout the system. o Addresses the history of who prior legislative changes were made decades ago due to concerns of inadequate screening by non-CSB clinicians resulting “numerous TDOs and admissions to that hospital and a lack of community. services and supports to prevent unnecessary hospitalization.” • This has been evaluated numerous times without such recommendation, including detailed in Study in December 2021: PLEASE READ THE REPORT Report on Item 320.II of the 2021 Appropriations Act Report on Who Should Conduct TDO Evaluations in Virginia https://rga.lis.virginia.gov/Published/2021/RD828/PDF . ALSO, Highlighted PDF Version attached. o This Bill ignores the study and concerns of representatives throughout the system regarding complexities that this. would unwind among other conflicts. • Individuals conducting evaluations as part of this pilot have no incentive to explore less restrictive alternatives above The fact that this pilot will give a private facility the ability to directly access state hospital beds in every part of the state which means although this is a pilot, it has statewide impact on bed access. • The pilot does not guarantee that this private facility will accept ANY TDOs and if it does accept TDOs, they can pick and choose based on insurance status and acuity. • Part of the reason the state made the CSBs the single point of entry in the first place was to ensure that the least restrictive alternative was always the first consideration. • This creates 2 legal tracks for law enforcement and magistrates must navigate and does not address concerns of ensuring that less restrictive alternatives are considered. • Inconsistent with GA investments in STEP-VA, counters recommendations of J-LARC Study only months ago.
While I do support change in the code regarding those who can initiate the TDO process, I cannot support this legislation and am baffled by how a bill benefiting only ONE provider could gain any traction. But I'm sure the bill's sponsors came up with this out of the kindness of their hearts; it would be illegal for a nonprofit to influence legislation in the traditional American way. The GA has had documented for them the inefficiencies of our system for well over a century and these have gone unaddressed. Having an objective 3rd party who advocates for or against what the US Supreme Court has referred to as a serious deprivation of liberty is one of the few things that has been working within our system. Having dealt first hand with the provider in question they have not proven themselves to be competent, compassionate, or unbiased toward any client that would be affected by this bill. Many within this organization have referred to the CSB as incompetent because they choose to disagree with their uninformed and untrained opinions, and I believe this has more to do with degrading the CSB's power rather than helping those in need. So while I do support busting up the monopoly that the public system has over this niche field of mental health treatment, there are better and more creative ways to do so that are consistent with national standards of care and what has shown to work in other states. There are experienced, competent, and licensed private providers of community crisis services that are available now should the GA choose to use them for this purpose.
Bill contradicts recent study directed by the legislature (Dec. 2021: Report on Item 320.II of the 2021 Appropriations “Report on Who Should Conduct TDO Evaluations in Virginia”). It addressed the complexities & concerns of bias & conflict of interest. https://rga.lis.virginia.gov/Published/2021/RD828/PDF Can a bill that a private hospital asked to be patroned really ignore & contradict recommendations of study directed by legislators incl. professionals of all vantage points by simply justifying as a PILOT? Contrary to Code & referenced as a concern for a hospital system with a FINANCIAL INTEREST in the outcome of the eval. FINANCIAL IMPACT STATMENT - A bill is patroned FOR ONE Private Provider, has a FISCAL IMPACT to the entire Commonwealth. Who has not considered impact to those local systems that will be encumbered. Lack of transparency DOES NOT benefit our system. Anticipate upcoming budget requests to provide TDO incentives for hospitals that accept TDOs. ONE PROVIDER requests to amend long standing CODE purposely allows ONLY CSBs to conduct preadmission evals. An authority affects individuals’ liberties, in many ways. Be clear, the system MUST respect the liberties of each individual. PROVIDER/VHHA stated that it is NOT A CONFLICT, because the Magistrate orders the TDO; not the evaluator? That is not what the CODE states & again addressed in the report. The Magistrate must have reliable, unbiased recommendation that EVALUATES LEAST RESTRIVE ALTERNATIVE without bias of financial interest. PROVIDER/VHHA stated this helps law enforcement “get back on the street”. Incorrect & disingenuous. This does not create a quicker path to a bed identified in JLARC & Gov. Prompt Placement Task Force. Delays in the system are to acquire a bed, not an eval. It DOES EMPOWER ONE PROVIDER to hold & direct LE anywhere in the state w/ authority to identify the TDO Facility. Their OWN or State Hospital while LE forced to hold those they chose not to admit. Allows a private facility to direct & further tax locally funded public resources. Provider & patron referenced cutting down delays waiting for duplicative assessment. NOT duplicative, that dismisses the very liberties needing to be protected. Statements about wait time for an eval inaccurate & purposefully misleading. Please speak to stakeholders, other hospitals, police, magistrates. CREATES 2 legal tracks for LE & Magistrate at request of ONE PROVIDER w/ a $ interest. Bill's OWN FINANCIAL IMPACT STATEMENT anticipates a strong likelihood of more TDOs (loss an individuals’ liberties) including to the State Hospital w/ waitlists. Requires significant adjustments or exceptions to Enhanced Certified Prescreeners Guidelines initiated in 2016 by the Deeds Commission to ensure liberties are protected & least restrictive alternative considered. For ONE PROVIDER. his lacks attention to the safeguards put in place to ensure liberties are protected. To accomplish this request of ONE PROVIDER, also require significant adjustments &/or exceptions in many areas including regulatory standards including Dept. of Licensure & changes to local, regional & statewide protocols. Directly contradicts efforts & GA’s own investments in STEP-VA & is inconsistent with the moving toward a Crisis Now System & Gov. Right Help Right Now. Counters recommendations included in the last 2 JLARC studies. Reckless.
Bill contradicts recent study directed by the legislature (Dec. 2021: Report on Item 320.II of the 2021 Appropriations “Report on Who Should Conduct TDO Evaluations in Virginia”). It addressed the complexities & concerns of bias & conflict of interest. https://rga.lis.virginia.gov/Published/2021/RD828/PDF Can a bill that a private hospital asked to be patroned really ignore & contradict recommendations of study directed by legislators incl. professionals of all vantage points by simply justifying as a PILOT? Contrary to Code & referenced as a concern for a hospital system with a FINANCIAL INTEREST in the outcome of the eval. FINANCIAL IMPACT STATMENT - A bill is patroned FOR ONE Private Provider, has a FISCAL IMPACT to the entire Commonwealth. Who has not considered impact to those local systems that will be encumbered. Lack of transparency DOES NOT benefit our system. Anticipate upcoming budget requests to provide TDO incentives for hospitals that accept TDOs. ONE PROVIDER requests to amend long standing CODE purposely allows ONLY CSBs to conduct preadmission evals. An authority affects individuals’ liberties, in many ways. Be clear, the system MUST respect the liberties of each individual. PROVIDER/VHHA stated that it is NOT A CONFLICT, because the Magistrate orders the TDO; not the evaluator? That is not what the CODE states & again addressed in the report. The Magistrate must have reliable, unbiased recommendation that EVALUATES LEAST RESTRIVE ALTERNATIVE without bias of financial interest. PROVIDER/VHHA stated this helps law enforcement “get back on the street”. Incorrect & disingenuous. This does not create a quicker path to a bed identified in JLARC & Gov. Prompt Placement Task Force. Delays in the system are to acquire a bed, not an eval. It DOES EMPOWER ONE PROVIDER to hold & direct LE anywhere in the state w/ authority to identify the TDO Facility. Their OWN or State Hospital while LE forced to hold those they chose not to admit. Allows a private facility to direct & further tax locally funded public resources. Provider & patron referenced cutting down delays waiting for duplicative assessment. NOT duplicative, that dismisses the very liberties needing to be protected. Statements about wait time for an eval inaccurate & purposefully misleading. Please speak to stakeholders, other hospitals, police, magistrates. CREATES 2 legal tracks for LE & Magistrate at request of ONE PROVIDER w/ a $ interest. Bill's OWN FINANCIAL IMPACT STATEMENT anticipates a strong likelihood of more TDOs (loss an individuals’ liberties) including to the State Hospital w/ waitlists. Requires significant adjustments or exceptions to Enhanced Certified Prescreeners Guidelines initiated in 2016 by the Deeds Commission to ensure liberties are protected & least restrictive alternative considered. For ONE PROVIDER. his lacks attention to the safeguards put in place to ensure liberties are protected. To accomplish this request of ONE PROVIDER, also require significant adjustments &/or exceptions in many areas including regulatory standards including Dept. of Licensure & changes to local, regional & statewide protocols. Directly contradicts efforts & GA’s own investments in STEP-VA & is inconsistent with the moving toward a Crisis Now System & Gov. Right Help Right Now. Counters recommendations included in the last 2 JLARC studies. Reckless.
I am the Crisis Dir. for the Hpt-NN CSB. The CODE purposely allows only CSBs to conduct preadmission evals. Despite many formal workgroups & thorough studies, including by DBHDS in Dec.2021, no recommendation to provide private hospitals w/ an exception was made. Instead, concerns related to conflict of interest & complexities such action would result. The authority this private hospital system is requesting, is a challenging & complex process & MUST respect the liberties of each individual, balance the legal & ethical demands w/ the clinical needs, & DOES deprive an individual of their liberties. To accomplish this request of ONE provider, in addition of changes to the code, also requires significant adjustments and/or exceptions in many regulatory standards & local, regional & statewide protocols. Significant adjustments or exceptions would be needed for the orientation, training, oversight, & supervision of Certified Pre-screeners initiated in 2016 by the Deeds Commission which are not practical & according to the Bill’s Financial Impact Statement, at cost to the Commonwealth, based on a ONE provider’s request. The Code addresses financial considerations which is directly contrary allowing an evaluator determining that an individual can be invol. hospitalized, having a financial interest in the outcome. Aside from the obvious concerns, there will be upcoming requests to provide financial incentives to hospitals accepting more TDOs. Approval of this bill or any substitution allowing this to occur: Directly contradicts efforts & GA investments in STEP-VA; is inconsistent with the goals of moving Va. toward a Crisis Now System & Gov. Right Help Right Now; counters recommendations included in the last 2 JLARC studies; allows a provider to refer to the state hospital; & an ability to directly tax locally-funded public resources including LEO, magistrates, justices, public defenders, & CSB. On Tuesday, the provider shared a rationale to assist with “Workforce Shortages” & that a similarly credential clinician would already working with clients would avoid “duplication”. Instead, it complicates roles of other local publicly funded resources by creating 2 legal tracks based on their request & w/o considering impact on the public servants. The CSB has met all performance contract guidelines & delays in individuals accessing care are due to the inability to acquire an accepting bed. The provider’s proposed use of this clinician’s role as stated is working in a dual role, also serving as the unit’s therapist while providing pre-screening duties, is inappropriate & devalues the importance for their convenience. In order to evaluate what may be needed to allow provider to be a certified prescreener, an alternative pathway for an allowance lacks attention to the needs of a prescreener, including respect to the local orientation and knowledge of resources for ALL & threatens safeguards put in place by the Deeds Commission to ensure protections for liberties. Nor could such a pathway place the adequate emphasis on ongoing supervision, oversight & significance of recommendations made in this process. Despite CSB playing such a critical role at all aspects of the BH system, at no time were we approached on consulted on the impact or potential consequences. Clearly, private entities have a role in our system, but not one that allows them to silo while encumbering public resources. this direction would be dangerous & egregious.
The Code of Virginia mandates that pre-screenings be completed only by individuals employed by CSBs and that an entity shall not have financial interest in the evaluation of an individual for psychiatric hospitalization. This bill defies both of these requirements in favor of supporting the request of one provider. This provider has stated that their goal is to support CSBs workforce challenges and move individuals needing care through the system more quickly. However, there was no conversation with us on how CSBs can be supported, and we disagree with these comments. Our CSB staff completed 3,945 pre-screenings last year; lack of access to a pre-screener was not an issue. Please refer to the 2021 DBHDS study on "Who Should Conduct Pre-screenings" for its recommendations and the recent JLARC study that points to the need for private hospitals to admit more people. This shows where the problems lie, including the fact that State hospitals have operated above 100% capacity while many private hospitals operated well-below. The pre-screening process is not the issue. We need hospital beds, and we need to have people be admitted to those hospital beds without bias. Please do not combine these issues—these are separate concerns and a not very veiled attempt by one provider to gain control to the entire behavioral healthcare process. Advancing this bill at the expense of the public is unacceptable to our community and our Commonwealth. We know that the people with the highest need will be served by our public system, while those with less intense needs will be selectively filtered through this private hospital system. Furthermore, our trained staff will be sought after with offers of higher pay. This will give this hospital system even more control in selecting who they serve while utilizing public funds to do so. This action will effectively dismantle our community safety net. We have information from two recent JLARC studies and a 2021 DBHDS study on the pre-screening process that do not indicate a need to do anything different with the pre-screening process. However, the JLARC study does place emphasis on the need for private hospitals to increase their admissions. Giving them more control to our public system compounds the current issues we are trying to overcome with the private hospitals and takes us backwards in our efforts to resolve issues to access. Previous legislators saw the need to keep pre-screening separate from service provision for this very reason. DBHDS’s own impact statement points out issues with this pilot which will also result in increased cost to our public system— again, to support a private provider. When we look at all of this, the only reason we can see that this is being done is that this provider lobbied for it. The guise of supporting our CSB is inaccurate. Advancing this bill by using the term “pilot” should not be downplayed. Pilots are made to be continued. We ask that you look beyond the benefit to a single provider and consider the damage that the passage of this bill will do to our system. This will be followed by one thing after another until our entire system is uprooted. We do not want to take this step back when so much has been done to move us forward.
The Code of Virginia establishes CSBs as the single point of entry into the publicly funded behavioral healthcare system, and mandates that pre-screenings be completed only by individuals employed by CSBs. This provides the opportunity for anyone who presents with a behavioral health crisis to have equal access to prescreening and when needed, follow-up care. Further, the Code of Virginia establishes that parties involved in the completion of the pre-screening shall not have financial interest in the pre-screening process. The Hampton-Newport News CSB serves over 12,000 people annually. We respond to six hospitals and completed 3,945 pre-screenings last year. We have outstanding staff who have propped this system up through all of the challenges, ensuring that people who need services were responded to, working countless hours to search for elusive hospital beds, while some private hospitals picked and chose who to accept at a time when they knew state hospitals were overflowing. CSBs endured the brunt of the anger and frustration from patients, families, and community stakeholders, to be met with this bill that shows that our work is not good enough. Please consider the recommendations of the recent JLARC study that points to the need for private hospitals to admit more people. This provides empirical data that shows where the problems lie. The pre-screening process is not the issue. We need hospital beds, and we need to have people be admitted to them without bias. Advancing the advocacy of one provider at the expense of the public is unacceptable to our community and our Commonwealth. Private hospitals have a place in this system, but this is not it. We know that the people with the highest need will still fall in our care while those that can be directed to other programs within a private hospital system will be chosen to financially support those programs. Furthermore, our trained pre-screener staff will be sought after with offers of higher pay which will impact the ability to keep our pre-screener positions filled. The result will be that the public will be filtered to one location rather than being provided equal access to pre-screening when and where it is needed. This will effectively dismantle our safety net. We believe the intentions of this bill are good, but no one consulted with our CSB on this matter. I assure you, as we have gone down this road in the past, the outcome will not be beneficial for the individuals we serve. Had the goal been the placement of pre-screeners within a psychiatric emergency department, this could have been done in conjunction with our CSB while remaining within the Code of Virginia, rather than by circumventing the established process. The ability of private entities to lobby with legislators for public funds intentionally cuts CSBs out of the conversation and eliminates necessary partnerships. We ask that you look beyond the benefit to one provider and consider the damage that the passage of this bill will do to our system. There is a reason that past legislators saw fit to put these safeguards in place as defined by the Code of Virginia. This action sets a bad precedent that will embolden private entities to continue to seek public funds while advancing motives that are in direct conflict with the Code of Virginia. We do not want to take this step back when so much has been done to move us forward. Thank you for your consideration of this important matter.
Opposition to HB608 Ryan Dudley Hampton-Newport News Community Services Board
HB620 - Medical assistance services; payment for essential hygiene products.
HB628 - Certificate of public need; hospitals licensed by DBHDS psychiatric beds.
HB652 - Funeral arrangements; def. of next of kin, proof of designated person to make funeral arrangements.
HB691 - Transcranial magnetic stimulation treatment; DVS to establish pilot program, report.
General commercially available treatments for PTSD and depression went through research and development to provide treatments for mainstream pathoetiologies. These treatments were never designed to treat the types of severe and intense physical and emotional insults endured our armed forces. Having worked in children's residential care for 30 years, I can attest to the limits of mainstream medicine in the treatment of the population of severe child abuse. Drug addiction and suicide are notable outcomes here too. The treatment offered here by HB691 shows promice amoung the destitute medical offerings to treat the aftermath of these extream insults. Early results among our Veterans is promising. Pilot studies such as the one offered here can help define who benefits most from this treatment. Virginia Beach has a large Veteran population whose medical needs have been neglected. There may not be pharmaceutical profit in developing treatments for severe trauma. I urge passage of this bill. The safety data does not generate alarm.
HB763 - Hospital regulations; use of smoke evacuation systems during surgical procedures.
I am expressing my support of HB763. This bill states "Requires the Board of Health to amend its regulations to require that every hospital where surgical procedures are performed adopt a policy requiring the use of a smoke evacuation system for all planned surgical procedures." Surgical smoke is generated by the electrocautery used to dissect tissue and cauterize bleeders during a surgical procedure. Studies have shown that the droplets within the smoke contain viruses, including HIV and HPV, carcinogens, bacteria, and blood contaminates. By having smoke evacuation systems within the OR the smoke is suctioned at the site of the incision and is contained with a HEPA filter that can be replaced when full. This decreases the smoke filling the OR suite thus lessening the hazard to the perioperative staff and the patient. I began my career as an operating room nurse in 1977 at 21 years old. I have been an OR nurse for 46 years. Data released by the Association of Perioperative Registered Nurses has shown that one day in an OR suite that surgical smoke is present is equivalent to inhaling 27-30 unfiltered cigarettes. This calculates to me having inhaled over 300,000 cigarettes in my career. I have never smoked in my entire life. After twenty years in the OR, after 3 bouts of bronchitis, and multiple upper respiratory infections, I was diagnosed with asthma. I thought this odd as I was living a healthy lifestyle, working out 5 days a week and eating a healthy diet. I now have chronic asthma that requires inhalers. The smoke within the OR aggravates my during procedures as well as making my eyes water. Several national organizations have made statements on the need for smoke evacuation including American National Standards Institute, National Institute of Occupational Safety and Health, Occupational Safety and Health Administration, and the Center of Disease Control. Please say yes on HB763 to protect the health and lungs of all perioperative staff, including nurses, surgeons, physician assistants, surgical technicians, surgical assistants, anesthesia providers, patients, and the tiny lungs of babies that are born by C-Section that take their first breath of life in a room with surgical smoke. Thank you. Janet Shortt, MHSA, BS, RN, CNOR
Enhancing healthcare safety is crucial and implementing smoke evacuation in operating rooms is a key step. By investing in this technology, we prioritize the well-being of both medical staff and patients thereby reducing the risks associated with surgical smoke exposure. The device to properly remove surgical smoke is available in many operating rooms and does not require construction or HVAC renovations; however, the use wavers, as there is no mandate. Surgical smoke was first identified by OSHA in 1988 as a known workplace hazard - that was over 35 years ago! There are several devices in the operating room that produce smoke: lasers and cautery devices to name a few. These devices are used to cut, coagulate, desiccate, and vaporize tissue during an operating causing a smoke plume. Surgical smoke has been studied for years proving there are over 40 hazardous chemicals found in the smoke which is equivalent to inhaling the smoke of 30 cigarettes a day! As a non-smoker, I am unable to protect myself from surgical smoke as even the best surgical masks (including N95 masks) do not provide protection. In 2021 only 5 states supported smoke evacuation mandates. Since then, 10 states have adopted smoke evacuation mandates, and I am looking for your support to make Virginia number 16! This bill aligns without commitment to advancing healthcare standards and ensuring a healthier environment for providers and patients.
Dear Chair and Members of the House Committee on Health and Human Services - Health: On behalf of the Association of periOperative Registered Nurses (AORN) and our more than 1200 members in Virginia, we urge you to support HB 763, a bill that would ensure that operating room nurses, their surgical colleagues and their patients are protected from harmful surgical smoke in the operating room. Surgical smoke is the result of human tissue contact with mechanical tools and/or heat producing devices, such as lasers and electrosurgical pencils. In other words, it is the smoke from burning flesh. Many surgical procedures generate surgical smoke. Common smoke producing surgical procedures include cesarean sections, hip replacements and mastectomies. Surgical smoke contains over 150 hazardous chemicals and carcinogenic and mutagenic cells. It contains toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material, blood fragments, and viruses. In addition to causing respiratory illness, asthma, and allergy-like symptoms, surgical smoke contains live viruses like HPV. There are documented cases of HPV transmission from patients to providers via surgical smoke inhalation. Surgical smoke can cause cancer cells to metastasize in the incision site of patients having cancer removal surgery. Babies born by C-section breathe in their mother’s surgical smoke at birth. Like cigarette smoke, surgical smoke can be seen and smelled. Unlike cigarette smoke, surgical smoke is still prevalent in employee workplaces like the operating room. Surgical smoke can be safely and effectively eliminated with available technologies and the equipment that many facilities in Virginia already have. We urge the members of this subcommittee to support HB 763 and provide a safe environment for healthcare workers to take care of their surgical patients.
HB808 - State psychiatric hospitals; temporary detention orders, delayed admission to determine med. needs.
HB808 is an important bill for those who are experiencing a medical emergency or medical condition that presents with behaviors which are often considered solely a mental health issue. Hospitals are quick to transfer patients that present with mental health issues without looking further into any underlying medical conditions. Please vote YES on HB808
Support, to support health of the overall individual. If a TDO is to help the person's health (in theory) then vote to prioritize their health which includes physical and mental. Meet medical needs
HB813 - Parental access to minor's medical records; consent by certain minors to treatment.
§ 1-240.1. Rights of parents. A parent has a fundamental right to make decisions concerning the upbringing, education, and care of the parent's child. The Virginia Supreme Court enshrined this right to parents. This committee has got to stop usurping parents in Virginia for their right to know. Do you really want your 13 yr old to make medical decisions on their own, and then you will be responsibile for the follow-up costs when something goes wrong. Protect your children and grandchildren and vote not for this horrific bill. Children belong to parents, not to the State of Virginia. Eileen Roberts, Parents For Life parentsforlifeva.org Protecting teens, empowering parents
HB848 - Veterinary medicine; traineeships.
HB855 - Home Energy Assistance Program; Bd. of Social Svcs. to allow applications to be submitted all year.
HB858 - Health care; decision-making, end of life, penalties.
YES on HB 858. This bill provides an OPTION for those with terminal illnesses who are found eligible by two doctors to end their lives gently and on their own terms. Isn't that what we all wish for? It cannot be used by someone with a disability or a mental illness and there are safeguards to prevent anyone from being coerced into it (which hasn't been found to happen in states where these laws are in place). Your personal beliefs prevent you from using it for yourself? That's fine, you don't have to. Please look beyond the usual party lines and make this law for the few Virginians who need it. Thank you.
See Attached.
Honorable House Members: Please take the time to review the attached "The Ethics and the Dangers" concerning Physician-Assisted-Suicide (PAS). Thank you, Nathan A. Rowe, APRN, PMHNP-BC, CEN Virginia Director American Academy of Medical Ethics
Dear Chair Sickles and Committee Members: I beg you to vote NO on HB 858. The bill’s fundamental wrong is to promote suicide—doubly wrong when we already have an epidemic of suicide. But its provisions also open the door to coercion, abuse, and lethal harm of our most vulnerable citizens. From falsified death certificates and overlapping roles to lack of Board review transparency and more, the bill is very, very dangerous. For example, the same provider can receive both of the oral requests, select a capacity reviewer (IF the provider feels it’s needed), approve the suicide request, fill the prescription (if the provider also is a licensed pharmacist), and even sign the death certificate, which must be falsified to hide the fact that the real cause of death is suicide by overdose/poisoning. It is hard to imagine a combination of provisions more dangerous than that. This clearly would allow bad actors to manipulate and abuse vulnerable persons who do not consent to assisted suicide. The danger would be especially high in settings like hospitals or long-term care centers that may have the provider, patient, pharmacy, witnesses, and even capacity reviewers under one roof. The risk of abuse is astonishing and must not be allowed. Falsified death certificates in particular are a huge red flag and are unspeakably dangerous because later no one will be able to determine how people actually died. To require lying and falsification of official documents is totally unethical and a betrayal of the public trust. Meanwhile the Board's findings on compliance will remain secret "[e]xcept as otherwise required by law." This means that in cases of concern or controversy, we may never be able to determine what happened, justice may be denied, and future patients of the providers or entities may be placed at tremendous risk. I have emailed each of you a more detailed list reviewing additional dangerous provisions. I urge you to take time to read that email in full. Suicide is always wrong because it is a form of taking innocent human life. Condoning the taking of innocent human life damages society, entrenching a mindset that sees taking innocent human life as a solution to suffering and difficulties. The harm caused by expanding that mindset must not be underestimated, especially when we already see increasing attacks on innocents breaking out in public places, and we already have some voices promoting the idea of involuntary euthanasia. I implore you to take all these threats seriously and vote NO to this appalling bill. Health care providers should never be dealers in death but always life, healing, and life-affirming care. And we have the best palliative care the world has ever seen. There is always a better path than suicide, even for the terminally ill.
As an older Virginian who has witnessed the needless suffering of terminally ill individuals unable to make end-of-life decisions with dignity at home, I am reaching out to you, a valued member of the Education and Health committee. I urge you to consider voting in favor of the end-of-life decisions bill HB858 to pass through the committee. Allowing individuals the choice to stay in their homes during such a challenging time is integral to Virginia's commitment to empowering its citizens to make decisions about their own lives. I implore you to recognize the significance of this legislation in preserving the liberty and autonomy of Virginians. Sharing this plea, I draw upon the desire to ensure that when the time comes, I have the empowerment to make such decisions within the comfort of my Richmond home, avoiding the necessity of doing so in a distant hotel room out of state. I respectfully acknowledge the committee's pivotal role in shaping policies that profoundly impact the lives of Virginians. Your thoughtful consideration and support for this bill would not only address a critical need but also stand as a testament to Virginia's dedication to the well-being and freedom of its citizens. Thank you for your time and consideration.
Hb858 vote yes. Terminally ill people deserve bodily autonomy and deserve to not live the rest of their life in pain of they dont want to
Sharon Quick, MD, MA (Bioethics)--Reasons to Oppose Virginia HB 858 I am President of the Physicians for Compassionate Care Education Foundation (PCCEF), an organization without religious or political affiliation. We advocate for the terminally ill, who often have compromised capacity to choose, making them vulnerable to abuse. I have expertise in pediatric anesthesiology, critical care, and medical ethics. On behalf of our Virginia members and as a physician residing in Washington State , where physician-assisted suicide was legalized in 2009, we urge you to oppose HB 858 which is the most radical, dangerous policy of its kind in the nation. Summary: Medically-assisted suicide laws inevitably violate (rather than uphold) patient autonomy, create (based on subjective, error-prone criteria) a class of marginalized patients from whom the standard of medical care is withheld, allow lethal drugs to unnecessarily substitute for good palliative care and pain control, disproportionately prey on those with mental health problems and disabilities, and destroy the foundation of medical ethics, creating distrust among patients and the health care profession. Oversight is inadequate to enforce the law or detect abuse, and the bill contains multiple conscience violations. This bill is a set-up for elder abuse. Please see the attached document for a discussion of the problems with medically-assisted suicide in general and a more extensive, but not exhaustive, list of the specific parts of this bill that make it particularly reckless and dangerous.
My name is Ian McIntosh, Director of Disability Outreach for the Patients Rights Action Fund (PRAF), a leading national organization fighting assisted suicide legislation across the country. Assisted suicide is suicide and any active participation in causing the death of a person is malpractice. Assisted suicide is suicide by any acronym proponents choose. But to counter course on the terminological war waged by professional assisted suicide activists, plainly, suicide was also known as self-murder. And in a healthcare system concerned with true choice and autonomy, the just thing to do when irrational action meets compromised thought is to act and think on behalf of the vulnerable and rescue them from their wrong decision. And yet, in our broken healthcare system, where mistrust between patients and doctors (and doctors and doctors) increases year over year, jurisdictions with assisted suicide legislation steers people with disabilities towards assisted suicide instead of suicide prevention solely on the basis of an immutable characteristic; That is discrimination. Professional assisted suicide organizations like Compassion and Choices and Death with Dignity are not -- I repeat -- not disability rights organizations. If they were a national disability rights organization, they would fight for...disability rights! If they were a disability rights organization, records would catalogue efforts fighting for health equity and there would be a word-of-mouth reputation identifying them as champions for those causes and concerns that actual disability rights organizations champion; They wouldn't face public rejection in the way the Alzheimer's Association rejected C&C's "educational" relationship approach in what's surely one of the clearest examples of how unlike assisted suicide is to real end-of-life care, every bit as much how unlike these professional assisted suicide activist organizations are to actual disability organizations:. From the Alzheimer's Association website: "Their [Compassion and Choices] values are inconsistent with those of the Association. We deeply regret our mistake, have begun the termination of the relationship, and apologize to all of the families we support who were hurt or disappointed...As a patient advocacy group and evidence-based organization, the Alzheimer’s Association stands behind people living with Alzheimer’s, their care partners and their health care providers as they navigate treatment and care choices throughout the continuum of the disease. Research supports a palliative care approach as the highest quality of end-of-life care for individuals with advanced dementia." I believe with new information comes new conclusions. I believe that disability rights are the domain of disability rights organizations and lawmakers of good will who turn data into policy that protects civil rights. No national disability rights organization with a position supports assisted suicide. All with a position, oppose it. Please side with those organizations who have championed the civil rights of the disability community and take the time to find out why they oppose this insidious legislation and the "work" of professional assisted suicide activists. As a Canadian emigre to the US, the thought of seeing Virginians in the thousands come under this eugenical boot is terrifying. Please oppose HB 858
Please consider the attached 2-page testimony from a disability perspective in opposition to this bill.
I am a practicing physician who has held a Virginia medical license since 1984 (#0101037516). I respectfully oppose the amendment proposed in HB 858, which would provide exemption for physicians who wish practice medical aid in dying (MAID) in Virginia. MAID is euphemism for physician-assisted suicide (PAS), a practice and ethos that is out of step with the long history of the medical profession, which runs counter to majority opinion in all religions, and is ignorant of the sustained condemnation of the practice by both the American College of Physicians (2017) and the American Medical Association (2018 and 2023). Physician-assisted suicide inevitably leads to active euthanasia, as the Canadian program bears witness. It places the vulnerable, marginalized, exploited and aged at risk of coercion and manipulation. The practice is toxic to society and under a PAS paradigm, race-based healthcare disparities will be augmented rather than mitigated. What we administer to our patients, for sickness or health, well-being or death, we administer to society. I urge NON-PASSAGE of this bill.
I believe that everyone should have the option when they are faced with definitive demise to choose how they leave behind this world and their loved ones. Giving people the dignity to say “I am ready” and to allow their loved ones to gather before the time is near to say one final goodbye is far better, and a far greater mercy than forcing them to wait anxiously and in agony for death to finally take them. Although this may not remove the pain of loss, nor will it eliminate the sorrow that will inevitably follow for those left behind, this option can alleviate the mental agony and fear of wondering when, and worrying if they’ll be able to say one final goodbye. I am in full support of MAID because we should all have the option if faced with imminent death to leave when we choose and when we are ready. This is a choice, not a requirement. Those who wish to continue to fight through their anguish have the option to do so, but for those who wish to have control over what will inevitably happen will have that availability with dignity.
As an end of life doula, I've had the privilege of serving some of Virginia's finest men and women as they journey through what is perhaps the hardest part of their lives. Every case is different but many clients suffer greatly during the last days/weeks of their existence on this earth. These fathers, mothers, brothers, daughters, friends all have unique personalities, fascinating stories, and individual needs. Every once in a while, I get calls for people who have declined to a state of total suffering and ask the doctor, the nurse, me, sometimes even their loved one to die. They beg. If they were a pet, the vet would be gently telling the owner that it's the humane thing to do. But here, a suffering person pleads in desperate pain to end it, and it cannot be done. The only recourse is to hasten death on their own via VSED: Voluntarily Stopping Eating and Drinking. In a doula role, I've supported several clients through this, and it was 4-15 long and agonizing days of hunger, thirst, and bodily suffering. They did not die in dignity or peace. Caregivers, as well were tormented as they watched their loved ones suffer despite continuously providing comfort care. Ultimately the intent and result of VSED and Medical Aid in Dying are the same, just much greater suffering in VSED. Only the laws in Virginia can dictate and change that experience for our loved ones, and how humane we are legally allowed to be with them. HB858 also comprehensively and appropriately addresses the critical topics that I've seen pop up through my experiences with VSED, such as not precluding people who are dysphasic, deaf, or have communication disorders as having capacity, provisions of wills/contracts, prohibiting acts of coercion, intimidation, and falsifying/destroying documents of patient's request as a Class 2 felony, as well as immunity of healthcare providers. This is well-written and extremely well thought out. I strongly encourage the passage of HB858 as a humane and compassionate act to all future Virginia patients who find themselves in this tragic misfortune, and in honor of those who've sadly gone before. Amy Nixon, Comforting Hands End-of-Life Doula Services, 757-987-5991 amy@comfortinghands.com
As a licensed physician in VA, DC, and MD, I'm submitting testimony in support of HB858: medical aid in dying.
I am writing as a board-certified Hospice and Palliative Care physician, but mainly as a 71-year-old who has seen the power of hospice to alleviate suffering and hopes that it is still available when I transition from physician to patient, and then inevitably to end-of-life patient. This bill is not the Oregon paradigm— it is the Compassion and Choices paradigm, much more coercive. We need patient-centered care, not activist-centered care. I was moved by last weeks's Senate testimony, but in every case I could not help but think: "Why were they unable to get good hospice care?" Palliative sedation, legal everywhere, can lessen suffering better than MAID, because it does not require self-administration. The best way to improve end-of-life care is to support expansion of the Medicare Hospice Benefit so that patients and caregivers have more support. In Oregon, the availability of MAID has not impaired hospice care because conscientious objection is respected. So 55% of hospices there do not allow their staff to be present for ingestion of MAID drugs, and 16% do not allow any involvement at all. That would not be possible under HB 858, which requires not just tolerance but affirmation of MAID. Since a core principal of hospice is neither to delay nor accelerate a natural dying process, I can say with confidence that the vast majority of hospice doctors, nurse practitioners, and nurses find MAID not only unnecessary but abhorrent. Compassion and Choices used to claim that they supported hospice, but this is no longer credible. Under HB 858, if I as a hospice doctor have a patient request for accelerated death, which is not at all uncommon, am I free to explore the patient's sources of suffering and recommend alternatives to MAID? Or would that be considered "undue influence" and therefore a Class 2 felony? And would a patient's spouse arguing against MAID also become a felon? Is MAID to be a last resort, as still recommended by one of its principal supporters, Dr. Timothy Quill, or is it now to be a first resort, replacing hospice, based on the expertise of Compassion and Choices? Under this bill, there is no escape from complicity with MAID, even with the secular rationale that it is not the best care available to the patient. When hospice care can compete fairly with MAID and not be compromised by MAID, it's not even close. In Oregon, after 25 years, less than 1% of deaths are from MAID. Do we want to risk the care of the other 99% in bowing to some abstract principle of absolute autonomy? I have attached an article from Ezekiel Emanuel, the principal author of the Affordable Care Act, and definitely not a member of the "religious right." He observes that "Legalizing euthanasia and [physician-assisted death] is really a sideshow in end-of-life care— championed by the few for the few, extensively covered by the media, but not targeted to improve the care for most dying patients who still suffer." I completely agree. This should be a nonpartisan issue, it's far too important not to be. If it narrowly passes on strict party lines, or even if it narrowly fails, most of you will not have given it sufficient thought. So please read this bill carefully, and learn enough about hospice to compare it fairly with MAID. I am happy to connect with any Delegate or Senator, on either side of this issue, to answer any questions. William R. Anderson, MD wrandersonmd@icloud.com
No one should be denied the right to die with peace and dignity intact. It is cruel and inhumane to prolong suffering against a person's wishes.
I am writing today to offer my strong support for the passage of HB 858, the Medical Aid in Dying Act. I know you are very busy, so I will try and be brief.
Dear Chair Sickles and Members of the House Committee on Health and Human Services, I am a now-retired physician, currently living in Woodville (Rappahannock County). I practiced medicine for thirty-five years in Washington, DC, specializing in the treatment of HIV/AIDS. In the 80’s and early 90’s there was no effective treatment for HIV, and it most commonly resulted in death. During this period my practice averaged one death per week. When we think of death we have images of gently passing away at home, surrounded by our family. However this is not always the case. There are “good” deaths and there are “bad” deaths. With AIDS I frequently saw the bad deaths: patients unable to breath from Pneumocystis pneumonia, lying in pools of diarrhea from cryptosporidium diarrhea, or in severe pain unresponsive to narcotics. In these circumstances, when I had no treatment available for the condition causing their suffering, I did feel the obligation to help them end their suffering. Given my experiences I am a supporter of Medical Aid in Dying. I would hope that a physician today would be able to aid patients at the end of life, and do so within the constraints of the law. I believe that SB 280 is well written and provides an appropriate framework to allow physicians to provide compassionate care at the end of life. Douglas Ward, MD Woodville, VA
Dear Chair Sickles and members of the House Committee on Health and Human Services, I was raised and currently reside in Norfolk, VA, and I practiced Internal Medicine and Gastroenterology here in Norfolk for 30 years, retiring in 2008. I have been a Community Faculty Member at EVMS since 1975 and am still active, interviewing medical school applicants almost weekly in season. From both my personal and professional perspectives, I support passage of the VA End-of-Life Option Act. Having seen many patients, friends and my mother over these years suffer needless pain and suffering in their final days of life, I have sincerely hoped that Virginia would join the other states in our country that offer this option to control their final time on this earth. The Hippocratic oath, which I swore to uphold, compels me to do no harm, to heal and to help eliminate suffering. I call on your and your colleagues to enable physicians to be of service to their patients by having this option. A majority of physicians and Virginia citizens join me by being in favor of allowing the doctor to go beyond the excellent care given to hospice patients now available by allowing the patient and the doctor to use medication to end the patient’s life. The strict requirements for protocol in this bill assure that this approach is given when no other measures can help, with a proper waiting period, when the patient is of sound mind and can decide independently and when another physician agrees with the approach. I’m sure you are familiar with the other arguments both for and against taking this measure, and I trust after careful deliberation your committee and the General Assembly will enact this compassionate approach to aid the dying patient. Edward L. Lilly, MD, FACP One Colley Avenue, Apartment 1509 Norfolk, VA 23510 757-440-5535 (home) 757-438-7715 (Ed cell)
BILL NUMBER – HB 858 Dear Committee Chair Sickles and Members of the House Committee on Health and Human Services, I reside in Midlothian and having practiced medicine for 30 years, I have experienced too many end-of-life events. Often the prolonged pain and suffering for patients and their families or caregivers becomes overwhelming and robs them of any quality of life. In addition, as doctors, nurses, and hospitals are conditioned to heal patients, so many tests and procedures are performed which have no chance of improving one’s condition, while seriously raising the cost of care and depleting family financial resources as well as government assistance programs. The Medical Aid In Dying option in those states that have legislated it has been well proven to offer great peace of mind for patients and families, even for those who never make that choice. I strongly urge the passage of Bill HB 858. Sincerely, Robert H. Perkins MD (ret) dotandtin@gmail.com (774) 212-1007
Chair Sickles and members of the House Committee on Health and Human Services, As a Gerontologist and Family Caregiver, I have seen countless examples of individuals and loved ones barely existing, with no quality of life. I have also witnessed first hand healthcare professionals challenging an individual's DNR when said individual has diminished capacity. We live in a state with very few options for productively dying. And even those limited options are often challenged or ignored by healthcare professionals. We need legislation with some teeth that supports dying on our own terms. Jay White <info@gerojay.com>
Dear Chair Sickles and members of the House Committee on Health and Human Services: I write in support of House Bill 858 which proposes medical aid to the dying. I am a citizen of Norfolk, a registered voter, and a retired physician. I am board-certified in psychiatry and neurology. Early on, I vowed to respect the natural inevitable, rhythms of life, i.e. birth, life, and death. I further vowed as a physician to do no harm. In my opinion it is a failure of these vows to allow pain to continue or to interfere with patient autonomy in a terminal situation. Both responses would interfere with life’s normal course and cause harm physically and mentally. Thank you for considering these thoughts. Larry Bernert MD (retired) 1 Colley Ave Apt 404 Norfolk, VA labjr@cox.net 757-620-2580
Dear Chair Sickles and members of the House Committee on Health and Human Services. As a physician who obviously cares deeply about my relationship with patients I want to refer to a portion of the modern version of the Hippocratic Oath. “ I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.” Medical Aid In Dying (MAID) is very much consistent with the Hippocratic Oath that we as physicians take. When everything that is tried to improve our patients’ quality of life fails, the question arises when do we then turn to warmth, sympathy and understanding. When a patient is fully competent mentally with a predicted life expectancy of 6 months or less, has exhausted every possible modality to give them relief of their suffering, it is then time to respect a patient’s wishes if they are no longer able to cope with their illness. Should a patient decide to end their life with medical assistance, the proposed law requires two health care professionals, as a safeguard, to evaluate the patient to assure they are fully competent to make and understand their decision. If it is determined in the affirmative it is certainly the “warmth, sympathy and understanding” that is due the patient. I ask all members of the State Legislature if this was you, a parent, a spouse or a child would you not want to help them end their suffering if all possible treatments had failed? I urge you to give this legislation strong consideration with an open mind and a sympathetic heart. KENNETH OLSHANSKY, M.D. Cell: 8046901635 olshanskyken@gmail.com
Dear Chair Sickles and members of the House Committee on Health and Human Services. As a physician who obviously cares deeply about my relationship with patients I want to refer to a portion of the modern version of the Hippocratic Oath. “ I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.” Medical Aid In Dying (MAID) is very much consistent with the Hippocratic Oath that we as physicians take. When everything that is tried to improve our patients’ quality of life fails, the question arises when do we then turn to warmth, sympathy and understanding. When a patient is fully competent mentally with a predicted life expectancy of 6 months or less, has exhausted every possible modality to give them relief of their suffering, it is then time to respect a patient’s wishes if they are no longer able to cope with their illness. Should a patient decide to end their life with medical assistance, the proposed law requires two health care professionals, as a safeguard, to evaluate the patient to assure they are fully competent to make and understand their decision. If it is determined in the affirmative it is certainly the “warmth, sympathy and understanding” that is due the patient. I ask all members of the State Legislature if this was you, a parent, a spouse or a child would you not want to help them end their suffering if all possible treatments had failed? I urge you to give this legislation strong consideration with an open mind and a sympathetic heart. KENNETH OLSHANSKY, M.D. Cell: 8046901635 olshanskyken@gmail.com
As a physician who is a former Canadian, I have attended the deaths of many patients during my 24 years in medicine. I have grieved at many funerals. Palliative Care and Hospice provide excellent services to our patients in the Commonwealth, and there are no significant barriers to accessing end-of-life care for patients from all walks of life. Medicaid and Medicare provide these services to patients who have fewer resources, and commercial insurance does the same. This is not an issue of the HAVES vs the HAVE-NOTS. When I had patients tell me that they wanted to end their lives, I have ALWAYS been able to meet them in their moment of need with medicine and therapy to wrap comforting care around them to ease their suffering. When patients want to end their lives because of the horrors of pain, we ALWAYS have ways to help. I have had patients, friends, colleagues and co-workers commit suicide, and I have wept with their families. WITH THE WIDE-AVAILABILITY OF FENTANYL AS A STREET- DRUG, INDIVIDUALS WHO CHOOSE TO COMMIT SUICIDE CAN DO SO WITH MINIMAL BARRIERS AND WITH MINIMAL SUFFERING. Individuals who want to commit suicide do so without the "help" of a physician every day in this country. As a Canadian turned Virginian, I can tell you the stories of Canadians being told by healthcare workers that they are a burden to society; that they should consider assisted suicide. It is not a matter of IF our most vulnerable patients are advised to commit suicide by healthcare providers, it is a matter of WHEN. Abuses will happen. The same thing happens in Oregon and Washington State. I did not train for 15 years (college, medical school, residency, fellowship) to kill patients. I trained for 15 years to save patients in their most vulnerable moments of need. When patients in Virginia choose to die with dignity, hospice and palliative care provide the right care at the right time. My cell phone is 434 401 8769 and my email is markdavidt@icloud.com Please don't hesitate to reach out to me if I can help in any way. Mark D. Townsend, MD, MHCM, Fellow of the American College of Cardiology
Dear Chair Sickles and Members of the House Committee on Health and Human Services. I support Senate Bill 280. Watching my mother, father, and aunt suffer and die from cancer was excruciating. My father's decline was particularly rapid; he went from being able to walk to the bathroom to being bedridden in a matter of weeks. I was able to give him morphine while he was in hospice at home, but eventually, it became less effective, and he experienced breakthrough pain. He developed bed sores but was too proud to complain. I will never forget the moment he took his last breath. The cancers that killed my parents were not hereditary. However, I understand that if we live long enough, the chance of developing cancer is around 40%. If I am diagnosed with cancer at some point in my life, I do not want to experience the same suffering that my loved ones did. I would like the option to reduce my suffering and not wait for the disease to take my life painfully and slowly.
As a healthcare provider in Virginia for over 40 years I have seen the sadness and agony of watching family members and patients suffer awaiting painful death when there is no longer hope. A patient should be able to make the choice for themselves how they will die and avoid painful suffering. This law has been passed in many states, as citizens of Virginia we should not have to leave our state to receive assistance in dying. Thank you for voting yes for this bill
HB858 Written Testimony: Margo Figgins, 2/1/24 My name is Margo Figgins. I am a resident in Virginia’s Fifth District and support the provision of Medical Aid in Dying (MAID) as defined in HB858. It is too often assumed that hospitalization and its extreme measures to prolong a life, and hospice care with its palliative measures to manage pain, are sufficient options for arriving at one’s last breath. But they are not. As a hospice volunteer, I witnessed conditions that palliative care could not adequately address and that resulted in tortured deaths. There are cases in which intractable suffering exists, wherein effective palliative treatment is impossible. Consider, for example, the person dying of emphysema. This illness is a hopelessly slow process of suffocation. There are no palliative interventions to make gradual suffocation tolerable, let alone peaceful. Another consideration needed for the terminally ill patient: Their fear of dying alone. Having accepted the fact of a terminal diagnosis, there were patients I sat with who were terrified of not knowing when that moment of death would arrive, of not having family or other loved ones with them when it did, and wishing they could experience the peace of knowing someone close to them – not an anonymous “Eleventh Hour” Hospice Volunteer – was holding their hand and assuring them that they were loved and would be long remembered. What could be more important in a democracy than one’s choice to author the closing lines of life’s final chapter – a life that represents the sum total of the choices made? Every person deserves a death consistent with their beliefs and their values throughout. For the terminally ill patient to have someone else’s beliefs and values imposed on the end of their life is an egregious offense to the autonomy they have exercised up to the moment of their death. They deserve the choice of conditions that ensure the comfort and dignity they desire. As your constituent, and someone committed to a responsive healthcare system that offers adequate options to the terminally ill person, I urge you to support Medical Aid in Dying as articulated in HB858.
I want this right at the end of my life. I am 80 and in good shape. But the last thing I would ever want is my family remembering me bed-ridden and slowly dying. That is not me. Thank you for supporting this bill. It’s long overdo!
Medical aid in dying is compassionate care for people who are suffering and the families who love them. Please pass this bill so that Virginians have the option to choose when they end their suffering and can do it at home.
I am one of your constituents, and at 61 years of age have concerns about future available heath related options. I am in support of compassionate care and fully support HB 858 because I want that choice if ever needed in the future. This is something that is very important to prevent unnecessary suffering for both the individual as well as their family as I’m sure you can appreciate. I hope you will support HB 858! Respectfully, Patricia McCormick Charlottesville, VA
I work with the dying. About 1/3 of the deaths I have witnessed have involved writhing suffering, despite Hospice's best efforts. Those with terminal illnesses are all too aware of the possibility of protracted suffering over which they have NO AGENCY, and this leads to an understandable avoidance of the fact of death's arrival. This avoidance, based in fear, prevents the dying from saying what needs to be said, completing the documents that need completing, stating the intentions that need stating. Too often, death "surprises" folks in Hospice and their families, and the result is family fracture, arguments, missed work, protracted grief. WITH AGENCY over the disease which is killing them, patients seem to translate that sense of control to other aspects of their final days. A prepared death results in so much less harm to society, and increasing access to prepared deaths is in the best interests of the Commonwealth. As a reminder: Pursuing, prescribing, and ingesting the medication is entirely optional, and is only available to those who are already dying. Disability is not a terminal disease. Mental health diagnoses are not terminal diseases. Patients in those categories would not be eligible for a prescription.
I strongly endorse House Bill 858. Medical aid in dying for terminally ill people is a proven medical practice that 7 out of 10 Virginia residents support implementing. This would allow a terminally ill, mentally capable adult with a prognosis of six months or less to live, to request from their doctor a prescription for medication they can decide to self-ingest to die peacefully in their sleep. It is completely optional; no one can be forced to use it, no doctor can be forced to participate, and at least two doctors must be consulted. The option is only available to an adult who is able to make an informed health care decision and is able to take the medication themselves. This is an incredibly personal issue for me. A peaceful death should not be illegal, and no one deserves to endure unnecessary, unbearable suffering at the end of their life.
Hearing Date: February 1, 2024 Bill Number: HB 585 Dear Chair Delegate Hope I am the Rev. Dr. Fred A. Soltow, Jr. I am a retired Lutheran Clergy person who served the church for 45 years. During the course of my ministry I witnessed first hand the passing of numerous people who would have welcomed the discussion of choice if Medical Aid in Dying had been an option. Medical Aid in Dying (MAID) as presented in this bill is an option, not a requirement. It is an option in the same manner that radiation, chemotherapy, stem cell replacement, and other medical procedure can be offered to patients with a terminal diagnosis. Patients have choices to make during their care and when faced with the end of their lives. Medical Aid in Dying should be one of those choices that is offered to a terminal patient with the input and the approval his/her medical team. My mother spent the last three years of her life in a nursing home hooked up to a breathing machine because she had COPD. She was in pain and feared the day ahead as yet another day of pain and suffering. As a family, we stood by her side in our pain as we watched our mother in her pain. As a family we prayed that she would leave this world of pain and misery and pass into a new life of peace, love, hope and joy. My mother and my family would have welcomed, with open arms, the opportunity to discuss Medical Aid in Dying as an option to relieve her pain and suffering on the threshold of a new life beyond this one. I do not know where the conversation would have taken us, but the option to have that conversation would have been a blessing for all. Rev. Dr. Fred A. Soltow, Jr 1301 S Providence Rd North Chesterfield, Va.
I completely support Medical Aid in Dying as a voluntary option for terminally ill, mentally competent individuals. No one should have to suffer needlessly. Having Medical Aid in Dying allows a person to feel in control and thus relieve mental anguish as they navigate the end of life. Having Medical Aid in Dying should be available to all Virginians on a completely voluntary basis. Thank you.
Please support this bill. It provides a humane option for terminally ill, mentally competent individuals the option to end their life peacefully. It is completely voluntary. History has shown no abuse or coercion.
In an attempt to be brief: HB519: Hope I'm reading the title of this incorrectly, but with the far-right extremists out there I fear I am not. ABORTION CARE IS A NECESSARY PART OF HEALTH CARE AND SHOULD NEVER, NEVER, NEVER *EVER* BE CONSIDERED "UNPROFESSIONAL CONDUCT." If you vote for this, I don't vote for you. HB609: Children do much better when they are wanted children. It is ridiculous to attempt to control the sexual behavior of others by restricting access to birth control ... or indeed even at all. Everyone has a right to affordable, safe, effective means of preventing unwanted pregnancy. HB858: I hope very sincerely to see a right to physician assisted euthanasia at the end of life enacted in this state. I am a practicing veterinarian and perform this every day. It is very sad that human beings should have to suffer and linger when there is no more hope at the end of life when we would never treat an animal in this manner. I have also lost my husband to brain cancer, and while I don't believe he would have chosen that option, I believe others should have this right and the means available.
I am a primary care physician who has practiced in Virginia since 1986. – first in private practice and now as medical director of the Moss Free Clinic in Fredericksburg. I believe there is a lot of unnecessary suffering among terminally ill patients, because of lack of access to medical aid in dying. It is a small number of people who are appropriate for, or would choose to, foreshorten their dying process with the aid of medicines prescribed by their doctor, but I see this as the ultimate in patient autonomy and they should be the ones making this decision – and not have greater suffering forced upon them by the philosophical and religious beliefs of politicians and conservative medical organizations. The objection from some doctors that they are healers and not in the business of ending lives overlooks that these people are not healable. Are dying anyway. I see my duty as a doctor to minimize suffering. The evidence from states where medical aid in dying is legal already, shows the safeguards are effective in stopping people from being coerced into ending their lives. Or doing it capriciously. I urge you to support the cause of legalizing medical aid in dying in Virginia and support HB 858.
Over the past four years I have spent hundreds of hours educating people on the importance of advance care planning and explaining what medical aid in dying (MAiD) is and is not. If I told my Mother's story it would take at least 30 minutes, so, suffice it to say she wanted out so desperately due to the pain and suffering from multiple diseases that she attempted suicide with knitting needles. That action ultimately forced a move from assisted living to a nursing home where she spent her final two months sitting in front of the nurses' station kicking and screaming at every passerby "HELP ME, PLEASE KILL ME". Why did her life have to end this way? Mom's story is typical of both friends and family members whose worst nightmares were serving time on the "other death row". The observance of severe neglect at even the best rated nursing homes coupled with their pleas for a way out of life, left me emotionally distraught for days due to anger and sadness. I still get teary whenever I think about what I witnessed and my inability to do anything about it. If I were given the opportunity, I could fill a book with hundreds of end-of-life horror stories. There must be an alternative to this sad state of affairs. Please vote YES for the forwarding of HB 858. Once passed, the decision to use the law should be between the patient and the prescribing physician.
Honorable Committee: My name is Nathan Rowe, and I am a practicing Psychiatric Nurse Practitioner with a long history of working with mental illness not just as an advanced practice provider, but as an emergency and intensive care nurse as well as a paramedic over the past thirty years. Prior to being a medical provider, I am also a survivor of childhood cancer (1993) therefore can speak from one who faced a deadly disease early in life that presented as hopeless. Currently I work in a busy psychiatric practice in Southwest Virginia as well as a co-Director alongside Dr. Thomas Eppes and Dr. Jim Avery in the Commonwealth of Virginia for the American Academy of Medical Ethics (AAME). The AAME has a mission to promote the interests of medical educators, medical practitioners and scientists, the care and well-being of patients, the protection of public health, and the betterment of the medical profession, as well as to protect and promote the historicalvalues that have provided the longstanding foundation for Western healthcare.1 I am providing written testimony to briefly state an opposition to HB858. The National Council of Disability: Safeguards and Their Limitations The National Council on Disability (NCD), which is described on their website as “An independent federal agency committed to disability policy leadership since 1978”3 released a report to the President on October 9th, 2019, titled “The Danger of Assisted Suicide”. This report outlined at least six key issues that they found to be problems even with proposed “safeguards” of what is described as Physician-Assisted-Suicide. SAFEGUARDS AND THEIR LIMITATIONS: VERBATIM • Insurers have denied expensive, life sustaining medical treatment but offered to subsidize lethal drugs, potentially leading patients toward hastening their own deaths. • Misdiagnoses of terminal disease can also cause frightened patients to hasten their deaths. • People with the disability of depression are subject to harm where assisted suicide is legal. • Demoralization in people with disabilities is often based on internalized oppression, such as being conditioned to regard help as undignified and burdensome, or to regard disability as an inherent impediment to quality of life. Demoralization can also result from the lack of options that people depend on. These problems can lead patients toward hastening their deaths—and doctors who conflate disability with terminal illness or poorquality of life are ready to help them. Moreover, most health professionals lack training and experience in working with people with disabilities, so they don’t know how to recognize and intervene in this type of demoralization. • Financial and emotional pressures can distort patient choice. • Assisted suicide laws apply the lowest culpability standard possible to doctors, medical staff, and all other involved parties, that of a good-faith belief that the law is being followed, which creates the potential for abuse.4 Recenently Canada (who has laws such as PAS) are expanding to mental health patients who I am committed to treating. Unfortunately these bills are known to expand on a slippery slope. Let us in Virginia say NO to bills that allow providers to kill; please empower us to heal. Say No to HB858. 1 https://ethicalhealthcare.org/ 2 https://www.psychiatrictimes.com/view/medical-aid-in-dying-slippery-slope 3 https://beta.ncd.gov 4 https://beta.ncd.gov/report/the-danger-of-assisted-suicide
I am a nurse who has lived in the US for over 30 years, 22 in Canada and 8 in Germany. I have seen the health care from both sides. I took care of my elderly parents in my home for 12 years until they qualified for hospice and both suffered immensely before they died. I’ve seen nursing home horror stories. I just want to live my last years in peace and quiet without worrying who will take care of me when I can’t anymore and am bedridden. This bill passage can help so many when they know there is no more hope of living a quality life. On the practical side-it will help with the issue of SS running out, not enough nursing home placements and also the improvement of the quality of life for the caretakers out there. Please pass it
Honorable Committee: My name is Nathan Rowe, and I am a practicing Psychiatric Nurse Practitioner with a long history of working with mental illness not just as an advanced practice provider, but as an emergency and intensive care nurse as well as a paramedic over the past thirty years. Prior to being a medical provider, I am also a survivor of childhood cancer (1993) therefore can speak from one who faced a deadly disease early in life that presented as hopeless. Currently I work in a busy psychiatric practice in Southwest Virginia as well as a co-Director alongside Dr. Thomas Eppes and Dr. Jim Avery in the Commonwealth of Virginia for the American Academy of Medical Ethics (AAME). The AAME has a mission to promote the interests of medical educators, medical practitioners and scientists, the care and well-being of patients, the protection of public health, and the betterment of the medical profession, as well as to protect and promote the historicalvalues that have provided the longstanding foundation for Western healthcare.1 I am providing written testimony to briefly state an opposition to HB858. The National Council of Disability: Safeguards and Their Limitations The National Council on Disability (NCD), which is described on their website as “An independent federal agency committed to disability policy leadership since 1978”3 released a report to the President on October 9th, 2019, titled “The Danger of Assisted Suicide”. This report outlined at least six key issues that they found to be problems even with proposed “safeguards” of what is described as Physician-Assisted-Suicide. SAFEGUARDS AND THEIR LIMITATIONS: VERBATIM • Insurers have denied expensive, life sustaining medical treatment but offered to subsidize lethal drugs, potentially leading patients toward hastening their own deaths. • Misdiagnoses of terminal disease can also cause frightened patients to hasten their deaths. • People with the disability of depression are subject to harm where assisted suicide is legal. • Demoralization in people with disabilities is often based on internalized oppression, such as being conditioned to regard help as undignified and burdensome, or to regard disability as an inherent impediment to quality of life. Demoralization can also result from the lack of options that people depend on. These problems can lead patients toward hastening their deaths—and doctors who conflate disability with terminal illness or poorquality of life are ready to help them. Moreover, most health professionals lack training and experience in working with people with disabilities, so they don’t know how to recognize and intervene in this type of demoralization. • Financial and emotional pressures can distort patient choice. • Assisted suicide laws apply the lowest culpability standard possible to doctors, medical staff, and all other involved parties, that of a good-faith belief that the law is being followed, which creates the potential for abuse.4 Recenently Canada (who has laws such as PAS) are expandinging to mental health patients who I am committed to treating. Unfortunately these bills are known to expand on a slippery slope. Let us in Virginia say NO to bills that allow providers to kill; please empower us to heal. Say No to HB858. 1 https://ethicalhealthcare.org/ 2 https://www.psychiatrictimes.com/view/medical-aid-in-dying-slippery-slope 3 https://beta.ncd.gov 4 https://beta.ncd.gov/report/the-danger-of-assisted-suicide
My husband suffered immobilizing back pain for most of early 2019. In June, we received the diagnosis: metastatic cancer had invaded his spine. He died one long, agonizing month later, unable to move from the sofa in our den. Had he been the family pet, we could have legally saved him that miserable month. Obviously, moving somewhere that permitted a compassionate choice was out of the question. Please approve HB858 and permit those like my husband to have an option to end the pain when the end is so imminent. Thank you.
Dear Chair Sickles and Members of the House Committee on Health and Human Services My name is Julie Hastings and I live in Chesapeake. I provided testimony in person last year, and am heartbroken to be unable to make it in person this year. Please accept this written testimonial in support of SB280, an act to support medical aid in dying. When my father became ill in 2021, we searched for any doctor who could give us a definitive diagnosis and a treatment plan. When we received a diagnosis of Amyotrophic Lateral Sclerosis (ALS) and Corticobasal Degeneration (CBD), the months forward were clear: He would lose his ability to use any muscles to his extremities, then the disease would affect his ability to eat, move his eyeballs, and eventually he would either suffocate or starve to death depending on which muscles went first. He died from starvation. Hospice was wonderful but in the end, they couldn’t manage all of his pain. He was suffering from muscle spasms and cramps that would pull him into a sitting position with guttural moans so deep they still give me nightmares. A 73-year-old man — who grew up in a farm town in Ohio, a devout Catholic, raised two children, worked hard every day of his life, gave to everyone he knew, always had a smile on his face and a kind word for everyone — in the end he couldn’t communicate his needs to us, his doctors, or even his Priest during weekly visits. My dad begged for a merciful death when he could still talk. His hospice doctor said that while they would do their best to keep him comfortable, getting him to DC, where Medical Aid in Dying was available would be almost impossible. The thought that he could have self-administered medication that would put him to sleep followed by a peaceful death — on his own terms — would have been a dream, but was an impossible one in Virginia. My dad did not want to die; my dad was living an incredible life. But as he said in the letter he left for me after his death, “simply being alive is not the same as living.” Disease took away his control over his life and death; having an option in the manner of his death would have given him peace. I urge you to report favorably on HB858, Medical Aid in Dying to give Virginians this option.
Chair Sickles and members of the House Committee on Health and Human Services: My name is Wayne Swatlowski and I live in Richmond, VA. My involvement as a volunteer with Compassion and Choices is a result of my personal experience. I’m an ordained Catholic priest and served in clerical ministry for 15 years before resigning and marrying. I now minister as a hospice visiting lay volunteer. In both of these positions I have been with people during their dying hours. For some, their transitions have been peaceful and relatively pain free. For others they have been marked by physical and emotional suffering for the patient and loved ones and by a loss of the highly personal pieces that make up quality of life for them; an inhumane final passage which could have been avoided for some if medical aid in dying had been an option. I support HB.858 so that dying individuals can be in charge of their own end of life care in order to ensure a more humane and compassionate transition for all eligible Virginians. Please vote yes on SB280 today. Wayne Swatlowski Richmond, VA gravski@aol.com
Dear Chair Faviola and members of Education and Health Committee, I am a retired physician resident in Henrico and I have practiced Cardiology for 50 years, starting in 1972 at the Veterans Hospital and the Medical College of Virginia. I strongly support SB280. At the beginning of my medical career I could not imagine any measure that would hasten a patient's death. During my long career I have witnessed many patients struggle with their pain and suffering in a prolonged slow death when curative and palliative treatments have failed. I have also seen my younger brother plead with his son to let him go when he was suffering multiple organ failure and facing mutilating surgery. My late colleague, Dr. Latane Ware, a very conservative physician who was honored with a citation by this legislature became an ardent advocate of patient autonomy in decisions regarding their own life after one of his close friends became involved in a murder suicide because he could not bear the suffering of his wife. Dr. Walter Lawrence, former Chairman of Oncological Surgery at VCU mentored hundreds of young surgeons and treated thousands of patients with cancer until his death at age 96. At the urging of these 2 eminent physicians the Medical Society of Virginia withdrew it's opposition to Medical Aid in Dying and joined several medical organizations in a similar stance. Today most of the U.S. public as well as physicians support patient autonomy in matters of life and death and MAID is allowed in 11 U.S. jurisdictions including the District of Columbia. I have come to strongly support this bill if it includes appropriate safeguards including the benefit of appropriate pain management, palliative care and hospice care. Just the knowledge that one has control over one's pain can provide immense relief with few patients actually exercising the option. This is borne out by the experience in other States where this is allowed. I believe it is the rational and conservative position. It can prevent much pain and save unnecessary loss of life. Best regards Zubair U. Hassan MD, FACC (em.) 200 Brookschase Lane Henrico, VA 23229
Dear Chair Hope and members of the House Committee on Health and Human Services, Subcommittee on Health, I am reaching out in support of House Bill 858 (being heard tomorrow in the Health Subcommittee). This bill would authorize access to Medical Aid in Dying (MAID) in Virginia for those who are terminally ill and of sound mind who wish to use this medical management tool during their end-of-life care. I am currently a 4th year medical student at Virginia Tech Carilion School of Medicine. In addition to being a future family physician in Virginia, I was also a caregiver for my mother during her 4 year battle with lung cancer, which had spread to her bones and brain. Given the nature of her disease, and having witnessed her own mother's painful final days combating this very same disease, my mom was very interested in pursuing Medical Aid in Dying. She wanted the autonomy and assurance of a painless death, something that I think all patients deserve access to given the vast medical advancements we are privileged to enjoy in the U.S. Unfortunately, the only jurisdiction near us at the time of her illness which had legally authorized Medical Aid in Dying was Washington, D.C. and we could not afford to relocate there from Virginia given the cost of housing (nor did we particularly want to leave beautiful Virginia). It is inhumane that we let one's zip code dictate the ease of suffering at the end of life… Virginians benefit from excellent academic medical institutions offering the best medical care across every specialty except for palliative medicine, which is hamstrung by the current legal status of MAID. I have seen many patients pass peacefully, but I have also seen many who have suffered unnecessarily. I hope you will consider supporting the bill which would provide patients the liberty they deserve in making choices about their care and which mirrors legislation that has been enacted in other states safely for many years. If you have any questions about Medical Aid in Dying, or would like to connect with physicians who offer this service in other jurisdictions please don’t hesitate to let me know. With gratitude for your service, Lauren Canary Roanoke, VA P.S. I have attached a picture of my family before my mom's passing. I advocate for MAID in her memory since she, like so many other late Virginians, cannot be here to do so herself. Their voices deserve to be heard and considered too.
My name is Brian Carlton, I live in Charlottesville, VA and I am here to show my support for SB280/HB858; Health care; decision-making; end of life; penalties. I am a retired Certified Financial Planner and formerly a licensed nursing home administrator (worked in 5 different homes around the state). I want to share two personal events in my life involving end of life situations: My father died of pancreatic cancer in Culpeper VA at the age of 67. He worked 35 years as an engineer at IBM and he and my mother raised 7 children. Dying of cancer is a traumatic experience, one filled with angst and pain. I witnessed his last month of life lying in a hospital bed in our family home living room. His suffering took a great toll on him and my mother. He knew the end of life was near but it was a prolonged, uncontrolled event. I wish he would have had the choice in those final weeks to end his life peacefully by his own hand. He could have called all his children together, said the proper goodbyes and had a “good” death. That was not to be - he did not have a choice. I worked in many nursing homes around this state in my first career as a nursing home administrator. People don’t like to think of these places as “the place you go to to die”. I tried to make the facilities as happy and life promoting as possible. I do recall though that there were always a handful of people who were suffering and near the end of life. It is an impactful situation when you are holding someone’s hand and they are begging you to help them end their life. I could see it in their eyes that they were ready to go and they did not want to prolong the impending suffering that was in store for them. If they only had a choice! Choice! That is exactly what medical aid in dying is! It is not for everyone, but for those who see and feel impending suffering and death and want to avoid the suffering part (and not put their families through it!), they deserve that choice. I want that choice in the future if I end up in an end of life suffering scenario. Please.
Testimony before the Virginia State House of Delegates Prepared & Submitted: 31 January 2024 Date of Hearing: 01 February 2024 Bill Number: House Bill 858 – Medical Aid in Dying Dear Members of the Health and Human Services Committee: I wish to inform members of this committee that I, along with a majority of other Virginians, support the right for terminally ill individuals to have the option to end their lives if and when their suffering becomes unbearable. Delegate Hope’s bill provides that choice, with over a dozen safeguards included to ensure that coercion does not occur, and that anyone who makes the decision to end their life can do so only if they are deemed mentally capable. The history of similar legislation in other states indicates that there have been no substantiated cases in which these laws have been misused. If enacted, this law would allow anyone to change their mind at any time. Indeed, in many prior cases, persons who have asked for and received the drug that they are considering taking have ultimately chosen not to use it. I want to live in a state that cherishes life. However, I also believe that the freedom to end one’s life should be available to everyone, in limited and controlled situations, if and when the prospect of enduring needless pain and suffering cannot be avoided, and when all hope for survival beyond six months has been lost. Thank you, James Beasley Woodbridge, Virginia
Dear Chair Sickles and Members of the House Committee on Health and Human Services, My name is Shannon Hibbard and I am writing to urge you to vote yes to HB858, which would give Virginians the right to use Medical Aid in Dying. For me, this is a subject I am very familiar with. In April of 2021, my father, Dr. David Hibbard, used Medical Aid in Dying in Colorado, one of the 11 states/district which has legislation in place. To be able to support my father’s choice to end his severe suffering was one of the most profound ways I could show my love for him and his decision. My father had an immense affinity for life. He was one of the first Peace Corps volunteers in 1961, he was a mountain biking enthusiast, and he loved his career as a medical doctor, being one of the last to make house calls. When my father was diagnosed with Parkinson’s in 2007 and later leukemia, he wondered what the last few months of his life would be like. He was a staunch supporter of palliative care and finding ways to make the last stages of life easier. Not only was my father a doctor, but he was the Director for Hospice in Boulder, Colorado. Given his work with hospice, he also was all too familiar with pain that was not responsive to medication or other treatment; seeing patients in such pain—while knowing what likely awaited him given his prognosis—gave him great fear about what his last months and days would be like. Prior to legislation being introduced that would enable Medical Aid in Dying, he considered alternate means to end his life if suffering became unbearable. Those conversations were gut wrenching to have, leaving us feeling hopeless. Thankfully it did not come to that. My father became one of the lead medical activists in Colorado to pass legislation in 2016. The last few months of my father’s life were extraordinary, both in how much I cherished my time with him and also how much I saw him suffer. He was taking narcotics every two hours, yet he would still physically change colors from the pain he was experiencing. I sincerely hope no one ever has to witness a loved one go through so much pain and know that there is nothing that any doctor can do, as your loved one is in fact dying and has less than six months to live. Instead of continuing through months of unrelenting pain, my father was able to take control of his life, to use Medical Aid in Dying medication to pass into the next world peacefully. He was in his home of 50 years, surrounded by flowers, photos of a life well lived, and his family who told him it was okay to go, that we loved him indefinitely and supported his decision. Every person should have this choice available, should they meet the stringent requirements to use Medical Aid in Dying. This legislation provides safeguards and has a history of safe use. No patient--nor doctor or pharmacist--is forced to use or be part of this law. But everyone should have the choice. I thank you for your time, and my father certainly thanks you for your consideration. Shannon https://www.dailycamera.com/2023/04/07/guest-opinion-devin-hibbard-our-fathers-empowered-death/ https://www.compassionandchoices.org/stories/hibbard
Regarding HB 858 January 31, 2024 Dear Chair Hope and Members of the House health and Human Services - Health Committee I am a now-retired physician, currently living in Woodville (Rappahannock County). I practiced medicine for thirty-five years in Washington, DC, specializing in the treatment of HIV/AIDS. In the 80’s and early 90’s there was no effective treatment for HIV, and it most commonly resulted in death. During this period my practice averaged one death per week. When we think of death we have images of gently passing away at home, surrounded by our family. However this is not always the case. There are “good” deaths and there are “bad” deaths. With AIDS I frequently saw the bad deaths: patients unable to breath from Pneumocystis pneumonia, lying in pools of diarrhea from cryptosporidium diarrhea, or in severe pain unresponsive to narcotics. In these circumstances, when I had no treatment available for condition causing their suffering, I did feel the obligation to help them end their suffering. Given my experiences I am a supporter of Medical Aid in Dying. I would hope that a physician today would be able to aid patients at the end of life, and do so within the constraints of the law. I believe that HB 858 is well written and provides an appropriate framework to allow physicians to provide compassionate care at the end of life. Douglas Ward, MD
I am Dr. Angela Herring, a retired Newport News Family Physician, and an acute leukemia survivor. I have had four months in the hospital with three bone marrow killing chemotherapy treatments and am in remission. I ask that you support passing a law in Virginia (HB858) that would allow me that option and let Virginia join the 10 states and the district of Columbia that already have such a law. Oregon, the first has shown there is no abuse or problems since the 1990s-almost 30 years. As a physician I have had terminal patients in hospice who asked me for enough medication to end their suffering and I could not provide that relief for them. The Medical Society of Virginia changed their stance last year to join with the Virginia Academy of Family Physicians from opposed to “engaged neutrality” which means it is up to the individual doctor and individual patient to decide. Polling results from CNU (Wason Center) for two recent polls show 70% of Virginians support MAID with support across political parties, religions and ages. In the event the leukemia returns I would like the option of Medical Aid in Dying as do not want to go through that pain and suffering again. Please support a bill that would allow me that option. Thank you. Angela Herring, M.D. Newport News, VA
Dear Chair and Members of the House Committee on Health and Human Services - Health: I am writing today to offer my strong support for the passage of HB 858, the Medical Aid in Dying Act, which will be heard on Thursday, February 1, 2024. In July 2022, I was diagnosed with metastatic pancreatic cancer, and my world was turned upside down. My doctors told me that the average pancreatic cancer patient lives 8 to 11 months after diagnosis although many die sooner than that. Only 1% of people with my disease are alive 3 years after the cancer is found, and almost none are cured. As a Virginia resident who had been working for years on legislative outreach for Medical Aid in Dying, I suddenly realized that my own life-threatening diagnosis meant a move to DC was in my future to be able to use their Death with Dignity law. I found it absurd that the choices of Virginia legislators made it impossible for me to continue to live in Virginia where I’ve spent most of my adult life and that, in addition to dealing with a cancer diagnosis, I also had to start dealing with moving. Knowing that Medical Aid in Dying would be available to me once I moved to DC gave me some sense of control over a very uncontrollable illness that has no cure. As I worked to structure my move, finding both a suitable rental and a cooperative doctor, I suddenly realized that months had passed, and I’d surpassed the timeframe when I was told I would die. This complicates my decision-making. I really don’t want to move to DC but feel that I must to avoid months of suffering once treatments stop working or the side effects become intolerable. Since I have no idea when that will happen, it’s become a constant concern that I don’t wait too long and then become stuck in a state that will not honor my wishes. Twenty years ago, I watched my ex-husband die of esophageal cancer. He spent the last several months of his life in bed, worrying that he would choke to death as some esophageal cancer patients do. I don’t want the end of my life to look like his did. Don’t deny this end-of-life option to Virginia residents. It’s legal basically to poison me with chemotherapy drugs that eventually my body will be unable to handle but illegal in this Commonwealth to let me die on my own terms rather than waiting through months of physical and emotional suffering. I should not have to leave Virginia to achieve bodily autonomy and do not see how anyone who has watched a loved one suffer through a lingering death could vote against this legislation. Please think about this as you vote. Sincerely, Barbara Green Falls Church, Virginia
February 1, 2024 Support HB 858 Dear Chair Hope and Members of the House Committee on Health and Human Services- Health: I support HB858 because I want the option of medical aid in dying, if I am diagnosed with a terminal disease. This bill is about compassion and providing terminally ill adults, body autonomy and the right to make the best decision for themselves. Medical aid in dying forces no physician or pharmacist to participate in the practice of aid in dying I want my physicians, health care professionals and pharmacist to know they will not be prosecuted if my terminal disease progresses at the end of my life. Having the option to consider my symptoms, and discuss medical aid in dying with my health care team, allows me to support my personal values of a gentle death and a peaceful passing. Watching a loved one suffer due to unmanageable symptoms in hospice care, is a common experience for families. I do not want the memories of my death to be traumatic for my family. Hospice is wonderful and they help patients as much as the law allows, but, in Virginia they cannot help people who want medical aid in dying. Please consider 70% of Virginians support medical aid in dying across all categories; age, gender, religion, race and political affiliation. Terminally ill adults in treatment, try to stay alive. When treatments no longer work, they are faced with a decision to stop eating and drinking in order to die. Starving to death is a very in- humane option, which is legal in Virginia. I do not want to move to D.C. but I will be forced to leave Virginia, like many other terminally ill adults, in order to have the option of medical aid in dying. Please vote for HB858, so the State of Virginia will allow me to have a peaceful passing. Thank you for your time and consideration on this timely bill. Every day, terminally ill adults pass without the option of medical aid in dying. Perry Patterson Virginia Beach
On behalf of Compassion & Choices Action Network, I'm submitting written testimony in support of HB858: medical aid in dying.
Chair Tran and Members of the House Committee on Health and Human Services; Subcommittee on Social Services: Thank you for the opportunity to offer testimony before you today. I am here to urge you to vote yes on HB Bill 858 . I live in Norfolk and am one of the state organizers for Compassion and Choices. In 2004 I became a caregiver for my sister who died from lung cancer that metastasized to her brain and spine. She treated and looked for remission as long as there was any hope. Once it became clear nothing was going to work for her, she suffered. Every day was another blow to her autonomy, her independence and the dignity of life as she had lived it. Once death is inevitable, modern medicine can keep people alive a long time. If this is their choice, they deserve every intervention possible. But, if someone is at peace with their death, why not give them final control of their lives - to relieve their suffering and be allowed to pass at the time and place that will bring them and their families the greatest comfort. In the work I do, I frequently hear people express that they are at peace with the fact they are dying, but are terrified of what they and their family will have to go through in the final days and weeks or even months before death. They want to die while they are still “themselves”, not being a burden to their families, not using precious dwindling resources and not some diminished shell of themselves. No one will ever be forced to use this option, but it will bring great comfort to many. Some may use it, but for others, just knowing it is available may be enough. For the people of Virginia who want self control over their end of life, please pass House Bill 858, Medical Aid in Dying. Thank You for your consideration.
In July 2022, I was diagnosed with metastatic pancreatic cancer, and my world was turned upside down. My doctors told me that the average pancreatic cancer patient lives 8 to 11 months after diagnosis although many die sooner than that. Only 1% of people with my disease are alive 3 years after the cancer is found, and almost none are cured. As a Virginia resident who had been working for years on legislative outreach for Medical Aid in Dying, I suddenly realized that my own life-threatening diagnosis meant a move to DC was in my future to be able to use their Death with Dignity law. I found it absurd that the choices of Virginia legislators made it impossible for me to continue to live in Virginia where I’ve spent most of my adult life and that, in addition to dealing with a cancer diagnosis, I also had to start dealing with moving. Knowing that Medical Aid in Dying would be available to me once I moved to DC gave me some sense of control over a very uncontrollable illness that has no cure. As I worked to structure my move, finding both a suitable rental and a cooperative doctor, I suddenly realized that months had passed, and I’d surpassed the timeframe when I was told I would die. This complicates my decision-making. I really don’t want to move to DC but feel that I must to avoid months of suffering once treatments stop working or the side effects become intolerable. Since I have no idea when that will happen, it’s become a constant concern that I don’t wait too long and then become stuck in a state that will not honor my wishes. Twenty years ago, I watched my ex-husband die of esophageal cancer. He spent the last several months of his life in bed, worrying that he would choke to death as some esophageal cancer patients do. I don’t want the end of my life to look like his did. Don’t deny this end-of-life option to Virginia residents. It’s legal basically to poison me with chemotherapy drugs that eventually my body will be unable to handle but illegal in this Commonwealth to let me die on my own terms rather than waiting through months of physical and emotional suffering. I should not have to leave Virginia to achieve bodily autonomy and do not see how anyone who has watched a loved one suffer through a lingering death could vote against this legislation. Please think about this as you vote on HB 858. Barbara Green Falls Church, VA
In July 2022, I was diagnosed with metastatic pancreatic cancer, and my world was turned upside down. My doctors told me that the average pancreatic cancer patient lives 8 to 11 months after diagnosis although many die sooner than that. Only 1% of people with my disease are alive 3 years after the cancer is found, and almost none are cured. As a Virginia resident who had been working for years on legislative outreach for Medical Aid in Dying, I suddenly realized that my own life-threatening diagnosis meant a move to DC was in my future to be able to use their Death with Dignity law. I found it absurd that the choices of Virginia legislators made it impossible for me to continue to live in Virginia where I’ve spent most of my adult life and that, in addition to dealing with a cancer diagnosis, I also had to start dealing with moving. Knowing that Medical Aid in Dying would be available to me once I moved to DC gave me some sense of control over a very uncontrollable illness that has no cure. As I worked to structure my move, finding both a suitable rental and a cooperative doctor, I suddenly realized that months had passed, and I’d surpassed the timeframe when I was told I would die. This complicates my decision-making. I really don’t want to move to DC but feel that I must to avoid months of suffering once treatments stop working or the side effects become intolerable. Since I have no idea when that will happen, it’s become a constant concern that I don’t wait too long and then become stuck in a state that will not honor my wishes. Twenty years ago, I watched my ex-husband die of esophageal cancer. He spent the last several months of his life in bed, worrying that he would choke to death as some esophageal cancer patients do. I don’t want the end of my life to look like his did. Don’t deny this end-of-life option to Virginia residents. It’s legal basically to poison me with chemotherapy drugs that eventually my body will be unable to handle but illegal in this Commonwealth to let me die on my own terms rather than waiting through months of physical and emotional suffering. I should not have to leave Virginia to achieve bodily autonomy and do not see how anyone who has watched a loved one suffer through a lingering death could vote against this legislation. Please think about this as you vote.
I am writing in support of SB 280/HB 858 which would legalize Medical Aid in Dying in Virginia. Perhaps the most important and often overlooked aspect of this bill is it is It is 100% voluntary – from the patient initiating the conversation with their doctor to the second or third doctor needed to sign off on a patient’s prognosis and mental stability to the doctor writing the prescription to the pharmacist filling the prescription – no one is required to participate in the process and can remove themselves at any time. This is just an option for those who want it, like my dad. My dad, George Vasiloff, a Marine Corp Veteran and Virginian wanted the option to die peacefully instead of suffocating or choking to death as is often the case with ALS. …and he’s not alone. For two years in a row, a Christopher Newport University Poll has found 7 in 10 (70%) Virginians support Medical Aid in Dying. This spans a majority of every gender, age group, race/ethnicity, region of the Commonwealth, and size community. Three-quarters (77%) of Catholics agree this should be an option in Virginia, as do majorities of protestants (56%) and other Christians (64%). Eight in ten (79%) of Democrats support Medical Aid in Dying as do more than one-half (56%) of Republicans in Virginia. In this tense political climate, it’s refreshing to find an issue on which both parties can agree.
Please support Delegate Hope's HB 858 to allow an adult diagnosed with a terminal condition to request an attending health care provider to prescribe a self-administered controlled substance for the purpose of ending the patient's life. The bill requires that a patient's request for a self-administered controlled substance to end their life must be given orally on two occasions and in writing, signed by the patient and one witness, and that the patient be given an express opportunity to rescind their request at any time. Those whose religious beliefs condemn this practice should NOT be imposing their beliefs on everyone else. My husband's grandmother in a nursing home would beg me to put a pillow over her face and sit on it, something she wouldn't dare ask family members for fear of distressing them. For them she put on a brave face and said things were fine, but everyday for her was full of meaningless suffering and loss of the autonomy she cherished so dearly. She lived to help others, to be useful. All I could do was wring my hands and say that one day a lawmaker will make a bill that will make this possible. She was ready to get off the bus, she'd led a good life, loved and been loved and now had had enough. Thank you, Delegate Hope, for introducing this bill in the Virginia Assembly.
Please support Delegate Hope's HB 858 to allow an adult diagnosed with a terminal condition to request an attending health care provider to prescribe a self-administered controlled substance for the purpose of ending the patient's life. The bill requires that a patient's request for a self-administered controlled substance to end their life must be given orally on two occasions and in writing, signed by the patient and one witness, and that the patient be given an express opportunity to rescind their request at any time. Those whose religious beliefs condemn this practice should be imposing their beliefs on everyone else. My husband's grandmother in a nursing home would beg me to put a pillow over her face and sit on it, something she wouldn't dare ask family members for fear of distressing them. For them she put on a brave face and said things were fine, but everyday for her was full of meaningless suffering and loss of the autonomy she cherished so dearly. She lived to help others, to be useful. All I could do was wring my hands and say that one day a lawmaker will make a bill that will make this possible. She was ready to get off the bus, she'd led a good life, loved and been loved and now had had enough. Thank you, Delegate Hope, for introducing this bill in the Virginia Assembly.
See attached testimony in opposition to HB 858.
Please do not pass this bill. As a wife to my husband of 49 years, his recent diagnosis of Altzheimer's has been difficult, however, loving him for 49 years does not give me the right and is not the compassionate thing to do - end his life. We have three adult children and 9 grandchildren who also love their father and grandfather. They are grateful for every single moment they have with him. We also believe each one of us were created in the image of God and to kill intentionally any person, is an act against the Almighty......God have mercy on your souls should you pass this legislation out of committee.
HB886 - Certified nursing facilities; administrative sanctions, facilities subject to minimum standards.
HB908 - Individuals with developmental disabilities; financial eligibility.
My name is Kathleen Walsh. My family and I live in Alexandria, Virginia. My autistic twins are 15 years old, Freshmen in high school. It is our hope that they will both be able to participate in and contribute to the community with support from the DD waiver. My husband is a federal employee. I was a lawyer. I now have a rare, progressive disease. As such, I currently receive the Social Security Disability Insurance that I earned. My son writes music and plays the piano. He plays chess and loves video games. He is also writing a fantasy book with his sister. They both love Dungeons and Dragons. My daughter is an artist of a different stripe. She draws and thrives while acting. She also takes karate and enjoys exploring the natural world. My son only recently received the DD waiver. We are currently setting up “community coaching“ services through the waiver. Although my son wants to engage and collaborate with people, he has difficulty understanding social cues and how to join in what’s happening around him. Through the waiver, someone will accompany him into the Community to teach him life skillsband how to read social cues and participate in the real world. We believe this waiver service has the power to broaden his horizons and possibilities for the future. This is particularly important to my family, because we are not able to take him out into the community and focus individually on these skills, because of my disease. My daughter does not yet have the DD waiver. She shares her brother’s needs, but to different degrees and may need different services. The great thing about the waiver is that each person uses only the services that they need. Its being individualized helps both the person grow and participate in the community and the state keep its costs down. As they become adults in a few short years, and especially after we pass away, the waiver supports become critical. Services provided through the waiver that would enable them to live and work in the community are not available through any other means. Community living and job coaching, to name but two. I recently learned that in less than three years, when they turn 18, because I already draw SSDI, the small amount of SS retirement that passes to them could take away all of their support, because they will exceed Medicaid’s monthly income eligibility limit. Please support Del. Shin's bill. HB908. It would allow my children to keep services and be productive members of the community. Knowing that the waiver services will be there to support our children, both now and when we are gone, enables my husband and me not to worry about their ability to function in the future, without us. Finally, Del. Shin’s bill will also provide a revenue stream for the state because they will have to pay any excess income in copays to stay on the Waiver. Your supporting this bill will make it possible for my children to be engaged and contributing members of the community rather than isolated from it. Please contact Del. Shin or Lucy Beadnell with questions. Lucy Beadnell (she/her) Director of Advocacy The Arc of Northern Virginia P: 703-208-1119 x116 Lucy.beadnell@thearcofnova.org www.thearcofnova.org Thank you.
The attachment references Congressionally established Medicaid continuation provisions under sections 1634(c) and 1935 (a)(2)(D) of the Social Security Act. Currently disabled Virginians receiving a Medicaid Waiver must count their gross earnings plus any social security insurance income (SSDI or DAC) towards a Medicaid Waiver income cap. This precludes some disabled Virginians from working at all and prevents others from working the same hours and at the same rate of pay as their non-disabled co-workers.
Testimony for HB908
HB909 - 1915(c) Home and Community Based Services Medicaid Waivers; state plan amdmts., prog. modifications.
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Hi I am writing to you on behalf of The Well Connection UK, a media and publishing company. We could easily get virginia.gov featured in various publications such as magazines, online blogs and news sites. This would undoubtedly help virginia.gov with publicity, reputation, domain authority and organic search engine rankings. We have a wide range of options including completely free collaborations, sponsored posts, guest posts and banner ads. If this sounds of interest, please reach out to the senior business development manager, Anita at info@thewellconnection.co.uk and whatsapp +447395206515 (GMT) Kind regards Clifton Junior Outreach Assistant
Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
My name is Donald Benson, and my wife and I recently adopted my almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of many disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. • ‘new guardrails’ that will compel many parents of minors to become employees of agencies and demonstrates a bias in favor of agencies and institutions. This makes a mockery of consumer directed service option. • Modify the 40-hour-per-week work limit to allow legally responsible individuals (LRI) with more than one waiver-receiving child to receive reimbursement for 40 hours of work per week per child receiving a waiver; Soft Cap of 56 and this still penalizes families with multiple waiver children • Eliminate the requirement that, in order for a legally responsible individual to receive reimbursement for personal care services, no one else be available to provide services to the member; No other state agency makes the Parent the last option and to be honest if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. Even though the system does not function correctly without these parents, these guardrails seem to assume the worst of intentions on the part of these same parents. • Allow a legally responsible individual or stepparent to be the employer of record when a member under the age of 18 receives personal care through consumer direction. EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents and forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. • DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. o In recent public communications as well as Emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion” • the guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families and in the eyes of many treat these families as guilty until proven innocent.
My name is Donald Benson, and my wife and I recently adopted our almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of over 1700 disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. Unfortunately, DMAS is making it much more difficult for parents (of minors) to be reimbursed for providing personal care for their child. DMAS is enacting ‘new guardrails’ that will compel parents to become employees of agencies. This makes a mockery of consumer directed service option and demonstrates a bias in favor of agencies and institutions. DMAS has failed to address significant problems with these guardrails such as the finding and enrolling of new consumer directed providers due to shortages and delays in the processing of forms needed to hire attendants. To be honest, if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. It seems strange to me that even though the system does not function correctly without these parents, DMAS would rather assume the worst of intentions on the part of these same parents. I understand that there may be bad actors but to implement a system where parents are treated as guilty of this until proven innocent is absurd. This is not the assumption with the any other state agency. Honestly no parent is making a living off of the under $13.50/hr. that most of the state is reimbursed for this care. Teenagers working in fast food make more than that. DMAS is also making it impossible for parents to be the EOR (Employer of Record). The EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. This role of the EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents. With that being said, expecting families to have a friend or neighbor act as an EOR (instead of a parent or guardian) forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. I DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. However, in recent public communications as well as emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion”. These guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families.
HB995 - Medicine, Board of; temporary licensure of physicians licensed in a foreign country.
As a medical student at Georgetown University, I have been privileged to meet and learn from numerous physicians in the DMV community. What I did not anticipate was that these skilled and talented individuals would have less interactions with patients than I would as a second-year medical student. Our medical community is struggling with shortages and burnout, and the health of our community at large is struggling even more as a result. We need capable physicians in our workforce who can provide for the diverse needs of Virginians. Bill HB995 will allow dozens of physicians to enter our workforce and begin providing for our communities in the ways in which they were trained while simultaneously ensuring that all physicians practicing in the US remain held to the highest standards. It has been an honor and privilege to learn from the incredible refugee physician in our local community through the research-based interviews that myself and other GUSOM students have been conducting. We would be even more fortunate to work alongside these physicians in our future careers. Our state--and nation--do not need more barriers to entering the healthcare workforce than the tedious, expensive, and strenuous prerequisites that already exist. We need physicians now, and HB995 will provide us them, and it will provide so many prepared physicians with the careers they have earned.
My name is Kenn Speicher, and I serve on the executive team of the Board of Church & society for the Virginia Annual Conference of the United Methodist Church. We strongly support passage of HB995. Welcoming and assisting refugees and other newcomers is a central tenant of our faith. Not only will HB995 create a temporary licensing pathway for qualified refugee physicians to practice medicine in Virginia, it will improve access to health care for underserved communities in the Commonwealth. Virginia will also gain a source of physicians that will help meet projected doctor shortages. Currently, it is impossible for many of these doctors to pursue the complex licensing process and requirements, especially if they are recent arrivals still struggling to get by and support their families. HB995 ensures that Virginia's high medical standards are met, while enabling qualified candidates to return to practicing medicine in a supervised setting as they complete the licensing process. As United Methodists, we see this as a very practical way to welcome the stranger and improve Virginia's capacity to bring health and healing to all.
I live in Williamsburg, and work with Hampton Roads Refugee Relief. I also had a kidney transplant in 2022 at Georgetown Medstar Hospital. I know firsthand about the medical doctor shortage we have in Virginia, which negatively impacts Virginian residents not in major metropolitan areas. We have to travel for good medical care. Allowing these refugees to practice in VA not only helps newcomers, it is vital for your constituents as well.
I am Tahera Ahmadi, a general physician who arrived in the United states from Afghanistan during a crisis and after the country entirely collapsed by the Taliban in late 2021, after the United States Army withdrew. I am a member of the Refugee Physicians Advocacy Coalition, and I strongly support HB995 because it allows doctors like me to return to medical practice under the supervision of a competent Virginia medical facility. This opportunity allows me to enter the profession, demonstrate my talents, learn best practices, and build a strong network while still earning money for my own medical future. Working as a non-medical employee will have a significant negative impact on my future medical career and educational achievements. I face numerous obstacles in my quest to enter the American medical field. As an older graduate, passing the USMLE exams and brushing up on my knowledge will require more time than it would for a recent graduate. I can't work at this time and won't be able to earn money. I need to make enough money to support myself as a refugee who recently arrived in the United States. Furthermore, there are high fees associated with exams, residency match applications, and observer/internship programs. For older grads, there are additional graduation year restrictions. Recent grads are preferred for most residency programs. Work experience doesn't seem to be a big deal to them.The chance to network and show off medical expertise is the other reality. Even very basic chores are beyond the acceptance of volunteers like me in most institutions. They have ties to universities and would rather hire such students for volunteer or internship positions. As a physician, I ought to have a resource I can turn to when I need to have U.S required training and medical field exposure, as it's a prerequisite for residency programs. Exposures include working as a research assistant, physician assistant, or medical assistant. Regretfully, in order to establish some kind of network in a clinical context, a lot of doctors are forced to accept the position of medical technician. Even someone with a high school diploma can complete this task. If an organization could help IMGs with their training and placement in the workforce, it would be a fantastic concept.
We support
Please support HB995 Temporary Licensure Track for Foreign Licensed Physicians
Dear Delegates of the Virginia Health and Human Services Committee, I hope this message finds you well. My name is Ahmad Khalid Stanikzai, a medical doctor, who recently arrived in the U.S. from Afghanistan. As a Virginia resident, I am reaching out to express my strong support for HB995. I am proud to be a part of the Refugee Physicians Advocacy Coalition, and I believe that HB995 is a crucial piece of legislation. This bill creates a pathway for doctors like me to return to medical practice under the supervision of an appropriate Virginia medical facility. This is a significant step toward harnessing the skills and expertise of physicians who have arrived in the U.S. seeking refuge. I would like to shed light on the formidable barriers that doctors like myself encounter when attempting to reenter medical practice. These barriers, ranging from complex licensing procedures to a lack of recognition for our qualifications, significantly hinder our ability to contribute to the U.S. healthcare system. Despite our extensive experience and qualifications earned in our home countries, the current system poses challenges that often make our integration into the workforce a daunting task. I am eager to serve the community and believe that HB995 will pave the way for us to overcome these obstacles effectively, ensuring that our skills and expertise are utilized for the betterment of the healthcare system and the communities we aim to serve. I hold an MD degree and bring 9 years of valuable experience from my home country. However, the current system poses challenges that impede our seamless integration into the U.S. healthcare workforce. HB995 provides a solution to these challenges, and I am hopeful that it will receive your strong support. In conclusion, I sincerely thank you for considering this matter. I kindly ask for your support for HB995, as it not only benefits individuals like myself but also contributes to the broader healthcare landscape. Thank you for your time and consideration. Sincerely, Dr. Ahmad Khalid Stanikzai
Upwardly Global supports HB995, which would expand pathways for eligible international medical graduates (IMGs) to practice medicine in Virginia. Though newcomers to the U.S. in recent times are more educated than at any other time in history — with roughly 45% of recently arrived immigrants possessing at least a bachelor’s degree — over two million college-educated immigrants and refugees are unemployed or underemployed because of the many cultural and structural barriers in the way of restarting their careers. The Migration Policy Institute estimates that there are 165,000 unemployed or underemployed immigrants in the U.S. with international healthcare degrees. Accessing and leveraging this talent pool would move the needle towards addressing the shortage of 122,000 physicians the U.S. is anticipated to face by 2032. For over two decades, Upwardly Global has been at the forefront of advocating for policies and practices that champion workforce inclusion for internationally trained healthcare professionals. Specializing in supporting international medical graduate professionals, our programs cater to both job seekers looking to relicense and those pursuing alternative pathways such as clinical research. To date, Upwardly Global has assisted nearly 900 healthcare job seekers across the U.S. in securing full-time placements, including 120 who successfully matched for residency positions. Over 40% of the healthcare professionals we are currently supporting nationally through our industry-aligned individual job coaching program were physicians in their home countries. If enacted, HB995 will not only help address Virginia's healthcare labor shortage, but also provide internationally trained immigrant and refugee medical professionals equitable career opportunities.
Dear Delegates of the Health and Human Services Committee, I am a doctor originally licensed in the country of Iraq and a Virginia resident (or DMV resident). As a member of the Refugee Physicians Advocacy Coalition, I strongly support HB995 because this legislation creates a pathway for doctors like me to return to medical practice under the supervision of an appropriate Virginia medical facility. Since I arrived in the US, I have experienced many significant barriers to returning to medical practice in Virginia and I am eager to use my skills to serve the community. I ask that you consider supporting HB995 as I believe it helps IMGs overcome the challenge of matching for residency while ensuring quality training and quality patient care. Further, it helps to address the shortage of doctors in underserved communities. I hope I can count on your support and consideration. Sincerely, Noor Al Azzawi MD 45811 Marlane Terrace, Sterling, VA 20166
Dear Delegates of the Virginia House Health and Human Services Subcommittee on Health Professions. Thank you for giving me the chance to join your committee meeting. It is an honor for me to speak in support of House Bill 995. I am Dr. Aziz Jami. I have over 20 years of clinical experience as a general surgery specialist and am a long-time professor at Herat Medical University. I successfully completed a fellowship in laparoscopic surgery from Germany and brought the specialized skills I learned back to teaching in Herat Province and Afghanistan. I was evacuated from Afghanistan in August 2021 and have sought to establish a new life in Virginia alongside my wife who specializes in obstetrics and gynecology. Since 2021, we both have applied to countless clinics and health service providers. We have applied through job fairs and networks of friends and medical professionals. . It has been so disheartening to be unable to use our education and expertise especially knowing that healthcare shortages exist in Virginia and among other recent Afghan arrivals. Although we have medical skills, language and culture, we are unable but eager to be of help in our new home communities. To subsist and be able to pay our bills and support my family, I took a non-medical position with Lutheran Immigration and Refugee Services. But my dream remains to get my medical license in my new home and serve our community. Unfortunately, during the last two years I heard from hundreds of overseas doctors who passed the USMLE and were applying for residency but not matching for 2-3 consecutive years. The residency barrier is especially discouraging and dissuades me and many other overseas medical graduates from even pursuing the USMLE which needs a significant investment of time and funds. But I am not ready to give up and I am eager to be a doctor again, helping people in my new home of Virginia. I will continue in my personal and team efforts to advocate for the next generation. I joined the Refugee Physicians Advocacy coalition and strongly support HB995 because this legislation can create a pathway for overseas doctors to return to medical practice where no path currently exists. I dream of the day when this bill becomes law, and this opportunity becomes a reality for doctors like my wife and me and so many others. I really appreciate your consideration and count on your support for HB995.
Please support HB995, which makes it easier for foreign licensed doctors to return to practicing medicine and will help fill workforce gaps in healthcare in rural and underserved communities across Virginia. The re-licensing process for refugees who were licensed doctors in their countries of origin is long and complicated. Many are working to make ends meet and have no time to complete the process, which means Virginia is missing out on a qualified pool of experienced medical talent. HB995: 1) offers qualified refugee physicians a temporary licensure pathway to return to medical practice under the supervision of an appropriate Virginia medical facility, 2) helps meet the doctor shortage in Virginia, and 3) fills workforce gaps for medically underserved populations and locations (e.g., rural hospitals). As a co-founder of NOVA Friends of Refugees, this is a personal issue for me. I have met and assisted several of the doctors and understand the challenges that have kept them away from their medical callings. As part of our work to welcome and assist newcomers, we helped found the Refugee Physician Advocacy Coalition (RCA) to assist refugee physicians seeking licensure and to advocate for needed legislation.. HB995 has earned support across the Virginia health sector, including endorsements from the Virginia Hospital & Healthcare Association, Virginia Medical Society, Virginia Association of Free Clinics, and Virginia Community Healthcare Association. I have attached RCA’s letter of support, which offers additional information and includes the names of more than 20 refugee resettlement, community services, faith and non-profit partners across the Commonwealth that have endorsed the legislation. These physicians are a valuable medical resource for Virginia. Passage of HB995 will help them restart their careers while continuing the high quality care available in the Commonwealth.
The below is our mid course reflection as Georgetown University Medical Students who are doing our Community Based Learning experience with NOVA Friends of Refugees through which we have been interviewing DMV refugee physicians. "As we get to the midway point of our time with NOVA Friends of Refugees, some of us have had experiences interviewing our physicians, while the world is undergoing some drastic changes in the Middle East. As many of our physicians were refugees from war-torn regions, it is vital to recognize the impact these current events can have on their mental, physical, and spiritual health. Throughout our student-held interviews, we see just how much these circumstances affect their lives and how they bear these problems all while focusing on becoming a physician in America. Many of us are shocked and surprised to hear about their lives both before becoming refugees and what it is like for them currently. It is through these moments in our interviews that we gain a deeper understanding of who refugee physicians are as people and how to be their advocates in such difficult times for them. Indeed, these interviews with refugee physicians have peeled back the veil on the determination these strong men and women possess. Their harrowing tales of adaptation reveal a fortitude that goes beyond the medical training they are pursuing. Also, as students, we are not merely chroniclers of these narratives. We are their future colleagues. Some went through difficult journeys at home, having to leave their families to train in foreign countries due to discrimination faced in their home country. They trained and worked tirelessly to serve those in their home country and want to continue serving others whilst continuing to care for their family and friends in unsafe conditions. It instills in us a profound respect for their journey, and reaffirms our commitment to advocate for their inclusion in our nation's medical community. Additionally, through these conversations, we are also reminded of the countless privileges that we, as Georgetown medical students possess. Simply attending an American, MD granting school, is an opportunity that millions of people, the world over, would give a great deal for. In our interviews, we have heard of the countless barriers and challenges that refugee physicians must face to obtain an American medical license, all while trying to survive and thrive in a foreign country. Frankly put, the current system is terribly broken, and if current American physicians do not speak up for our equally qualified and capable colleagues, we will continue to squander the great potential of these individuals. While some of us have not personally interviewed a physician yet, we have been struck by the stories told to us during our interview training and initial sessions with NOVA Friends of Refugees. Each of us in this group knows the amount of work that goes into becoming a physician, and to essentially have to start over in another country seems impossible. As we approach the final remaining sessions with NOVA Friends of Refugees, we wish to leave a lasting message to the refugee physicians: that we will continue to advocate for them, even beyond the scope of the CBL course. Through our actions, we hope to set an example to future stakeholders to work closely with these refugee physicians and bring them one step closer to realizing their aspirations ."
Please join me and Refugee Physicians Advocacy Coalition in supporting Delegate Tran's HB995, that makes it easier for foreign licensed doctors to return to practicing medicine in Virginia while filling workforce gaps in medically underserved communities. As you may know, the re-licensing process for refugees who were licensed doctors in their countries of origin is long and complicated. Many are working to make ends meet and have no time to complete the process, which means Virginia is missing out on a qualified pool of experienced and diverse medical talent. HB995 provides a solution that: -Offers qualified refugee physicians a pathway to return to medical practice under the supervision of an appropriate Virginia medical facility -Helps meet the doctor shortage in Virginia -Fills workforce gaps for medically underserved populations and locations (e.g., rural hospitals) I am a physician in the DMV area who has been involved in both mentoring and interviewing more than 20 refugee physicians in the area. They are brilliant, passionate, and skilled physicians who have face so many barriers when trying to re-enter the medical field here. I would be honored to work alongside these incredible physicians in providing care to our communities. I believe this bill will make a huge difference in improving the health of our diverse communities. For all these reasons and more, I hope you'll join us in supporting HB995.
World Education Services (WES) supports HB 995, which would expand pathways for eligible internationally trained physicians to practice medicine in Virginia. World Education Services (WES) is a non-profit social enterprise that supports the educational, economic, and social inclusion of immigrants, refugees, and international students. For 50 years, WES has set the standard for international academic credential evaluation, supporting millions of people as they seek to achieve their academic and professional goals. Through decades of experience as a leader in global education, WES has developed a wide range of tools to pursue social impact at scale. From evaluating academic credentials to shaping policy, designing programs, and providing philanthropic funding, we partner with a diverse set of organizations, leaders, and networks to uplift individuals and drive systems change. Together with its partners, WES enables people to learn, work, and thrive in new places. The Migration Policy Institute (MPI) estimates that, as of 2020, 165,000 immigrant and refugee health care workers who hold health-related degrees from another country were unemployed or underemployed in the U.S. Among them 4,000 lived in Virginia. According to the American Immigration Council, Virginia is expected to have a shortage of 1,622 primary care physicians by 2030 to address the health care needs of its residents. Data collected by the Health Resources and Services Administration indicates that more than 2.6 million people are affected by access to care in Virginia’s 160 federally designated primary care Health Professional Shortage Areas (HPSAs). In addition, job postings for bilingual health care workers in the state increased by nearly 39 percent between 2017 and 2021. Immigrants and refugees with a background in health care are well-positioned to help address employment gaps, offering in-demand skills and multilingual abilities. Their perspective and knowledge of different cultures is also an asset: Studies have found that patient outcomes improve when health care teams are more diverse. HB 995 will help address Virginia’s physician shortage, ensure a more diverse health workforce, and promote access to quality care for all Virginians by making licensing pathways more accessible for internationally trained physicians in the state.
My name is Victoria Francis, and I am the Deputy Director of State and Local Initiatives at the American Immigration Council (the Council), an organization that works to advance positive public attitudes toward immigrants and create a more welcoming America—one that provides a fair process for immigrants and adopts immigration laws and policies that take into account the needs of the U.S. economy. I am submitting this letter to express the Council’s support for removing barriers that keep qualified Virginians from contributing to the state’s healthcare workforce. To this end, I respectfully encourage the passage of HB 995, which would expand pathways to practice for international medical graduates (IMGs) seeking to enter the state’s workforce and reduce barriers to career advancement for Virginians
My name is Susannah Lepley, and I join you today as Director of Church World Service (CWS) Virginia. CWS is a 78-year old humanitarian organization representing 37 congregations. In my testimony today, I would like to express our strong support for HB 995, “Temporary Licensure of Foreign Licensed Physicians,” a bill championed by Delegate Kathy Tran that creates a pathway for qualified doctors licensed overseas to fill workforce gaps in medically underserved communities. Virginia is facing a healthcare workforce crisis. A RAND report commissioned by the Virginia Health Workforce Development Authority notes that “Virginia, like the U.S. as a whole, faces a significant shortage of healthcare workers,” especially in primary care and behavioral health, with shortfalls projected to increase as the population ages. Many refugees remain unable to fully contribute their talents to the workforce because of systemic barriers, including the lack of recognition of their international education and experience, and outdated occupational and professional re-credentialing processes. Because of this, we are leaving needed talent on the table. In 2021, more than a quarter of immigrants with professional and doctorate degrees worked in occupations in the healthcare industry that did not require a medical doctorate or professional degree. Addressing the barriers that prevent additional qualified, internationally-trained medical graduates from practicing in Virginia will be vital to helping the state meet its growing healthcare needs. HB 995 will help Amiry who is working as a medical assistant at a University Health Center. He is a pediatrician who practiced for 5 years in Jordan. Medical professionals like Amiry are a ready and untapped workforce from Afghanistan, Ukraine, Congo, Cameroon, and other countries with medical and language skills and cultural sensitivities needed to serve communities throughout the Commonwealth. This legislation would ensure that the pursuit of licensure by foreign-trained doctors is more equitable and streamlined. The need in Virginia is clear. Rural communities, immigrant communities, and communities of color are served by an aging medical workforce that lacks the diversity to best serve their populations. According to pre-COVID estimates, 270,000 under-utilized foreign trained health workers are ready and available to serve. Accessing this workforce would go a long way toward addressing the shortage of 122,000 physicians the U.S. is expected to face by 2032. The cost of this untapped talent can amount to millions of dollars in underutilized taxes and spending power. Virginia’s lawmakers should open pathways so that immigrants and refugees can reach their career goals and strengthen our communities, especially in high-demand fields like healthcare. As Virginia seeks to address healthcare shortages, policymakers can reduce barriers to licensing by passing HB 995. HB 995 is the legislation that will allow these talented professionals to provide high quality support to patients, especially in underserved communities, and improve access to needed medical care. We call for the Virginia legislature to support and pass HB 995.
I am writing this letter as an international medical graduated (IMG) physician, to request from delegates for supporting HB995
My name is Brandi Kilmer. I’m a Loudoun voter and co-founder of the Refugee Physicians’ Advocacy Coalition (RPA). RPA grew out of a partnership between my organization, Their Story is Our Story, the Georgetown University School of Medicine, and Nova Friends of Refugees. In our effort to help refugee physicians re-enter healthcare, we are joined by over twenty Virginia refugee resettlement organizations, nonprofits and faith based institutes spanning from Hampton Roads to the Shenandoah Valley, Northern Virginia and beyond. National experts in our coalition from the World Education Services and the American Immigration Council have provided Virginia specific analysis and have helped pass successful efforts in states ranging from Washington and Idaho to Tennessee and Massachusetts. One of my key roles with RPA this year is interviewing the refugee doctors in Virginia who bring great skills, years of clinical experience, and an eagerness to return to medical practice. To date, I’ve met with and interviewed 50 refugee physicians, with expertise in fields like: surgery, gynecology, Emergency Medicine, mental health, addiction recovery, and general medicine. Two of these outstanding doctors are testifying today. They are fortunate to have medical-adjacent work. But the vast majority of these refugee doctors from Afghanistan, Africa, Ukraine and other parts of the world are working low-wage jobs as medical assistants, pharmacy techs, or uber drivers. Some have left medicine entirely because becoming a doctor feels unattainable and the financial demands of the residency pathway are too high. Delegate Tran’s HB995 offers hope to these doctors, several of whom are listening to today’s deliberations or offering their testimony. More than hope, we believe HB995 would remove a significant barrier for International Medical Graduates “IMGs” to return to medicine and help fill coverage gaps in underserved communities in rural areas and among harder to reach immigrant communities, where their language and cultural knowledge would be invaluable. HB995 does that while maintaining careful supervision and high quality standards. We hope you will pass HB995 and we stand ready to help Virginia put these talented individuals back to work in the hospitals and health clinics where they are most needed.
The Refugee Physicians Advocacy (RPA) Coalition Supports HB995 “Temporary Licensure of Foreign Licensed Physicians.” (Del. Tran) Status: Assigned to Virginia House Health & Human Services Subcommittee: Health Professions on Jan 19 Committee Meets Thursday mornings. House Bill995 creates a pathway for qualified doctors licensed overseas to fill workforce. gaps in medically underserved communities. These gaps existed before and were exacerbated. by the COVID pandemic. Foreign trained doctors, also known as International Medical Graduates (IMGs) are a ready and untapped workforce with medical and language skills and cultural sensitivities needed to serve communities throughout the Commonwealth. There is no doubt that Virginia is facing a healthcare workforce crisis. A RAND report commissioned by the Virginia Health Workforce Development Authority notes that “Virginia, like the U.S. as a whole, faces a significant shortage of healthcare workers,1” especially in primary care and behavioral health, with shortfalls projected to increase as the population ages. In addition to shortages, there is a mismatch of talent. Rural communities, immigrant communities, and communities of color are served by an aging medical workforce that lacks the diversity to best serve their populations. According to pre-COVID estimates, 270,000 under-utilized foreign trained health workers are ready and available to serve. Accessing this workforce would go a long way toward addressing the shortage of 122,000 physicians the U.S. is expected to face by 2032.2 Virginia must compete with states that already have programs to attract IMGs. The National Conference of State Legislatures (NCSL) recognizes workforce development shortages, including in healthcare, as among the top priorities of state legislatures in both 2023 and 2024.3 Colorado, Idaho, Illinois, Washington and neighboring Tennessee have all passed legislation to license IMGs At least 10 other states are considering such legislation this year. In its first month, the Washington state program had 40 IMGs submit applications for their program.4 I support this Bill. Respectfully yours, Williiam W. Shugarts III 10522 Wildbrooke Ct. Spotsylvania, VA 22551 wshugarts@verizon.net 703-690-7760
The Refugee Physicians Advocacy (RPA) Coalition is joined by 25 Virginia resettlement agencies, nonprofits and faith organizations, and national experts in supporting HB995. This legislation streamlines professional re-entry for foreign qualifying physicians while maintaining rigorous assessment and evaluation of qualifying candidates and offering a solution to the challenge of healthcare shortages in underserved communities. RPA has interviewed over 50 high talent refugee physicians across a breadth of specialities and with years of clinical experience. Most of these individuals would otherwise be unable to secure licensure in Virginia, though other states have moved to offer such a pathway with more considering legislation this year. Let's put this talent pool to work in the Commonwealth by passing HB995!
HB1021 - Community services boards, local; waiver usage flexibility.
HB1052 - Local government; alternative and conventional onsite sewage systems.
HB1168 - Children's Ombudsman, Office of the; powers.
I am a grandma in preston county wva, CPS /GAL/Court system are inhumane and cruel. Can you imagine a child instantly alienated from a mother,father,or grandparents, Entire family, you cannot imagine till it happens to you based on the unethical practices of these entities.they should NEVER say,,,, in the childs best interest, we need help.
I am a grandma in preston county wva, CPS /GAL/Court system are inhumane and cruel. Can you imagine a child instantly alienated from a mother,father,or grandparents, Entire family, you cannot imagine till it happens to you based on the unethical practices of these entities.they should NEVER say,,,, in the childs best interest, we need help.
Please say yes to passing this bill. My family is victims. We have also involved the ombudsman center for children to help my family.
As a Father that has had to fight the CPS/DSS system and win pro-se. Virginia has a systemic problem within CPS. I was not informed my children had been taken by by CPS from their mother. I was a working Paramedic in Grayson County when CPS took my children. Me being a well respected Paramedic in the community had to take on the whole system of Judges, Attorneys, and DSS workers. it wasn't until I learned the law, and represented myself pro-se, i was finally able to beat the system . but not before the damage to my daughters had already been done by "court ordered blue haired counselors". CPS in Virginia is harming kids for profit. I can prove it to anyone that wants to listen.
I truly believe this bill being passed would shed some light on the darkness that's taking place. It's needed tremendously. My Honest opinion, there needs to be even more added to this bill, the more accountability and oversite of an agency the better. It's time for the state agencies and the judicial system actually do what's right for these babies and at all cost have safeguards and committees like this in place to stop the corruption and horrible monstrosities, that have been taken place. The real pandemic in America isn't covid 19, it's legal child trafficking done by our court systems cloaked as for the best interest of the child. When all its doing it ruining those babies lives. The goal has been and should always be reunification, anymore it seems the corruption has turned it into a money racket. I support this bill in hopes that we the people realize what's wrong within our judical systems and write these wrongs before it's to late.
Please Pass HB1168 it will help so many families in the Commonwealth
I absolutely support this bill.i have spoken to ombudsman many times,and there is not much they can do to help you.but that would change with this bill
please pass along
The Ombudsman needs more authority. Social Services, jdr judges g .a.l., and those court appointed lawyers need to understand 9 times out of 10 they are causing more harm to the child and the families when removing a child from loving Parents . And ultimately is a form of domestic abuse . Their is no ch ecks and balances . It mentions funds for f oater parents but what about the parent rights and child's right t that was violated from the beginning they do have rights to be left alone .
Please pass this.
Yes I agree passing HB1168
Please say yes to signing this bill!! My husband and I have fallen victims to the corruption of CPS as well.
Yes I agree passing HB1168
Vote no on bill 1168. Keep kids informing private.
Please pass this
My grandson was illegally adopted out based on fraudulently things that were not true. Also the opposition attorney was my daughter sis in law by marriage. My daughter got railroaded from the beginning. No investigation was done . The system failed her and her son . Social services job was not done properly!
Approve it!
My son was illegally adopted out based on fraud. My sister in law was the attorney for the opposite party . No investigation was done . No lie detector was given. Fraud and lies . They accused me of something i did not do. The grandmother had custody got pinned on me . I want my son and love my son . My case needs to be reopened
Needs to be passed
Needs to be passed
Yes please pass the bill because cps should be held Accountable for their False actions and everyone There is a second chance as a mother or father
Hello. I just met Mary Love that has made federal complaints against the exact same providers I have here in Fairfax county va. My name is Catherine Litchfield and I have one child in fostercare with Bethany reeves. I also have five children under protective custody with pps Elizabeth Allstat. These providers knowingly and willing sent me to Dr. Corbet that was under active investigation for fraud diagnosing patients. Dr Corbett is still practicing! I was referred for a second psyche eval. They know something going on, but also may very well be part of it. Many of my families right have been violated. I advocate for change and a system that operates with integrity. Fostercare is holding me back from my child u til setvices are complete with the remaining five children. Pps says they can’t force kids to do services. If you don’t know me my children summer Burrus and Connor burruss had an amber alert issued on Jan 28,2024. The system say I’m abusive but is not accountable for who they place your children with. There are physical and sexual abuse allegations with my sons foster parents. The commonwealth wants to criminally charge my 13 year old daughter for taking her four year old brother away from the sexual abuse that my son connor spoke of. The supervisor was actively texting supervision lies o me at this particular visit and ignoring connors truth. That’s when my daughter took him and ran. But for my daughter and connor to get away shows you that the supervisor at the visit is was negligient performing her duties that day and was more concerned with how to keep us entangled into the system to keep profiting of the funding that is provided for my large family. This isn’t about reunification or the family or natural parents abusing their kids. Families are being tortured and tormented for the agenda of a broken system and monetary gain! The hypocrisy!
It matters a lot.
vote yes in support of this bill
Yes! Please help keep families together and stop children from being traumatized by unnecessary separation from their parents.
Yes change it
Please pass this bill thank you
YES We the People have a Right to be heard! For it is our Right
This is something that needs to be pass to help out previous and future parents against DSS and child services to help battle corruption among the government
Yes please... pass this
I agree with this petition it is unlawful to hold people accountable for there past
I serport the hb11168 act.
This bill is long overdue. Please pass it.
I support HB1168 giving the OCO better oversight to our local departments. This is something that I find to be very important.
I am submitting this on behalf of Ms Brittany Whitworth of budsman cordoza in order to change the bill for kids returning home
I am writing to support HB1168. I am the father of children who were the point of an investigation by the OCO, and without our family even having all of the evidence the Ombudsman's office found policies that were not followed that resulted in the breaking of our constitutional rights. Even having this report and other various reports from the Commonwealth of Virginia our children are still not home. It has now been 2 years and nothing has been done, and even worse the criminal acts committed by the city and state actors involving this case have gone unpunished. The passing of HB1168 can help ensure that true justice for families is being sought in the State of Virginia and show that qualified immunity does not mean that you can break state and federal policies and in a lot of cases state and federal laws to destroy families across the Commonwealth. We absolutely need a system that protects children in the most vulnerable state, but we also need accountability for those who have taken the oath to protect these children. Ripping families apart is not in the best interest of children. In our case during the illegal kidnapping by state actors of our children, you can hear on police-worn body cameras how well loved and taken care of our children were as they were being taken from our home. Is not these systems here in place for children who are actually abused and neglected and not the ones who are so well loved? It seems highly unlikely that children who are being discussed as so well loved and cared for are at such imminent risk of danger that removal would occur. Still, when this is found to be the case, there is nowhere to turn for help. The OCO does a good job of pointing out what is not being followed, but the departments realize he does not have the authority to make them or anyone else fix the problems found. This bill would help reinstate that there are policies, laws, and federal guidelines in place for a reason and that to protect the integrity of not only families but the Commonwealth of Virginia they must be followed. There must be a way to restore justice to families like mine and the hundreds if not thousands of others who are also facing these injustices in our state. It was discovered when the news aired parts of our story locally that the department has an outdated reported system, and that there has never been a system to track Kinship Care or Alternative Living Arrangements, or as we parents who have experienced call it, shadow foster care or blackmail arrangements. The parents of the Commonwealth need a path to justice and to restore their sacred family bonds that have been broken with no regard for people. Pass HB1168 and help show that Virginia will not tolerate unintentionally or intentionally destroying families by using the process of lawless and policyless tactics. We have spent over 2 years without our children, even after proving we have not neglected or abused our children. 2 years and no help, 2 years and no end in sight, 2 years and we have no idea when or if ever we will get to see them again. A quick "custody exchange" at the hands of CPS to the malicious caller has cost us moments in time with our children we will never get back. Our Son is now 10. Our daughter was 21 months old and will be 4 years old next month. She spent 21 months with us every day of her life, to nothing. Because we were given no rights to our children Please say yes to HB1168
This house bill needs to be passed and made effective immediately. The corruption within the child welfare system being brought to light but nothing being done to correct it just continues to allow the wrong doers to be as such. Accountability without penalty nor correction in this affair will only make the government and the people a laughing stock even further to those departments. As it is now the government is seen as leaders of the human trafficking ring by not correcting the kidnappers labeled cps/dss. Is there no one courageous enough to be the shining light our kids need? Or are the decision makers just pawns in a sick game?
We need this passed on behalf of all families in virginia. Not one parent dealing with Cps and foster care get ANY DUE PROCESS. The last time I read the constitution of the United States it CLEARLY says this is a fundamental Right. So if this bill passes we will now have a way to hold people accountable for their actions and as they want parents to be accountable if we ACTIONALLY GET SOME accountable and DUE PROCESS UNDER THE LAW OF THE LAND then the change we all need just might happen.
This bill needs to be on a fast track for implementation as there is a severe oversight crisis that exists in the Child Welfare System of our State. Workforce in this state are extremely deficient with understanding of federal laws and guidelines, best practices, trauma informed practices, and unconscious bias/cultural competency. Currently there is a training academy for social workers that is being created but to see the benefit of this investment will take quite a bit of time. It is very difficult to maintain our workforce and recruit new talent for our severe workforce issues if we don’t make it a point to have accountability and oversight. No one with a license will choose to work in Virginia. It must be understood that due to our State not having Child welfare data systems that were in compliance with federal guidelines since 1996, there were bad actors that took advantage and actually purposely put families through these systems for a pecuniary benefit. Whole entire cases were offline to federal monitoring and children & families were taken advantage of, ultimately being exploited through our systems. Countless other situations of child abuse occurring as a result of internal factors such as abuse at the hands of government employees including law enforcement, vendors and foster parents were also offline to federal monitoring. I was in a meeting last year where Eric Reynolds, the Children’s Ombudsman testified to the State Board of Social Services that children were being put into the foster care system as a means to qualify fraudulently for mental health services. The parent was merely trying to get services for their child and was never told they did not have to put their child in foster care as the locality withheld that information from the parent. The parents involved in this situation are left fighting the locality in court proceedings to get their child out of the system. This can go on for years with no end in sight. There must also be a means to have a check and balance to the information obtained from the Ombudsman office. Maybe adding to this bill language that for accountability purposes these investigations (or when the Ombudsman chooses not to investigate) and subsequent findings are also reported to the general assembly. In my family’s case the Ombudsman’s Office chose not to investigate and I had to seek out justice though the federal government. I had no option to override his decision as the perpetrators were County employees and vendors.
It is of the utmost importance that HB1168 passes and grants these authorities to the Office of the Children's Ombudsman(OCO). Currently, the Ombudsman only has the power to look into the law-breaking and policy violations that are occurring at an extreme rate, resulting in massive violations of families' civil and constitutional rights. In Dec of 2021, The Hampton Department of Social Services(HDSS) Illegally removed our children. I was lucky to be one of the families the OCO accepted a complaint from in Jan of 2022. By July of 2022, I had a report, showing that the HDSS did not try to prevent the removal of our children, did not offer our family any services or path to have our children returned to us and never even opened a case correctly as they were supposed to. After this time and fighting over a year to get the Police Worn Cameras that proved the truth we eventually overturned the HDSS findings in a state-level hearing. The OCO proved that the department did not follow local or federal policy, which ultimately showed the violations of our Civil/Constitutional rights, the State agreed that we never neglected our children, yet our children are still not home. We are told they do not have the authority or jurisdiction to make a difference in bringing our children home. There is no accountability to this system, and the oversight currently has no authority to fix the issues they find. Leaving no relief for families who have proven that what was reported or done by these state actors was false. Passing HB1168 would help this situation and help protect not only the families from unfair practices and overreach and protect the Commonwealth from eventual further sought relief from violations of protected civil rights/liberties. My Children have been gone 773 days as I write this. When anyone sees the findings of the OCO, or the appeal results from State Level DSS, the question I am always asked is "Then why are the children not home." The passing of this bill would help solve this issue and restore families like mine throughout the commonwealth. In these 773 days I have only been "allowed" to physically see, hold, and hug my children I had never been away from twice. We have created an office of pretend oversight. And that is not speaking negatively to the OCO. I fully support his work and the level of speaking out I have seen from this office about the issues being found. Virginia needs to give this office the power they deserve to benefit the Commonwealth as a whole. HB1168 does that. My family has proved repeatedly throughout the state the unjust actions that occurred, yet have found no help, relief, or way to make our family whole again. Child removal warranted or not is a traumatic experience, I truly feel the passing of this bill, while not preventing the trauma, will help begin the healing processes for families all across Virginia that need relief at the hands of a system with no actual checks and balances. I truly hope you will see the dire need for HB1168 to pass. Thank you. I have submitted a copy of the Ombudsman report. I would have loved to submit the State Findings from the Office Of Fair Hearings but the file is too large. Thank you again for your time and please say yes to HB1168
I would like to support this bill because it would allow the office of the ombudsman to reverse wrongful decisions made by social services and return wrongfully removed children to their families. It would also help with release of the reports to the courts if the courts have been involved and wrongdoing was found to be committed. Also allowing him to petition for the courts to relook at already closed cases, it would greatly help the families who have been affected in the commonwealth and to work towards helping keep families together.
HB1185 - Prescription Monitoring Program; overdose information.
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Hi I am writing to you on behalf of The Well Connection UK, a media and publishing company. We could easily get virginia.gov featured in various publications such as magazines, online blogs and news sites. This would undoubtedly help virginia.gov with publicity, reputation, domain authority and organic search engine rankings. We have a wide range of options including completely free collaborations, sponsored posts, guest posts and banner ads. If this sounds of interest, please reach out to the senior business development manager, Anita at info@thewellconnection.co.uk and whatsapp +447395206515 (GMT) Kind regards Clifton Junior Outreach Assistant
Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
HB1239 - Unaccompanied homeless youth; consent to surgical or medical care.
HB1278 - Auricular acupuncture; use of the five needle protocol.
I have had the five needle protocol done to me several times in order to help battle stress and anxiety. Every time, I have walked away with a feeling of well-being and calm that has lasted for a few days. Many times this has been the impetus to look at my problems with a more calm and clear perspective.
Good Morning, I am currently working on my doctorate PhD in Naturopathic, Drugless Medicine, and have been a holistic practitioner, licensed massage therapist (LMT) and health educator for over 30 years. As part of my practice, I am a POCA (People’s Organization for Community Acupuncture) Auricular Acupuncture Technician (AAT, AAT-RT)as well as a registered trainer for the technique. I have seen such benefit in this safe and effective treatment professionally as well as personally. Expanding this legislation to allow this protocol to be utilized to promote behavioral health and to include those effected by tragedy and trauma, such as our military and first responders, would encourage early access to critical incident stress management resources and improve the health of fellow Virginians. For over 8 years, I volunteered with VBEMS (now known as Virginia Beach Rescue) as a first line responder, NREMT, EMT-B, and my husband is a retired Marine with 23 years of combat operational service. The 5NP has been instrumental in our wellness. Please consider approving the legislation so that I, and others, may expand our work to better people’s lives with 5 quick pokes! Thank you for your time and attention.
I am writing in support of this bill to broaden treatment access through auricular acupuncture. Currently in Virginia, the 5 Needle Protocol (5NP) is restricted to licensed acupuncturists and trained providers who work only in the context of a chemical dependency setting. We have seen the 5NP change the field of drug treatment, and through a simple change of language to § 54.1-2900 and § 54.1-2901 we can broaden treatment access for all behavioral health needs. This change would allow for the 5NP to be further utilized as a tool for prevention, instead of a path toward recovery. Beyond the primary intention of assisting in substance use disorder, 5NP can help with stress, anxiety, depression, and PTSD. So many of us deal with these issues on a routine basis, and so many of you have experienced the relief that the 5NP brings. We have an opportunity to help further reduce these symptoms and the consequences that often stem from creating self-coping habits that can potentially be destructive.The passage of HB 1278 will allow 5NP to be an alternative form of care for all Virginians, but especially the overworked and high-intensity jobs of our healthcare workers, law enforcement, and first responders. As we address substance abuse disorder, along with the daily stress of first responders providing care to persons experiencing this disorder, we have an opportunity before us to expand treatment access. The Wellness Wagon in Roanoke is one such provider doing extraordinary work. Please support this bill. Thank you.
Angela M Dobbins Acupuncture Detoxification Specialist I first received the 5 point needle protocol in my twenties. It was my first time receiving a treatment that truly eased my mind and brought me back into my body. As an early childhood trauma survivor, survival mode and the peak of my nervous system became a mental loop for me. The 5 point protocol helped me ease my mind without putting pills or other harmful substances into my body. Last year I decided to take the course to become certified in NADA. My knowledge deepened as I learned more about what this protocol was actually doing for and with me. This was/is my body doing the work to calm itself with the help of 5 tiny pins. To administer this treatment and watch people go from 10 to calm is nothing short of a miracle. It restores an edgy nervous system and sanity. When I was a child, I lost my father to suicide. He grappled with depression and anxiety which lead to substance abuse. Most who suffer from addiction need assistance because they also suffer from trauma, depression, anxiety and so much more. If tools like these were readily available in situations which warrant relief, there is no doubt in my mind, that lives would be saved. We all know someone who suffers mentally and or emotionally. This tool is a key that has the potential to unlock numerous closed doors. Us key holders are happy to administer this treatment for FREE…this is life saving.
I am writing to support the expansion of the legal use of the five needle protocol for chronic pain. I am a Registered Nurse and an Accu-detox specialist. Working with our veteran population and interacting with them daily as we find ways to help them better manage their chronic pain conditions and other mental health issues is mind blowing. Seeing the benefits that the Five Needle protocol has helped hundreds and thousands of these veterans better deal with stress, anxiety, sleep issues and chronic pain is out of this world. When a veteran tells you thanks to NADA, I can sleep better or that I no longer stress or worry over issues of life or even telling you that they are at a better place mentally and emotional thanks to the protocol bring tears to your eyes. The use of the 5 Needle protocol in our in our Integrative pain program at Central Virginia VA Healthcare system has changed lives. Veterans who had lost hope found hope and are thriving in that new found hope that there is something that can help them. Even after graduating from our Integrative Pain program they have continued to thrive. You do not want to be one the one that takes away something that has been helping with veterans live a fulfilled life even in the presence of chronic pain. I therefore believe that this protocol enhances the effectiveness of other integrative modalities offered for pain management, sleep issues, depression and anxiety. It is in expensive and has no risk associated with its application. It would be of great benefit to expand its use in Virginia for individuals suffering from chronic pain, anxiety, depression, sleep issues and not only substance use recovery. Thank you in advance for passing this bill and helping us help our veterans and others who so very much need this Five Needle protocol to have some quality of life and better manage their chronic pain conditions and other Mental health challenges. Respectfully, Claudia Kem-Bumbala
Greeting VA representatives - I commented earlier, and am creating a second one on behalf of my patients. I shared with them this information and they wanted their feedback to be heard. Below are their comments: "Acudetox is very relating and calming. I have had it done multiple times." "I have had 2 sessions, very relaxed. I became tearful the 2nd time and it was cathartic & would do it multiple times." '"Full body reset, I felt myself truly relax for the first time. I would recommend this highly." "An excellent way to release emotions and tension regardless of the reason"
Good- morning, First, I wanted to say how grateful I am to be included in this movement (HB1278) for Auricular Detox Specialists. I instantly became a believer in acupuncture while being treated for Trigeminal Neuralgia which led me to the knowledge of the 5 NP and how it is beneficial to individuals. Through experiencing this treatment, after 35 minutes I felt renewed, re-energized and most of all at ease. I then became educated on how the 5NP was brought forth for treatment of addictions, traumas, PTSD etc. etc. I too have my own story of survival and wish I would have had the knowledge for this type of medicine free, side effect free and less evasive treatment for the human body. I became such a believer and so intrigued I had to become an ADS so that I may help others heal while giving back with my own story of healing. This would allow the awareness to spread for such a simple, peaceful treatment and give people an alternative way to naturally help heal their bodies. Sarah Baxley ADS – In Training Roanoke Virginia
As a Mental Health Survivor and Advocate, I can say one thing with confidence: no two people are exactly alike in their depression or their addiction. Why, then, would we limit someone's access to a treatment modality which so many people have found relief from? I have only had the opportunity to experience this form of treatment a couple times in my life, but, each time, I have noticed an improvement in my overall mental health. For me, the impact is not long lasting, but, because of how quick acupuncture is to administer, it is not to make some time for this to be done, and, then continue about my daily life. What IS hard, is finding someone who can administer this for me, and, being able to afford to pay it out-of-pocket. In this day and age, we need to be using all of the tools in our arsenal to help people get well and stay well. Medications can only do so much, require trialing, and, come with many side effects- some, which can follow you for the remainder of your life; I see no reason to not make this more accessible to the general public.
I would like to express my support for HB1278 to expand usage of the 5 needle protocol and allow its use in more behavioral health care settings. This protocol has brought my nervous system back to a steady baseline and I have been relieved of depression and anxiety symptoms. Medication has not given me the long lasting relief that the auricular acupuncture has brought to my life. It is my hope that all Virginians in need, may benefit from this protocol.
Hello committee members and delegates. I support the passage of HB 1278, which expands access to the five needle protocol (5NP) beyond the restrictions of chemical dependency treatment programs. This simple, safe, inexpensive treatment is easy to learn and beneficial to many. I am a trained ADS, but because I don't work in a mental health or substance abuse treatment facility, I am currently unable to freely offer this treatment to members of my community seeking relief from trauma, grief, anxiety, depression, stress, sleep problems and other mental health issues. It can be done seated on a chair in a living room, on a porch, in a community room, in the school staff room, a fire station, and in an emergency, just about anywhere. Five needles in each ear, in five very specific location on the ear, and 30 -40 minutes sitting quietly is all it takes. It costs less than $1 per treatment. Sterile needles along with clean needle technique makes the 5NP extremely safe. And the treatment is so calming and relaxing - I wish you could try it for yourselves! Thank you for taking the time to consider HB 1278 and thank you for your service to the citizens of Virginia.
I support the passage of HB1278 that will expand the use of 5 Needle Protocol to treat behavioral health issues. I am an acupuncturist who was trained in this procedure when I attended acupuncture school. Over the past 15 years I have seen this safe, simple, and powerful treatment provide relief to people suffering with substance use disorder, anxiety, PTSD, trauma, anxiety and more. Research has shown that this treatment is effective in treating burnout in healthcare workers (see attached from The Journal of Trauma Nursing). Just imagine when we are able to use this treatment to benefit some of the hardest working Virginians such as healthcare workers, first responders, and teachers. All Virginians will win with the passage of HB1278
Honorable Health and Human Services - Behavioral Health Committee Delegates : I write in support of HB1278, Auricular acupuncture; use of the five needle protocol. As a licensed acupuncturist in this state of Virginia with active board certification through National Certification Commission or Acupuncture and Oriental Medicine, I strongly believe that broadening the possibilities to provide this low cost, extremely safe and effective therapeutic protocol is in the best interest for all residents of this state. Currently in Virginia, this 5 needle protocol (5NP) is restricted to licensed acupuncturists and trained providers who work only in the context of a sanctioned drug treatment program. While this has been a good start, it falls short of allowing communities greater access to the 5NP. Under current legislative language, people only have the opportunity for this caring and cost effective treatment if they are also seeking addiction care. While many people already successfully benefit from this 5NP as an effective adjunct therapy for a range of substance addictions, this procedure is also quite useful for a much wider range of psychological/behavioral/spiritual traumas. During 9/11, 5NP providers reached out to support first responders and came to appreciate its effectiveness in treating trauma at large. The underlying benefits come from the 5NP treatment of psychological/behavioral/spiritual traumas that lay at the root of many problems people struggle with. This is why we seek to expand access to this protocol and where it can be practiced. The language additions as presented by Delegate Eric Zehr address this issue by broadening treatment access for all behavioral health needs. Scientific research supports the utilization of the 5NP for behavioral health. Feel free to learn more here: NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health Providers: The Case for Auricular Detoxification Specialists. The simple language addition to § 54.1-2900 and § 54.1-2901 would allow for treatment under the general field of behavioral health thus allowing 5NP practitioners to support first responders, healthcare workers, victims of disasters, military veterans, and whole communities that may need this valuable, inexpensive treatment due to tragedy. Having supervised, assisted, and lent my ears for practice needling in a number of 5NP training sessions both prior to and through the COVID disruptions these past several years, I would like to affirm that the students who attend these classes already bring a wide range of professional skills and a passion to expand and incorporate this procedure into their already considerable repertoire. They are always curious, open to new ideas, and eager to put this new skill to use. Whenever I have worked with these folks, I have also gained valuable therapeutic insights and strategies. Your support would be greatly appreciated. Thank you for time. Best wishes always, Stephen Kirbach
I am an ADS at a mental health facility, and the positive response I get from the people I service is clear, below are a few: "I have been having a rough day and was going to ask for medication just before I came to this group, but now I feel even better than if I had taken meds" "This sounds weird, but I feel like the acupuncture gets me in a more positive frame of mind. It makes me feel hopeful" "I have enjoyed this so much, I am definitely going to be adding this to my treatment program, I want to get it weekly when I get out" The most consistent question I get from patients is, 'where can I get this when I leave?'. This bill would support our patients who are struggling to continue to receive the 5 Needle treatment as they transition into outpatient services. I am grateful for this bill and am truly excited about the benefit this can have for our community. Thank you for your time, Kari Decker, MS, CTRS, ADS
I wish to speak to the efficacy of 5 point protocol. Three times when I have found myself spiraling into anxiety, I have arranged to receive “pins in my ears” from a trained practitioner. The resultant calm has each time been almost immediate, surprising, but true,that something so simple could have such profound effect. Dorothy S Clifton, LCSW (retired)
I appreciate the opportunity to provide comment on HB1278, and I am thankful that Delegate Zehr has chosen to carry this bill. The 5 needle protocol provides so many benefits. I know this because I have experienced it first hand. As a former law enforcement officer and emergency management professional, I have been in many situations throughout my career that have stretched the limits of my professional and personal capacity. The risks and toll that these lines of work take on individuals is well documented, and can lead to many physical and mental health conditions that can lessen quality and length of life. The 5 needle protocol has helped me lead a better life, one with improved mental health and less stress from my years of public service. The minor modifications to this area of the Code of Virginia to clarify that behavioral health is included in the 5 needle protocol's area of beneficial influence will simply provide this service to more that need it. There are no downsides to this proposed bill, and I hope very much that you will support it moving forward.
As an ADS (Acupuncture Detoxification Specialist), I have first-hand seen the relief that many individuals receive from the 5-Needle Protocol (5-NP) treatment. I am adamantly in support of the expansion of this treatment; so many Virginians would benefit from this low-cost, and very safe modality. Beyond the primary intention of assisting in substance use disorder, the 5-NP can help with stress, anxiety, depression, and PTSD. So many Virginians deal with these issues on a routine basis. We have an opportunity to further help reduce these symptoms and the consequences that often stem from creating self-coping habits that can potentially be destructive. HB 1278 has the potential to allow the 5NP to be an alternative form of care for all Virginians, but especially the overworked and high-intensity jobs of our healthcare workers, law enforcement, and first responders. We have an opportunity to make this treatment more accessible to all Virginians and be a positive example for other States to follow.
As a trauma informed Tuina massage therapist and caring citizen, I urge you to carefully consider amending the Virginia regulations that limit access to the NADA 5 needle protocol to only those participating in a chemical dependency treatment program. The beneficial attributes of this safe, inexpensive, easy to administer, and effective treatment extend beyond chemical dependency. The reduction of anxiety, improvement of sleep, decreased pain, and connection with others, increases the potential for healing. We live in troubled times and many people suffering from behavioral health issues need easy access to affordable care and support. Personally, in Floyd County, Virginia, I am equipped to offer the NADA 5NP in my clinic on a donation basis. Many of my clients would benefit tremendously if this could be included in their treatment plan. In addition, I imagine the EMTs in our Rescue Squad being trained to give and receive the 5NP to reduce the affects of trauma related to their profession. I also work with our aging seniors at Warm Hearth Village and there is solid data to support the efficacy of the NADA 5NP to aid with pain management, insomnia, emotional outbursts, agitation and general depression that many people experience near the end of life. Scientific research supports the utilization of the 5NP for behavioral health. With legislative support, we can broaden treatment access for all behavioral needs. The expansion of regulations governing the administration of the 5NP would help create a healthier society, and we all would benefit. Thank you for your time, service and attention. With care, LoraLeigh Giessler LMT, RSME/T, ADS
As an acupuncturist, I work with patients each and every day that are battling PTSD, stress/anxiety, addiction, and many other mental/emotional struggles that see significant benefit from auricular acupuncture. This is a service that should be widely utilized, especially considering Virginia’s overwhelming opioid crisis. Patients are begging for help and support with these struggles, and the 5-Needle Protocol is an inexpensive, effective way to enhance these patients’ lives. I hope that you will strongly consider supporting this bill as it will enhance the lives of so many and revolutionize the way we approach treating addiction in a more holistic manner.
While completing Acupuncture Detoxification Specialist training, I had the opportunity to provide 5NP treatments to individuals in an inpatient residential drug/alcohol treatment facility. On one occasion, a noticeably anxious woman requested to be last to receive the treatment as she wanted to see how others responded to having needles placed in their ears. As requested, she was last to receive the treatment. Within 10 minutes, she went from being fidgety and unable to sit still to falling asleep. While watching peace come over her, I thought of how beneficial the treatment could be to those experiencing grief, MST, PTSD, and so many other behavioral health conditions; the list is truly endless.
Hello, please register my support for HB 1278, expanding access to the extremely helpful, safe, drug-free therapeutic benefit of the 5-needle acupuncture protocol. As a licensed acupuncturist, I recognize that this protocol is something that can be safely taught in a short course and stands alone as a treatment for the stresses and impacts of all sorts of mental and behavioral health conditions. This Bill 1278 will greatly expand access to a low cost, high yield treatment modality that can support not only recovery from substance use disorders, but also emotional trauma such as PTSD and depression. Thank you for supporting mental health across Virginia. -erin mckelvy, L.Ac. Migrants' Rest Acupuncture, Christiansburg VA http://migrantsrestacupuncture.com
Regarding Bill 1278 HB1278 Auricular acupuncture; use of the five needle protocol. The Five-Needle Protocol (5NP) was developed in the 1970’s as a community-based response to the heroin crisis in the Bronx. Because of its focus on drug treatment, 5NP is often called “acudetox.” After 9/11, the same treatment protocol was effectively used to provide relief from trauma for firefighters, other first-responders, and survivors. Acupuncturists Without Borders employ the 5NP for disaster relief all over the world. In 5NP, thin, sterile acupuncture needles are placed in five specific acupuncture “points” in each ear, after which the person is asked to sit quietly for 30-40 minutes, usually in a group setting. The calming effect is almost always immediate. Currently, Virginia has an exemption allowing non-acupuncturists to be trained and provide the 5 Needle Protocol in the context of a chemical dependency treatment program. This suggested amendment in HB1278 would eliminate the restriction of a treatment setting (chemical dependency treatment program) as it disrupts the continuum of care and availability of this treatment to address Virginia’s staggering behavioral needs. Whether people seek 5NP for trauma or substance use problems, and regardless of the substance involved, the same 5 points will be used. Because no chemicals are involved, there are no contraindications. Therefore, no intrusive inquiries are needed before administering 5NP, making the Protocol particularly effective for people dealing with trauma or stigmatization, who are often reluctant to verbalize concerns. The Five-Needle Protocol is extraordinarily safe. Adverse outcomes are very rare and easily managed. The cost of 10 needles (5 needles in both ears) , alcohol wipe and cotton ball is 70 cents per treatment. Because 5NP is non-diagnostic, people with no health background perform as well in training as health professionals. People who successfully complete NADA (National Association Detoxification Association), POCA (People's Organization of Community Acupuncture) or an equivalent training would be exempt from regulatory requirements for acupuncturists as long as they only use the 5 ear points that are the basis for 5NP training. Because no new regulatory structure is created, the cost of the proposed changes to Virginia taxpayers will be negligible. The 5NP is an effective first line intervention and can be taught to community members especially those in rural areas where needs are often high but geography and socioeconomic barriers exist. 5NP also can be utilized in drug courts, jails, rehabilitation centers, public and private healthcare settings to address the surge in drug use, homelessness, school shootings, and natural disasters. Now more than ever we need to increase the availability of this simple, low cost yet effective behavioral health treatment. Scientific research supports the utilization of the 5NP for behavioral health. Feel free to review the article attached entitled: NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health Providers. Your support would be so appreciated. Thank you for your time and service.
I am writing to support the expansion of the legal use of the five needle protocol for behavior health. I have seen first hand the utility of this treatment technique for individuals suffering fgrom addiction, trauma, disregulation, anxiety, and depression. This protocol enhances the effictivity of most other therapies without interfering with the modality. It is inexpensive and simple to both provide and to learn. The protocol ought to be available to all Virginians suffering from behavioral health challenges, not only to individuals in substance use recovery.
HB1282 - 1915(c) Home and Community-Based Services Medicaid Waivers; state plan amendments, program rule.
My name is Donald Benson, and my wife and I recently adopted our almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of over 1700 disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. Unfortunately, DMAS is making it much more difficult for parents (of minors) to be reimbursed for providing personal care for their child. DMAS is enacting ‘new guardrails’ that will compel parents to become employees of agencies. This makes a mockery of consumer directed service option and demonstrates a bias in favor of agencies and institutions. DMAS has failed to address significant problems with these guardrails such as the finding and enrolling of new consumer directed providers due to shortages and delays in the processing of forms needed to hire attendants. To be honest, if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. It seems strange to me that even though the system does not function correctly without these parents, DMAS would rather assume the worst of intentions on the part of these same parents. I understand that there may be bad actors but to implement a system where parents are treated as guilty of this until proven innocent is absurd. This is not the assumption with the any other state agency. Honestly no parent is making a living off of the under $13.50/hr. that most of the state is reimbursed for this care. Teenagers working in fast food make more than that. DMAS is also making it impossible for parents to be the EOR (Employer of Record). The EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. This role of the EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents. With that being said, expecting families to have a friend or neighbor act as an EOR (instead of a parent or guardian) forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. I DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. However, in recent public communications as well as emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion”. These guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families.
HB1318 - 1915(c) Home and Community-Based Services Medicaid Waivers; state plan amendments, program rule.
My name is Donald Benson, and my wife and I recently adopted our almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of over 1700 disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. Unfortunately, DMAS is making it much more difficult for parents (of minors) to be reimbursed for providing personal care for their child. DMAS is enacting ‘new guardrails’ that will compel parents to become employees of agencies. This makes a mockery of consumer directed service option and demonstrates a bias in favor of agencies and institutions. DMAS has failed to address significant problems with these guardrails such as the finding and enrolling of new consumer directed providers due to shortages and delays in the processing of forms needed to hire attendants. To be honest, if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. It seems strange to me that even though the system does not function correctly without these parents, DMAS would rather assume the worst of intentions on the part of these same parents. I understand that there may be bad actors but to implement a system where parents are treated as guilty of this until proven innocent is absurd. This is not the assumption with the any other state agency. Honestly no parent is making a living off of the under $13.50/hr. that most of the state is reimbursed for this care. Teenagers working in fast food make more than that. DMAS is also making it impossible for parents to be the EOR (Employer of Record). The EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. This role of the EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents. With that being said, expecting families to have a friend or neighbor act as an EOR (instead of a parent or guardian) forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. I DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. However, in recent public communications as well as emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion”. These guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families.
HB1389 - Practice of athletic training; amends definition.
HB1423 - Home care services; publication of information.
HB1455 - Virginia Memory Project; established.
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Hi I am writing to you on behalf of The Well Connection UK, a media and publishing company. We could easily get virginia.gov featured in various publications such as magazines, online blogs and news sites. This would undoubtedly help virginia.gov with publicity, reputation, domain authority and organic search engine rankings. We have a wide range of options including completely free collaborations, sponsored posts, guest posts and banner ads. If this sounds of interest, please reach out to the senior business development manager, Anita at info@thewellconnection.co.uk and whatsapp +447395206515 (GMT) Kind regards Clifton Junior Outreach Assistant
Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
January 31, 2024 Respected House Health and Human Services - Behavioral Health Committee Members: I am writing to state my utmost support for passage of the 2024 Virginia House of Delegates Bill NO. 1455. I am most hopeful that passage of this bill will codify and underwrite the establishment of the Virginia Memory Project (VMP) as a population-based, statewide Alzheimer’s Disease and Related Disorders (ADRD) registry. I am passionate about the VMP. To be sure, national and statewide data on ADRD incidence, prevalence, and cost is chilling. More personally, as a Geriatrician, I have cared for many Virginia patients and families with ADRD. I thus have seen over and over the suffering these devastating disorders inflict. I see the VMP as a leader and a cutting edge innovation in Virginia’s battle against ADRD. In establishing the VMP, Virginia becomes only the 4th state to boast a statewide ARDR registry. Benefits are multiple, first as a means of examining ADRD distribution and determinants, and second by offering crucial insights on unmet needs for purposes of planning of medical and social services, examining ADRD-related socio-demographic disparities, and supporting ADRD research. Moreover, the VMP goes above and beyond registry” functioning as usual.” In its intentional design to allow self-reporting by ADRD caregivers and persons with undiagnosed cognition issues, it gives voice to constituencies that would otherwise be overlooked. With its linkages to education, support, and access to care, the VMP is of immediate benefit and help to its enrollees, thereby becoming the first and only “ADRD registry with a heart”. Although there is excellent return on investment, the VMP needs monetary support-for staff, consultants, infrastructure for data entry and management, structures and processes to ensure accuracy and confidentiality, and the capacity to generate accurate and timely reports. That such support would be forthcoming for the VMP via House bill 1455 would indeed be a huge win for this Commonwealth. Sincerely, Daniel Bluestein MD, MS, CMD-R, AGSF-R, Certificate Added Qualifications-Geriatrics Adjunct Professor, Virginia Geriatric Education Center/Virginia Center on Aging Virginia Commonwealth University College of Health Professions Professor Emeritus Department of Family & Community Medicine Eastern Virginia Medical School
HB50 - Central State Hospital; designation of additional beds as forensic and psychiatric beds.
Comments Document
HB 50 support. Currently Hiram Davis medical center Petersburg serves psychiatric and violent individuals in the same building as intellectual disabilities. Please prevent harm to defenseless Cognitive impaired. I have witnessed armed guards and sharing same hallways as intellectual disabilities populations. HB313, request amend to include Hiram Davis medical center and Sevtc Chesapeake Training Center. Equal protection and investigations for individuals with intellectual disabilities. HB 515 Oppose. Violates Olmsted Supreme Court case federal law protects choice by guardian. Lack of due process timeframe for Medicaid and Medicare recipientsm Individuals with profound intellectual disabilities cannot make their own decisions. Mental health discharges intended but remains Linked in the code section. See Olmsted and ADA federal laws. I'm a legal guardian for son Taylor Bryant at Hiram Davis medical center after displaced from CVTC. Vote No.