Public Comments for 02/08/2024 Health and Human Services
HB324 - PA Licensure Compact; authorizes Virginia to become a signatory to Compact.
I have attached a file with a "no position" testimony for HB 324 from The Council of State Governments.
HB326 - Social Work Licensure Compact; authorizes Virginia to become a signatory to Compact.
I am a licensed clinical social worker and resident of Richmond, Virginia. I am writing to you to encourage caution, care and curiosity when considering HB 326 (Glass) which seeks to authorize Virginia to become a signatory to the Social Work Licensure Compact. The Social Work Licensure Compact is shortsided legislation that appears sound on the surface however it is deeply flawed. The Social Work Compact as it is written infringes on states’ rights, does not account for fiscal implications, and fails to provide guidance on the oversight, maintenance or regulation of compact licensure. Yes, it is critical that we find ways to address the behavioral health workforce crisis however the Compact has the potential to impact insurance reimbursement, social work wages, and push Virginias out of the job market market. Two helpful scenarios to examine the holes in the Compact are: If a social worker resides in a state outside of Virginia that is a signatory of the Compact providing services to a resident of Virginia that are in violation of the state laws and regulations where does jurisdiction fall? Which state and regulatory board is responsible for handling this violation and sanctioning the social worker that resides out of state who violated Virginia state laws and regulations? As written, the Compact does not provide guidance. State regulatory boards, like the Virginia Board of Social Work, are already understaffed and under-resourced. With an increase in licensed practitioners that reside outside of the state providing services in Virginia, what budgetary implications are not considered in terms of staffing and time that will become necessary in order to monitor, maintain, and provide oversight for compact licensure? As written, the Compact does not provide guidance. There is a reason that 26 states have not introduced legislation to sign on to the Compact there are more questions than the Compact has answered. Other states are proceeding with caution and calling on the Compact to undergo revisions that reflect these and other deeply valid concerns. I urge you to proceed with great caution in considering support for HB 326. We do not have enough information and do not trust that this Compact will not harm Virginians across the Commonwealth.
Please vote yes to support HB326 for Virginia to become a signatory to the Social Work Compact. As a LCSW, this Compact will allow me to practice with clients outside of Virginia. Especially with the enormous growth in virtual therapy, this will significantly increase access to mental health care to residents of all of the states in the compact.
Pyramid Healthcare, Inc. urges you to adopt HB 326 to have Virginia join the Interstate Social Work Licensure Compact. We are an integrated behavioral healthcare system serving Medicaid and commercial clients in 9 states across a continuum of residential and outpatient substance abuse, mental health, autism, and eating disorder treatment services. We employ 3,100 team members across our 80+ active facilities. Our Newport News facility has operated since July 2021 and offers 150 withdrawal management/detox and residential treatment beds for adults. We also offer structured outpatient treatment for adults with substance use and co-occurring disorders. Our New River Valley facility opened in August 2023 and offers residential and partial hospitalization programming for adults throughout the New River Valley. We will soon begin the construction of a 100 bed residential detoxification and rehabilitation treatment facility in King George County. Virginia has already recognized the value of interstate licensure compacts, having previously adopted compacts for audiology and speech-language pathologists, counselors, EMS personnel, nurses, occupational therapists, psychologists, and physical therapists. Missouri has already adopted the Social Work Compact and legislation is currently pending in 23 other states. The Compact is supported by the Council of State Governments, the Department of Defense, and the Association of Social Work Boards, as well as numerous other organizations who helped develop the SW Compact. The Compact is an interstate occupational licensure compact that allows social workers with bachelor’s degrees, master’s degrees, and clinical licenses to provide services to clients in all other Compact states instead of having to file duplicate license applications in each state in which they practice. Each Compact state extends licensure reciprocity to the other states in the Compact. In order to be eligible, a social worker must first already be eligible for or hold a social work license in their primary state of residence and meet other criteria. After the social worker’s eligibility is determined, they receive a multistate license and may begin working in any Compact member state. There are over 500,000 licensed social workers across the country and we employ many social workers across our counseling, operations, clinical, quality, compliance, and utilization review teams, among other functions. The Compact will streamline the licensing process while reducing administrative burden and allowing social workers to quickly resume providing care. It does so while protecting patient and public safety. Joining the Compact will facilitate multistate practice and reduce the barriers to license portability for our current and potential employees by easing mobility across state lines, expanding employment opportunities to address crucial workforce shortages, allowing continuity of care for our patients that move across state lines, allows the use of telehealth to be leveraged, and supports the relocation of military spouses and their families. Given Virginia’s unique geographic location, bordering NC, TN, KY, WV, MD, and DC –as well as the presence of major military installations where members of the military and their families are frequently relocated into and out of the region, the Compact will positively impact the state’s ability to attract and retain qualified and desperately needed social workers.
HB449 - Child abuse and neglect; mandatory reporters, statute of limitations, penalties.
Apologies for submitting attachment which was not submitted correctly last Thursday on HB 858. Testimony Opposing Virginia “Medical Aid in Dying” Bill HB 858/SB 280 One of the most frequently repeated claims by proponents of assisted suicide laws is that there has not been “a single documented case of abuse or misuse.” To the contrary, I refer you to two resources describing problem cases. The first is from the Disability Rights Education and Defense Fund, Oregon and Washington State Abuses and Complications. The second is a journal article by two New York medical doctors, Drs. Herbert Hendin and Kathleen Foley, Physician-Assisted Suicide in Oregon: A Medical Perspective (2008). Data from states where assisted suicide is legal show that all people who request assisted suicide have disabilities, even if some don’t think of their impairments that way, and that unmet disability related needs are their reasons for wanting to die. The top five reasons Oregon doctors give for their patients’ assisted suicide requests over all reported years are not pain or fear of future pain, but psycho-social issues that pertain to disability. Three of these (losing autonomy, losing dignity, burden on family) could be addressed by consumer-directed in-home personal care services, but the law operates as though the person’s reasons don’t matter, and nothing need be done to address them. (See attachment)
HB511 - Out-of-state health care practitioners; temp. authorization to practice in assisted living fac.
LeadingAge Virginia supports House Bill 511.
We support HB511. Workforce shortages and the limited availability of health care practitioners specializing in geriatric care have created unnecessary burdens on assisted living communities. Sometimes the shortages are exacerbated by delays in paperwork with licensing agencies. HB511 will help to alleviate the burden caused by delays by allowing the health care practitioner to temporarily practice while awaiting the paperwork processing, etc.
HB516 - Prescription drugs; labels provided for blind and disabled users.
I am a newly blind person, and enjoy all the independence I can have with the sudden onset of my blindness. After going blind taking my medications was a big obstacle, many times I took them wrong and suffered the consequencess. Now that I have Script-talk I am able to take care of my self, and not feel like a kid and need a babysitter. Bill 516 will give all blind people the ease of the use of script-talk from the start, and not have to go through the trouble I went through to get it.I spent months fighting to get it, and needing someone to give me my medicines. Please give equal opportunity to all, even the blind. Thank you Cindy Thompson
Without talking labels on all my prescriptions, I can get confused about which ones they are and when to take them. It’s impossible to refill them by myself. Many times, I have to wait for sighted assistance before taking a medication or knowing the name and amount I take . As you can imagine, this can become dangerous when you are guessing according to size and smell without definitely knowing the meds I am taking.
Please pass HB516: I am a totally Blind woman who sometimes lives alone. I should not have to depend on anyone to tell me what my medication is when I have the independence to read the information with the assistance of verbal labels. There should be a requirement for all medication to have talking labels on the medication bottle or package because it is dangerous to take the wrong medication. ScripTalk talking labels are available from En-Vision America, and I appreciate the peace of mind that I have when I take medication, knowing that it is prescribed for me, what it is prescribed for, who it was prescribed by, and how much, and how often to take the medication. I feel that it is an invasion of my privacy to have to ask for assistance from anyone concerning taking medication, and this should be my right as a citizen, and the right for everyone with print reading limitation.
This is a very good program for those that are visually in pared or who can not see at all. Because it helps with our independence. I feel that it is discrimination to take something away from us that rely on it for our daily life and it would enable us from knowing if we are take the right med's or not.
I feel that the bill HB 516 should be passed because health is important to blind people like myself as much as it is sighted and non-disabled individuals. To me, it is very hard to read the labels on my prescription bottles because the writing is so small. Having accessible labels would mean the world to me.
As a blind person, I greatly benefitted from the prescription labels given to me by CVS. I can now daily organize and take all my medications by myself. This has improve my independence, confidence, health safety and quality of life.
I think that prescription drug labels should be provided to blind and disabled users because they need to be accessible so that they can follow the instructions to administer the medicine prescribed by their physician. They need to be in larger font, and be available in Braille for users who have visual impairments. At some point, in our lives, any of us could be visually challenged, and especially as we get older.
As a person with low vision, I have used the labelling of my prescriptions for two years and it has worked beautifully. It allows me to be independent and to manage my prescriptions safely.
This bill would give blind people the ability to read prescription information privately and independently which should be a given. People with disabilities in this country deserve to be treated with the same respect and consideration as their non disabled peers. The fact that there professionals in the pharmaceutical industry who don’t wish to provide adequate access to their patients is gross and unfair to say the least. Please do not listen to their false testimony and pass this bill to give all blind Virginians access to their medications! Thank you very much. And the captia below isn’t accessible to the blind so please fix this!
I am blind and live alone. My local pharmacy refused to put the Script Talk labels on my medicine, and so I was unable to use the Scrip Talk machine. HB516 would mandate accessibility for all persons who receive prescriptions at their local pharmacy. My former pharmacy is now closed, and now I have to re-negotiate with my new pharmacy whether it will provide accessibility for my prescriptions. It is vital to have that information for safety reasons, even if someone is able to create their own identification process, for example, identifying by the shape and color of the pills. The pharmacy could change companies when they order new pills, thus changing their description. There are also important directions related to when you should take the pill and if you should take it with food, etc. If you have sight, try to imagine getting a prescription and not being able to identify it or read the directions!
I am visually impaired and take multiple medicines that are the same shape in tablet form and capsule. Without the labels being placed on my prescription bottles, I would either over medicate or under medicate. I am a diabetic and have hypertension as well as other medical issues, so the labels have been a great help in keeping track of what I am taking, the amount as well as refills. Please consider this option for those in Virginia who needs this particular help in knowing and taking meds.
As a visually challenge person, I wish I knew about script talk labeling years ago. In fact, I just learned about it when I came across this bill. Increasing awareness of such service should be encouraged and enforced.
I'm old enough to remember when prescription bottles did not have safety caps and children died. Implementation of technology saved lives. I also remember car manufacturers resisted installing seat belts even though it was proven they would save lives. Too expensive they said. Now, technology exists to allow blind and low vision people to safely take their medication and to read about the side effects and other information . Some pharmacies are using this technology. Why not all pharmacies ? Why would legislators not want to protect people ? Technology exists that will save lives and allow people to be independent. Please pass this life-saving legislation . It's the right thing to do .
Virginia needs topass this bill. Reading and identfy medication is difficult if you can not see. I believe in this bill. Request Joe McNamara and others do the right thing related to accessibility. and by the way this process is not accessible with the recaptha request. Does not work with screen readers!
I feel this bill is very much needed for the Blind and Low Vision Community. We need more accessible things and places such as this bill.
As a blind /low vision individual, managing my medications was a daily health risk. I couldn't read the labels and drug information. The frustration of guessing if I was opening the right pill container, taking the medication as instructed, or even being able to read drug interaction risks or identify side effects was completely (and a few times) devastating guess work. When I learned about SripTalk through the Dept for the Blind and Vision Impared, my whole world changed. I no longer have to deal with the stress, frustration, and fear of taking my daily medications, Prescription reader technology has numerous benefits for a host of people who are vision impaired and don't yet know there's a solution out there...consider the elderly. For some, the guesswork is so scary and potentially lethal that we choose not to take our prescribed medication...seeing it to be a lesser risk than incorrect dosage or living with side effects because we don't know what to watch for. Millons if people ate relying on your support to champion this bill. We may not be able to see clearly but we have a need and we have a voice. We NEED this technology. There are many challenges to being vision impaired, simply taking your medications SHOULD NOT be one of them. Thank you for hearing us.
My daughter is filling this out for me.I can not see and depend on help so anything that can help us the people who are disabled blind please help pleaE pass this bill.
I am writing on behalf of NFB and the blind community to encourage Congress to pass HB 516. As a blind individual it is a challenge to keep track of medications and the correct dosage. I need to rely on a family member for help or place them in a specific location and memorize the information because there is no way to identify the prescriptions. It would be a minimal cost to make prescription labels accessible. It could be as simple as adding a QR code to the label. Please pass this bill to make it easier for us to manage our prescriptions. Thank you.
As a rehabilitation teacher working with the blind and visually impaired I fully support HB516. It is imperative that pharmacies notify any person receiving a prescription drug that an accessible prescription label is available upon request at no cost and to provide to individuals who are blind, visually impaired, or otherwise print disabled. This is not only a safety issue, but pivotal in helping those with visual impairments remain independent.
In regard to bill HB516, every blind or visually impaired person wants to be as independent as possible each day. I applied to use script Talk where I pick up medication and headquarters denied the opportunity for me to use this technology. Many blind people want to be in charge of their lives and Script Talk can tell you things about your medication such as refill number, expiration date, dosage and printed information about the product. I urge Virginia to pass this bill whereby blind people will have the same rites as sighted people and have all the information needed to understand their medications without needing to ask for help from others.
As a visually impaired person, I fully support bill HB516. This should be a standard practice at all pharmacies for blind and visually impaired customers. How else would a visually impaired person be able to read the labels on their prescriptions? This would be especially challenging for those who have to manage several medications. Having had a few prescriptions with the labels that can be read by my phone, I can tell you it is a life saver. Those of us who have issues with our vision, need all the tools we can get our hands on to make life easier.
I have low vision and work in a low vision clinic and resource center. The ability to manage medications is critical to allowing individuals with visual impairments especially the elderly live independently. Providing accessible labels on medication is easy. In fact there is existing technology available to all pharmacies. ScripTalk labels if used allow patients to have medication information spoken using either a smartphone app or using a Spriptak device. These devices are provided to patients free of charge. As baby boomers continie to age, the number that develop age related vision loss due to conditions such as Macular Degeneration and Glaucoma is increasing. The inability to read medication labels is dangerous and impacts the ability to live independently. And this impacts younger visually impaired and blind Virginians as well. Please vote move this bill forward and vote to pass it. The technology is readily available so pharmacies should have no problem implementing accessible labeling. Thank you for proposimg and hopefully passing this very important bill. It will be lifechanging for visually impaired Virginians.
HB 516 i am a legally blind male and it is imperative to me that this bill be approved it would allow me to independently continue filing my own pill box ,with the assistance of script talk that provides me with instructions on when to take my medication and how. As I might not have someone available all the time to read these labels to me. This device is a great help for me As a Blind person, one of my many concerns regards my medications and being able to tell them apart etc. special prescription drug labels are critical for the visually impaired, and disabled, obviously. My future as a blind person presents many hurdles,Hopefully medication use won’t be one of them.
I am in support of HB 516. I use accessible pharmacy labeling, and it makes my life extremely easy. However, I know others who don’t and have many many issues. The fact is the technology already exists. The programs are already out there. So it is a fairly low cost solution to help countless people with possible life-saving independence. why should we as blind individuals be punished for some thing that is beyond our control
I belief to me that if bill is approved it would provide me with a better way of independence regarding instructions when taking medicine. As I might not have someone available all the time to read these labels to me. Dhis device would be a great help for me and my fellow Virginians dealing with the same situation. Thank you for your time dedicated in this matter.
HB 516 As a low vision person, one of my many concerns regards my medications and being able to tell them apart etc. soecial prescription drug labels are critical for the visually impaired, and disabled, obviously. My future as a blind person presents many hurdles,Hopefully medication use won’t be one of them.
I feel the strip talk will help me to keep my independence and live a more rewarding life
Bill HB516 is so critical to the blind and visually impaired community in that we need to be able to Our medications just as much as anyone else would. This would help us stay at home and independent like all folks would like to be. This also helps us know everything about our medication that is important to taking and using it appropriately. I have used this type of accessibility for my meds and it helped save my life.
I am a totally blind Virginian. I am also a parent to 2 small children. Accessible prescription labels are not only important for my own health but also for my ability to safely care for my children if and when they need medication. I also believe this legislation is especially important for our seniors who may not be as familiar with alternative techniques and assistive technology to access prescription information, but who often must manage multiple life-saving medications on a daily basis. Please pass this legislation and give Virginians who are blind or visually impaired equal access to the same vital prescription information that is available to everyone else.
I am testifying about HB516. I have been totally blind for almost 30 years, and have numerous health conditions, such as multiple sclerosis, lupus, and rheumatoid arthritis and with these health conditions, I take a lot of medication. Luckily, both my local and mail order pharmacies offer accessible labeling options if it was not for that, I would not be able to safely and independently manage my own prescriptions. I think is vitally important that all pharmacies be required to offer some kind of accessible labeling options. In order that the blind visually impaired community be able to safely and independently manage their health and prescription needs
I urge the Virginia General Assembly to pass HB116 which will require labelling of medical prescriptions in an accessible manner for Virginians who are blind or visually impaired. With out accessible drug information those of us who are blind face a major deficit in the quality of care we receive. Information about dosages, side effects, and interactions are critical. why is this information readily available to sighted persons and not to the blind? Other states have passed similar laws, Virginia, let’s join them.
I am a legally blind elderly woman. With my sight being as bad as it is. The prescription reading lable is a necessity for me, because I live alone and basically do everything for myself except read. The talking label is the only way I can keep up with and take the correct medications.
In favor of HB 516 for script Talk to used in prescription bottles by pharmacist to label name, prescription name, dosage, usage, and reordering info such as script number and date to refill. It is so important for blind and vision impaired people to have the right to receive the same information as sighted people in an accessible format. This is crucial for safety and recovery. A lot of blind people live alone, have no one to set up their medications properly in pill boxes and could face overdosing by taking a pill at the wrong time or taking night meds during the day and causing faa as les or accidents because of being to drowsy. This is an inexpensive means to provide the blind and vision impaired (especially seniors) that they take the proper meds at the proper time. In an age where everything I’d computer based, refills are difficult to refill with out the script number and script talk allows people to be more independent and and family members to feel safe that prescriptions are taken properly. Please support in favor of this bill. We need you to assure accessibility is provide to the blind and vision impaired. Unless you have a family member affected with blindness you have no idea the struggles a blind person goes through trying to be independent and self supporting. With seniors living much longer these days, more and more are losing their sight. This bill could change their lives and maybe even, change the life of someone you know or care about.
As a person that is vision impaired and a diabetic, it is imperative that I know which medicine I am taking and the correct dosage. If the medicine is taken incorrectly it could cause detrimental effects and could lead to death. I do not always have someone sighted near by to assist me. I have Kaiser Permente and they offer to put labels on my meds that can be scanned and read back to me. This helps so much. I know exactly what I am taking and how much needs to be taken. However this service is only offered for prescriptions that are mailed to me. So if I am at the doctors and he prescribes something I need to start taking now, I am back to square one. Because the labels can not be put on there at the pharmacy. Please pass this bill, I know I need it.
This is a comment on Bill, HB 516 Prescription drugs; labels provided for blind and disabled users. this type of labeling is necessary for blind people to be able to reliably identify the pills they are taking. Especially when we take sometimes up to 10 different prescriptions. this is a real life issue that is personally impacted me, and possibly could’ve caused me harm. unbeknownst to me my pharmacy change the dosage on my pills from two 10 MG to one 20 mg figuring I was taking two at the same time so the replacement was OK. in reality this actually was OK but only if I knew I was doing it. I almost took a double dosage by taking two pills of the higher prescription. At the time I did not have anything reading me the labels but luckily, I noticed something was different and found a sided person to tell me why the pill felt a little different. please see that this bill is passed so I can continue to easily find prescription with accessible labels. Thank you.
I depend on script talk to fill my pill box.With out script talk labels I surely won't be able. I am vision impaired.
Please vote to pass HB 516, "Prescription drugs; labels provided for blind and disabled users," into law. Talking prescriptions are a life-saving necessity for anyone who has difficulty with reading normal print, and particularly the tiny print that appears on containers of medicines. We should have access to information about our prescriptions so that we know what medicines we are taking, and so that we will not take the wrong medicines, like oxycodone or fentanyl, by mistake. This should be a basic human right.
The ScriptTalk station/App facilitates my basic human right to read/manage my prescriptions as a blind veteran. When my prescriptions must be filled by a local pharmacy that does not provide such labels, I am denied the same basic human rights as sided people. as a tax paying Virginia I would like to believe that all politicians are doing everything they can to support my personal rights. ScripTalk prescription readers are a right and not a privilege; hence, I expect politicians to do everything possible to support the ScripTalk reader and prescription labels!
I believe that RX drug labels should be provided at all pharmacies. This is a need, especially for people who are blind or visually disabled. When you take more than one medicine, you cannot rely on the shape. Often people with my problem cannot see all colors so that is a limitation also. If only a few pharmacies use the labels we are limited to their prices. We need all the info on the script & the special label provides that information. Thank you for hearing my voice.
I work with the blind population throughout Virginia to help them become independent. One of the most valuable tools we implement with them is an audible prescription reader, such as the Scrip Talk system. Use of the Scrip Talk device allows them to safely identify and manage their medications independently.
Dear Members of Congress, I am a productive, tax-paying citizen of Virginia. I work full-time, for over eight years, at Covington & Burling, LLP in Washington, DC, while living in Virginia. Many of you may be familiar with this prestigious firm. After 41 years of being a Type 1 diabetic, I also happen to be blind. In addition to causing my blindness, this disease also led to kidney failure, and ultimately, a kidney transplant. I was fortunate to previously live near the Cleveland Clinic, in Ohio, so I have also had a pancreas transplant, so I am no longer a Type 1 diabetic. Add in hypertension, due to decreased kidney function, and you can probably deduce I take quite a few medications. In the past, I have spent an evening in the Emergency Room because of an accidental overdose of an incorrect medication. I thought I was taking one prescription, but in fact, I took a different one. Fortunately, my wife noticed this soon after, and I was able to get to a hospital quickly. This accident was clearly caused by my lack of vision. With comprehensive insurance provided by my employer, I was able to find a pharmacy that can provide talking labels for my prescription medications. Because of this, I have been able to avoid any repeat incidents like my previous accidental overdose. We all know Virginia has had its share of self-inflicted overdoses. Please help avoid accidental ones by supporting HB516. This potentially life saving prescription feature should be available to everyone in Virginia, not just those with the best insurance, and access to the leading pharmacies. Respectfully, Tom Schmitt 10139 Woodbury Dr Manassas, VA 20109 (440) 610-5687
I am a Rehab Teacher for individuals with Blindness and Vision Impairment. I closely work with my client's independent living skills and medication management. Administering right meds impacts health of our senior citizens and accessible meds enable them to perform it safely. This is a game changer for persons with vision loss and should be supported for an inclusive society.
I am a 50 year old blind professional who, as most Americans do, takes medications to manage chronic illnesses. I also care for my 72 year old mother who has difficulty reading. Being able to obtain medications with talking labels has been a god-sent for us, enabling us to take the right medication at the right time, know how many refills we have left, and understand essential information about the medications we have to take. Unfortunately, due to lack of regulation, even the pharmacies we regularly use sometimes fail to prepare the labels; and if we have to move to a new pharmacy, we often have to jump through hoops to get the correct labels, and that is not always a winnable fight. I feel that having a regulation in the state of Virginia will make it easier for people who are blind, which, in addition to persons such as myself, includes many elderly folks, to independently manage their medications. While some may argue that there just aren't enough people to justify mandating talking labels, I would argue that most people, including pharmacists, do not know that such a thing as a talking label exists. I urge you to advance this bill forward and lead it to a passage to make the lives of many citizens of the Commonwealth of Virginia better.
I am concerned that this bill would mandate new technology that may or may not integrate with our current systems and that would come at an additional cost. While I sympathize with the concerns raised in accessibility - mandating all pharmacies provide this service, whether they have a known vision-impaired patient or not will result in undue costs. Too many pharmacies are closing up shop due to reimbursement issues and this would be another expense that cannot be recouped.
I am a RN and Certified Diabetes Care and Education Specialist that works with the blind population throughout Virginia to help them become independent in their medical care. One of the most valuable tools I implement with them is an audible prescription reader, such as the Scrip Talk system. Use of the Scrip Talk device allows them to safely identify and manage their medications independently, reducing medication errors, morbidity and mortality. The unfortunate barrier that I come across is only select pharmacies in Virginia, such as Walmart, Sam's Club, Giant, Publix, Friendship Pharmacy, Safeway, and the VA, can provide the Scrip Talk system for their patients. If my patient lives in an area without these pharmacies, or doesn't want to switch pharmacies for a myriad of reasons, then this safety measure of medication identification is not available to them. I strongly urge you to pass this bill. People's lives are counting on it.
My mother is 92 years old and is blind. She needs to pay someone to come in and help sort her medication’s because they are not labeled. The person puts them in a daily pill minder. Many blind people do it themselves if the pill bottles are labeled. We hope you will support this very important legislation.
HB519 - Unprofessional conduct; disciplinary action against doctor for providing abortion care, etc.
Members of the Virginia Legislature, I am writing to express my strong support for SB716 and HB519. These bills address an important issue concerning the protection of reproductive rights and the autonomy of healthcare professionals in Virginia. These bills are critical in the fair treatment of doctors providing abortion care, regardless of where the care is provided or received. It is my hope that we can recognize how abortion care is a fundamental aspect of reproductive healthcare. Doctors who provide such care should not face disciplinary action based only on the nature of their service. I am aware, and I hope you are too, of how crucial reproductive rights and access to comprehensive healthcare services is. I urge you to support SB716 and HB519 to protect the rights of healthcare professionals and uphold a patient’s choice to have access to a full spectrum of reproductive healthcare services. SB716 and HB519 support key elements of medical ethics and ensure that healthcare workers can provide inclusive and compassionate care to their patients without fear of punishment. Reproductive care is lawful. Medical care is a basic human right. Abortion is healthcare. Thank you for considering my testimony in support of these bills. Sincerely, Danielle
HB519 Unprofessional conduct; disciplinary action against doctor for providing abortion care, etc. The League of Women Voters of Virginia supports HB 519 which would prohibit the Board of Medicine from taking disciplinary action against a doctor based on the alleged provision or receipt of abortion care that is not prohibited under the laws of the Commonwealth, regardless of where such abortion care was provided or received. This bill clarifies current law to ensure that practitioners may provide abortion care permitted under Virginia law without fear of professional reprisal. We urge you to support this bill. HB609 Contraception; establishes right to obtain. The League of Women Voters of Virginia supports HB609 which would protect the right of individuals to receive contraceptives and the corresponding right of health care professionals to provide contraceptive care and information. Virginians strongly support reproductive freedom for individuals without government interference and this bill would protect that right. We urge you to vote yes.
Progress Virginia supports this bill. We cannot penalize medical providers for performing procedures that are legal in the Commonwealth; Virginia makes our own laws and we’re not beholden to the practices that other states may adopt.
Please vote YES on HB519. It's absurd that providing safe, effective, proven medical care should ever lead to professional censure, whether here in Virginia or other states. We're not responsible for other states' backward, anti-scientific cruelty, and Virginia doctors should be free to fulfill their Hippocratic oath and provide needed care in every circumstance without fearing for their careers.
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.
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
HB609 - Contraception; establishes right to obtain, applicability, enforcement.
HB519 Unprofessional conduct; disciplinary action against doctor for providing abortion care, etc. The League of Women Voters of Virginia supports HB 519 which would prohibit the Board of Medicine from taking disciplinary action against a doctor based on the alleged provision or receipt of abortion care that is not prohibited under the laws of the Commonwealth, regardless of where such abortion care was provided or received. This bill clarifies current law to ensure that practitioners may provide abortion care permitted under Virginia law without fear of professional reprisal. We urge you to support this bill. HB609 Contraception; establishes right to obtain. The League of Women Voters of Virginia supports HB609 which would protect the right of individuals to receive contraceptives and the corresponding right of health care professionals to provide contraceptive care and information. Virginians strongly support reproductive freedom for individuals without government interference and this bill would protect that right. We urge you to vote yes.
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.
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.
HB971 - Nurse practitioners; patient care team provider, autonomous practice.
I write this letter with wholehearted support for House Bills 971, 983, and 978. These bills recognize the importance of empowering advanced practice nurses (APRNs) to self-manage as a profession, and move beyond outdated and unnecessary oversight by physicians. They represent a significant step towards acknowledging the expertise and capabilities of APRNs. HB 971, 983, and 978 will allow APRNs to be competitive with our peers in the District of Columbia and Maryland, localities which have far fewer restrictions on advanced practice nursing, and to whom we regularly lose entrepreneurial nurse practitioners who would rather open their businesses out of state than pay a physician a monthly cut of their business in an arbitrary "collaboration." Thank you for your attention to this matter.
Writing in SUPPORT of HB971. Dear Delegates, I write to you a second time today as a Certified Nurse-Midwife and Family Nurse Practitioner in Virginia, and also as a fledgling small business owner. Having been in clinical practice for 6 years in Virginia, across various practice settings, I am permitted to practice independently as a CNM in VA but cannot practice independently with my FNP credential. This is because three of the years I spent working for a CNM-owned private practice do not “count” toward the arbitrary 5-year practice agreement requirement in Virginia. Changing the practice agreement requirement period from 5 to 2 years, and changing the language to enable practice agreements with not only physicians but also with autonomous APRNs would make Virginia significantly less restrictive. It would make me eligible to apply for autonomous FNP license and start providing the full range of care that I am otherwise qualified to provide. Please do not be swayed by physician special interest groups who may use anecdotes in place of reliable research data, or fictional phenomena like “scope creep” to attempt to influence policy to maintain market control. The scope of practice for advanced practice nurses is defined by our professional organizations and in alignment with our education and national certification exams and continuing education requirements. We simply request the professional courtesy to be allowed to practice our professions independently with accountability to our own licenses and to be entrusted with regulating our own profession in the Commonwealth. To keep physicians as gatekeepers to APRN entry to practice hurts small businesses like mine and limits access to high quality, affordable health care that people like me are willing to provide. Thank you, Tana McCoull, CNM, FNP
I'm a nurse practitioner providing care as a solo provider in rural Bedford County and beyond. I'm planning on recruiting a local nurse practitioner who is interested in providing care to our community. After several months of searching, we have been unsuccessful in obtaining a collaborating physician for her at this time. She will have reached her 5 years of practice in April but is short 2,000 hours in qualifying for her autonomous license. By passing this bill, she would be able to join our practice in July if no collaborator is found before that date. It would also allow us to expand services to to the people in our community,. We primarily serve Medicare and Medicaid patients, many of whom have come recently after losing their previous provider due to retirements, relocations and closures. Her additional certification would allow us to expand services to include the care of children as my license is specific to adult patient care. We would also be able to open our Big Island location on more days of the week to accommodate the increase in new patients. Please consider the implications of continuing to limit access to care by this example and allow autonomous practice after 2 years of experience and collaboration. I thank you in advance for your vote for passage of this bill. Sincerely, Phyllis C Everett, NP-C Executive Director, Sapient Health Services, PLLC Past President, VCNP
I need to ask you to support Nurse Practitioners in Virginia to be able to practice at the top of their education, certification, and licensure. Virginia is the most restrictive state in regulating nurse practitioners. Currently a NP must be practicing under a physician collaboration agreement for 5 years. We are requesting full practice authority (FPA) after 2 years of practice. The word “collaboration” does not define the relationship between a NP and physician. The relationships are collegial with mutual contributions from both skilled and knowledgeable professions to improve patient care. That has been my experience as a NP of more than 30 years in practice. However, those opposing this progression feel threatened by the removal of the term “collaboration” and a practice agreement. It is a power struggle that is divisive and impacts patient care- the reason we do what we do-to help patients. Their oversight costs NPs and organization’s money. Data shows that NPs are safe and effective health care providers. Collaboration does not cease when a NP receives his/her FPA. Collaboration in health care is common and a known process that we all practice that should not require regulation or mandated statues. Physicians of various disciplines just like NPs know how to “stay in their lane”. A family practice doctor will collaborate with a cardiologist to determine what is the next test or medication to try for a complex patient. NPs do the same. NPs should not have to be regulated to collaborate. It is a standard of practice. Two bipartisan bills HB 971 and HB 983 will reduce the number of years from five to two, which would align Va with most other states with full practice authority (there are states with zero requirement). NPs have an average of 10 years’ experience as a RN before getting their master’s or doctoral degree and the 2 years under the mentorship of an experienced clinician before granting of full practice authority prepares them for the transition. Currently if the physician retires or leaves the office, the NP must scramble to get another practice agreement signed or risk closing the doors. Access to their provider will cease and leave patients, families, and communities without health care. Across the Commonwealth, thousands of patients entrust their care, and their families care to NPs. The FQHC that I work for operates with NPs that practice exceptional standards in delivering care to a rural and vulnerable population. We are committed to sustaining a collaborative and collegial relationship with our physicians. With much gratitude, Dr. Rosie Taylor-Lewis, Doctor of Nursing Practice, ANP-BC, GNP, PMHNP-BC
I have been a registered nurse since 1987 and an adult nurse practitioner since 2000. I spent 6 years as a member of the GA trying to explain why NPs can provide care independently based on data and other factual information. I found that people believe facts are in the eye of the beholder. It's frustrating. For seventeen years in a row, nurses have ranked number one in honesty and integrity, making them per the national Gallup poll, the most trusted profession in America. And yet, when it comes to the issue of honestly assessing our preparedness for our work, we are told we are liars and not to be trusted because we are ill-prepared and unsafe. People have spent the last several years through and post the pandemic calling nurses heroes, and yet when these same individuals seek professional growth and pursue additional education to practice within a very limited scope, they supposedly do not have the good sense or ethics to stay within their boundaries. Suddenly members of the most trusted profession will go rogue and with utter abandon disregard their professionalism to work outside of their area of competence. It is an insulting and ridiculous argument that wins year after year. As a clinician, educator, and former lawmaker I have struggled to reach a conclusion that isn’t cynical. The conclusion I have reached is that it is institutionalized misogyny. Nursing has been primarily a woman’s profession. For decades nurses were mocked as battle axes, bimbos, handmaidens, and subservients despite being independently licensed professionals and the backbone of the healthcare system. Nurses have always been hardworking, smart, educated, driven, and competent. Advanced practice nurses, like NPs are exactly this with the education to offer additional service to their community. Yet without autonomous practice, NPs are relegated to practicing in an area where they can find a supervising physician. This is not always easy, and frankly, sometimes the only physician available isn’t someone the NP wants due to professional concerns. Others are charged outrageous fees for this mandatory supervision when there is little to no oversight at all. Still, others who have supervision are kept from growing, relegated to unwanted tasks, and undervalued for the privilege. Physicians and institutions have historically made money from NPs kept in submissive roles. Changing this dynamic is not only a hit to the wallet but a hit to the ego. The old model of healthcare is steeped in patriarchy, but there are many professions outside of the traditional physician model who have been trained and educated to support the healthcare needs of patients and communities. We must allow all professions to practice to the fullest extent of their education and training and believe them when they and their credentials say they are able. The quote that comes to mind here is that of the great Justice Ruth Bader Ginsburg, "I ask no favor for my sex. All I ask of our brethren is that they take their feet off our necks." Thank you for your consideration.
HB978 - Advanced practice registered nurses and licensed certified midwives; joint licensing.
Please support the bill to bring the regulatory board structure for midwives in line with other regulated professionals. There is no evidence to support a dual-board structure. Thank you for supporting this bill.
I write this letter with wholehearted support for House Bills 971, 983, and 978. These bills recognize the importance of empowering advanced practice nurses (APRNs) to self-manage as a profession, and move beyond outdated and unnecessary oversight by physicians. They represent a significant step towards acknowledging the expertise and capabilities of APRNs. HB 971, 983, and 978 will allow APRNs to be competitive with our peers in the District of Columbia and Maryland, localities which have far fewer restrictions on advanced practice nursing, and to whom we regularly lose entrepreneurial nurse practitioners who would rather open their businesses out of state than pay a physician a monthly cut of their business in an arbitrary "collaboration." Thank you for your attention to this matter.
In the interest of patient safety and access to care, Virginians deserve confidence in a well functioning regulatory process that isn’t weighed down by unnecessary red tape. Moving license issuance, regulatory enactment and disciplinary review of Advanced Practice Registered Nurses (APRNs) and Licensed Certified Midwives (LCMs) to the Board of Nursing and establishing an advisory committee of Advanced Practice Midwives to the Board of Nursing reduces regulatory burden, serves to increase access to healthcare by decreasing duplicative steps that exist in the current regulatory process and further ensure the public that any disciplinary investigations will occur swiftly. Virginia is an extreme outlier in the country to utilize a joint boards of nursing and medicine structure to regulate all Advanced Practice Nurses and Licensed Certified Midwives. Certified Midwives and APRNs are capable and qualified to solely regulate their professions. To continue to adhere to the rigid view point of the need for regulatory oversight from physicians is outdated. Boards of Medicine lack the requisite nursing and midwifery experience to regulate APRNs or Advanced Practice Midwives. 3 studies submitted by the Department of Health Professions since 2021 support this change. The only statutory laws governing APRNs or LCMs in the Medical Practice Act is definition of these professions. As clarified in the Dec. 2023 report submitted by the Department of Health Professions, approval of regulations governing APRNs and LCMs must go through a cumbersome multi-step process. In practice, regulations are first drafted with a workgroup voted on and recommended by the Committee of the Joint Boards at their discretion and then must be approved by the both the Board of Medicine and the Board of Nursing necessitating separate, multiple board meetings either by following recommendation or by action of the boards without recommendation. Any revision at the individual board level necessitates bringing the language back through the other two boards in order to move on to the next stage of the regulatory implementation process. In review of other health profession boards in Virginia, they are uniformly composed by the professions they represent. The board of psychiatry is made up of psychiatrists. The board of pharmacology is made up of pharmacologists. The board of Optometry is made up of, you guessed it: Optometrists. While you could argue that their roles share overlapping areas of practice with physicians, they do not have medical doctors on their regulatory boards. One must question what is so different about the profession of Advanced Practice Midwifery or Advanced Practice Nursing, that to date Virginia has not recognized these professions as being able to self carry out the duties of regulatory process. Even the the Federal Trade Commission weighed in on this in 2016 when it referred to medical doctors regulating APRNs as anticompetitive, writing: “[w]e urge you to consider whether to allow independent regulatory boards dominated by medical doctors and doctors of osteopathy to regulate APRN prescribing,given the risk of bias due to professional and financial self-interest.” Passing SB351 is a necessary initiative to show all Virginians that reducing unnecessary overregulation and spending while maintaining the integrity of the regulatory process is a goal of our government which is important for sustaining the trust of the public.
Dear Delegates, I’m Tana McCoull, a Certified Nurse-Midwife and Family Nurse Practitioner writing on why HB978 matters and asking you to support it. If the primary function of health regulatory boards should be to protect consumer safety and interests by the least restrictive means necessary, then these two rules of thumb should apply: 1. Any regulatory restriction should have a demonstrated benefit and 2. If multiple options exist to confer the same public protection, the least restrictive option should be chosen. The current structure for regulating advanced practice nursing and advanced practice midwifery requiring the Joint Boards of Medicine and Nursing does not follow these rules of thumb. HB978 would improve upon the existing structure by eliminating a redundancy (Joint Boards structure) which confers no benefit to the public but does significantly, and disproportionately, restrict the ability of APRNs and APMs to regulate their own professions. 1. No benefit to joint board structure: There is no evidence that the existence of a redundant regulatory structure in the form of the Joint Boards of Medicine and Nursing offers any benefit to public safety or other interest. The joint board structure has been touted by physician interest groups as a means for physicians to help nurses regulate the subset of advanced practice nurses and midwives. Proponents of this idea have not been able to produce evidence that our Board of Nursing needs this kind to make appropriate regulatory decisions. Meanwhile, decades of national healthcare quality and safety data show that advanced practice nurses and advanced practice midwives are capable of regulating themselves. APRNs and APMs function safely and to high patient satisfaction when practicing according to their own professional standards, regardless of physician oversight. 2. Less restrictive means exists: The structure of the joint boards is, by its very existence, the most restrictive way to regulate any group of healthcare professionals in Virginia. We know that less restrictive regulation is possible in Virginia, since among our 13 health regulatory boards, comprising 62 professions and over 500,000 healthcare practitioners, APRNs and APMs are the only ones singled out to be regulated by a superimposed redundant board structure. Any revisions APRNs or APMs wish to make to the regulation of their professions must pass through not one, but effectively three regulatory boards, as such changes must first be approved by both the Board of Medicine and the Board of Nursing, then approved again by the Joint Board of Medicine and Nursing, then approved by the executive branch, often with public comment periods in between. This may not seem important, but consider that legislation to allow Certified Midwives to practice passed in 2021, and there is still no application for them to become licensed to work in VA, due to the lengthy regulatory process. Furthermore, HB978 improves upon the existing structure by establishing an advisory board on advanced practice midwifery allowing the APMs a necessary degree of self-representation. This is consistent with the structure for massage therapists who are regulated by the Board of Nursing. So please help pass HB978 to improve upon the existing structure and make the regulation of APRNs and APMs in Virginia more fair and consistent with other healthcare professionals in the Commonwealth. Thank you, Tana McCoull, CNM, FNP
IN SUPPORT of HB978. Virginians deserve to have faith in their regulatory systems, especially when it comes to health care. The current system is not based in safety, science or public support. Over-regulation delays necessary actions for improving patient outcomes and erodes trust from the public. Midwives practice midwifery. APRNs practice nursing. Midwives and Nurses are the only clinicians with relevant expertise to evaluate, establish and maintain adherence to the standards of practice for their respective fields. No other advanced practice profession is expected to be regulated by an entirely different profession. Please support the move of the professions of advanced practice registered nurses and licensed certified midwives from being licensed jointly by the Board of Medicine and the Board of Nursing to being licensed by the Board of Nursing only.
NPWH is the national professional association and community of Board-certified Women’s Health Nurse Practitioners (WHNP-BCs) and other advanced practice registered nurses (APRNs) who provide women’s and gender-related health care. We set a standard of excellence by generating, translating, and promoting the latest research and evidence-based clinical management, providing high-quality continuing education, and advocating for patients, providers, and the WHNP profession. Our mission includes protecting and promoting women’s and all individual’s rights to make their own choices regarding their health and wellbeing within the context of their lived experience and their personal, religious, cultural, and family beliefs. NPWH gives voice to nearly 13,000 WHNP-BCs in the United States, who provide sex and gender-focused care across the spectrum, from puberty through senescence. Our membership includes WHNP-BCs, certified nurse midwives, family nurse practitioners and other advanced practice providers who support women across their life spectrum. The certified WHNPs and APRNs we serve are recognized experts in the primary, complex and specialty care of women, and are leaders and advocates in the advancement of healthcare towards a more just, healthy, and equitable world. NPWH Workforce Priority WHNP-BCs provide sex and gender-focused care for women from puberty through menopause and beyond. Their care includes primary care, common and complex gynecologic, sexual, reproductive, menopause transition and post-menopause healthcare; uncomplicated and high-risk prenatal, antepartum, postpartum, and interpregnancy care; and sexual and reproductive care for men. Further, the WHNP-BC is the only nurse practitioner population focus to hold enumerated competencies in providing high-risk antepartum and postpartum care that includes advanced assessment, diagnosis, treatment of risk factors, complications, and urgent conditions. They provide and co-manage care for patients with high-risk antepartum and postpartum conditions in collaboration with multidisciplinary teams in inpatient and outpatient settings. A 2012 Rand Corporation study projected a shortfall of WHNP-BCs, a subset of the NP workforce with enumerated competencies in sexual and reproductive health care, as demand for these services rise. Since that time, the number of students entering academic programs in preparation for the WHNP role has remained flat. Further, WHNP-BCs are rarely included in reports of women’s health and maternal health provider shortages, yet many states have relatively few WHNPs. For example, states such as Wyoming (16 WHNPs) and South Dakota (27 WHNPs) have few WHNP-BCs available, thus further limiting access in rural and frontier areas. Lack of recognition of the WHNP-BC as a key provider in women’s and maternal health services creates a “silent provider” and limits incentive to enter the field. NPWH advocates for the recognition of WHNP-BCs as integral to the provision of women’s health care, including maternity care, sexual and reproductive health care, gynecologic care, and care during perimenopause, menopause, and beyond. We recommend that in all APRNs have full practice authority and oversight over their own professions reporting to a Board of their peers.
The American College of Nurse-Midwives represents Certified Nurse-Midwives and Certified Midwives. ACNM supports HB978. This bill will allow midwives and APRNs to be regulated by the board of nursing. Midwives practice midwifery and will have an advisory committee to the board of nursing. Midwives and nurses are the only clinicians with relevant expertise to evaluate, establish, and maintain adherence to the standards of practice for their respective fields. No other advanced practice profession is expected to be regulated by an entirely different profession, as is the case with CNMs and CMs being regulated by a joint board. The VA government has done its due diligence concerning research on this bill, and the Department of Health Professions is recommending this change to a single board rather than a joint board. Virginians deserve to have faith in their regulatory systems, especially when it comes to health care. The current system is not based on safety, science, or public support. Over-regulation delays necessary actions for improving patient outcomes and erodes the trust of the public. ACNM strongly endorses this bill which will increase access to CNMs and CMs, professionals with a proven track record of safety and who reduce the incidence of preterm birth, cesarean births, and low birth weight infants.
This legislation seeks to remove joint licensure of advanced practice registered nurses by the Boards of Nursing and Medicine and solely license advanced practice registered nurses (APRN)s under the Board of Nursing. Current regulations governing Virginia’s APRNs require them to go through an additional and unnecessary layer of approval by the Committee of the Joint Boards of Nursing and Medicine in addition to being licensed by the Board of Nursing. This requirement is incongruent with the national APRN Consensus Model, and the Virginia Department of Health Professions studies from both the Northam and Youngkin administrations, which recommend regulating APRN nurses solely under the Board of Nursing. According to the Department, as is the case in 47 other states, “The Board of Nursing, with multiple APRN Board members, is fully capable of regulating and disciplining APRNs.” The primary legislative change needed is to amend the Virginia Code to eliminate joint licensure and regulation by the Boards of Medicine and Nursing. In 2016, the Federal Trade Commission referred to medical doctors regulating APRNs as anticompetitive, writing: “[w]e urge you to consider whether to allow independent regulatory boards dominated by medical doctors and doctors of osteopathy to regulate APRN prescribing, given the risk of bias due to professional and financial self-interest.The ability to attract and retain nurses in the Commonwealth is paramount to addressing our nursing shortage. Please support the federal recommendation to eliminate the unnecessary joint oversight of the Committee of the Joint Boards of Medicine and Nursing. We are losing providers to less restrictive states!
HB1068 - Pharmacy outsourcing and pharmacy technician remote database access; regulations.
HB1068 & HB1166 are very similar bills. I have some concerns with the extent that HB1166 goes to outline exactly what the Board of Pharmacy must do and allow. I believe that the Board of Pharmacy must be given some flexibility in the items sought in HB1166 and I believe HB 1068 allows for that flexibility. HB1068 also allows for additional input to be provided by other relevant stakeholders. HB1166 was written to satisfy one set of interests - HB1068 allows for the opportunity for perspective and insight to reign in some of the prescriptive expectations of HB1166. I ask that you pass HB1068 over HB1166 - and allow for the proper process to play out in the regulatory fashion at the Board of Pharmacy.
HB1295 - Drinking water; maximum contaminant levels, water treatment systems.
I wholeheartedly support HB1295. I am currently on the board of a group in Grayson County Virginia called Preserve Grayson. We formed because of the rapid influx of large corporate tree farms being planted in our area who spray massive amounts of chemicals. One particular company - Bottomly Evergreens - has been in trouble in other states (NC, Oregon)due to their lack of environmental best practices, mainly filling up trout streams with sediment after they clear and burn for christmas tree planting. So they have moved to our area in VA where they are getting away with all sorts of poisonous activities such as aerial spraying on windy days, planting right up to creeks and wells of neighboring properties, dumping in the creeks and the rivers, etc. Our community is super concerned about our water - most folks in this rural area have wells and springs which are now subject to leeching poisonous chemicals. People living next to these farms are getting cancers but nothing can be done to prove it's the contaminated water they are drinking. So please - we need this bill so our communities are safe and protected from the bad agricultural actors who only think about money and not a lick about poisoning their neighbors, water, wildlife, and pollinators.
Hello, I live in Southwest Virginia, where most of us get our water from wells and springs (unregulated by the EPA). The Health Department will not give a permit for a well to be dug any closer than 50 feet from agriculture. The EPA recommends 100 feet. We have gotten along just fine in this county (Grayson) until a giant corporation started buying up thousands of acres here and planting Christmas trees. Said corporation has no respect for the land or the people living nearby, and clearcuts and plants right up to people's wells and springs. They use aerial spraying of pesticides on our steep mountainsides in our unpredictable and gusty mountain winds. Since it is "agriculture" in a right to farm state, landowners can not find out what they are being exposed to, and have absolutely no recourse for their health or property damages. Enforcement is virtually non-existent -- we have one pesticide inspector for 17 counties. One 85 year-old lady had her land sold out from under her by her conservator, with right of occupancy. Said corporation planted trees within 12 feet of her spring, which is at the bottom of a funnel shaped land form. They spray herbicides and pesticides regularly. Nitrates in her drinking water are off the chart, and the whole family, consisting of her bedridden husband and her two special needs adult children, are all very sick. The smell of pesticides near spring is sickening, but of course testing for pesticides is virtually impossible because you have to know which of the 17,000 pesticides on the market to test for, and the cost is in the neighborhood of $200 per chemical. The Health Dept says that they can help her if we prove that her levels of acetylcholinesterase are depressed. We can get her that blood test, but the only way that the results could be valid is if we had a test before exposure. Which, of course, doesn't exist. All we can do is bring her bottled water, but the whole family bathes in that nasty water. We desperately, desperately need funding to test wells and springs. Please, please approve HB1295
HB1306 - Veterinary Medicine, Board of; powers and duties, satellite offices.
HB1322 - Certified registered nurse anesthetist; elimination of supervision requirement.
I am writing you today to urge you to support HB 1322 for removal of supervision of Certified Registered Nurse Anesthetists (CRNAs). I am a Certified Registered Nurse Anesthetist (CRNA) who practices at a small, rural hospital in Lexington, Virginia. Myself and 3 other CRNAs are the sole anesthesia providers at our hospital. Not only do we administer anesthesia for every surgery performed here, but we are also called upon to sedate patients in the emergency department, place emergency lines in the ICU, and many other duties. We are the only professionals in the building who are trained in anesthesia. Our amazing surgeons, hospitalists, and emergency room physician are experts in their respective fields; however, they have not studied nor have they ever practiced anesthesia. Yet, because of statutes in Virginia they are “supervising” our practice. This makes absolutely no sense. Furthermore, the physicians supervising us generally have no input into my anesthetic care, as it is not their specialty. The reality is that they are supervising in name only and there is no real utility to these requirements. Vene worse we are the only Advanced Practice Registered Nurses in Virginia that have these archaic requirements. In fact, the entire country is moving away from requiring supervision of CRNAs. Virginia is one of the few left with these laws. I urge to please support this bill and make the law match the reality of our practice here.
I am practicing CRNA in the Roanoke Valley, and I support the current legislation in place in Virginia for advance nurse practitioners. I do not support HB 1322 as it does not optimize patient safety.
I am writing this testimony in support of HB1322, the removal of physician supervision for CRNAs. You will hear testimony regarding the benefits of this bill in improving the national anesthesia shortage, so I will focus on what you may not know; the emerging field of evidence-based, integrative mental-health clinics utilizing Ketamine infusion and Ketamine-assisted therapy. Around the country, there are many of these clinics, and the majority are run by highly trained and qualified CRNAs. We are trained down to a molecular level in the medication, ketamine, are proficient at administration, and are qualified airway experts that safe administration requires. These clinics run either with offsite supervision from a medical director or, in many states where supervision is not required, they are owned and operated completely autonomously by CRNA’s. I have partnered with my sister-in-law, a psychiatric Nurse Practitioner, and my wife, an Occupational Therapist who specializes in pelvic health and trauma-integration therapy, to come full circle to my true purpose. Together, we are creating an integrative health clinic in a severely underserved area, Newport News, VA. We will provide evidence-based and holistic treatment for those struggling with mental illness and chronic pain conditions. This includes ketamine infusion therapy, trauma-integration therapy, nutrition counseling and lifestyle medicine. We will also offer free workshops and group therapy sessions for community outreach and support. HB1322 will increase patient access to essential medical services and facilitate additional opportunities for these types of clinics to address the pervasive mental health crisis in our communities. Kind regards, Caleb Lesch, CRNA Illuminate integrative health, inc 212-518-1944 141 Beechwood Hills Newport News, VA 23608
HB1431 - Alternative onsite sewage systems; approval of treatment units.
HB1479 - Health professions; universal licensure, requirements.
HB1499 - Virginia Health Workforce Development Authority; powers and duties, definition.
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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.
Strongly Oppose
Hi, Im Lydia Figueroa and I’m a nurse educator. As a nurse educator I’m concerned about faculty not being qualified to provide the education needed to teach nurses the critical thinking skills needed to provide quality patient care. Instead of decreasing educational requirements for nursing faculty, could this bill helped secure funding for graduate schools in nursing. It is important that nursing students to gain the knowledge needed to become safe practitioners from highly qualified faculty members. Exactly how will this bill help the body of nursing education, research and practice. Moreover, I do not believe this is the answer for underrepresentation of remote locations or minority health care. Funding more qualified healthcare facilities in those locations will help with that. My final statement reflects upon the large number of nurse educators who were not aware of this bill in a timely manner. Was there a survey or other opportunities for our input? Where did this come from. Nursing should be more respected. We put in the work for our profession and we need to maintain the integrity. Thank you.
I am extremely concerned about the potential change of education requirements. There are potential ramifications they may not have been considered. Where academic nurse educators made aware of this desired change prior to this point?
As a faculty member teaching in both the graduate and undergraduate nursing education program in an accredited school of nursing, I am writing to provide comments to HB 1499. Over the past year, I have worked collaboratively with representatives from nursing education, practice, and regulation to create an actionable strategic plan to address the unprecedented nursing workforce the Commonwealth is experiencing. Yet, critical steps to address the nursing workforce shortage are visibly absent from the current legislation (HB 1499) being considered. Virginia is projected to experience a shortage of more than 20,000 registered nurses within the next ten years, and some models predict that the national nursing shortage will reach more than half a million nurses by 20301. This shortage compromises the health of all Virginians and the stability of the healthcare system in the Commonwealth. While this proposed legislation attempts to address health care provider shortages, it falls short of addressing the needs of preparing a highly educated nursing workforce to care for the increasingly complex needs of Virginians. Therefore, I ask the committee to consider specific actions to amend this bill and address the nursing workforce crisis. One key action is to allocate funds within the Virginia Health Workforce Innovation Fund to: 1. Build a sustainable and more diverse nursing workforce • Launch a Virginia Nurse Educator Academy for new academic educators, clinical instructors, and preceptors. • Prioritize debt forgiveness opportunities for contracted worktime for nurses and expand wrap around services to support nurses in school. 2. Create innovative models of nursing education and practice • Establish a designated fund to support research and development of innovative models of nursing education and practice such as the Earn While You Learn program. 3. Strengthen the Nursing Education Pathway • Establish joint academic/practice (employer) appointments to enhance nursing faculty in schools or nursing. • Standardize student onboarding processes across the Commonwealth to streamline clinical education and reduce institutional burden. 4. Engage the Nursing Workforce through Collaboration and Partnerships • Establish a Virginia Nursing Workforce Center to administer innovation funds and coordinate efforts to educate, recruit, and retain a professional nursing workforce. 5. Retain the Nursing Workforce • Develop a clearinghouse of best practices/exemplars for nursing recruitment and retention and workforce development. In conclusion, investing in nursing education and practice is the pathway to ensuring a stable healthcare system in the Commonwealth. Thank you for your consideration of these important requests. Respectfully, Theresa Gaffney, PhD, MPA, RN, CNE
As one of Virginia’s healthcare workforce educators and leaders, I am writing to support HB 1499. This bill, if passed, has the potential to significantly impact the healthcare landscape in our state and, specifically, the Rappahannock Region, which suffers from extensive health inequities and health workforce shortages. The legislation aims to develop and implement strategies to recruit and retain underrepresented minority and rural populations to join and remain in Virginia’s healthcare workforce.
I am writing to support HB 1499. Passage of this important workforce development bill could significantly allow us to expand strategies to recruit and retain healthcare professionals of all types. Specifically, it would give us the opportunity to impact underrepresented minority, and in the Southwest Virginia area, rural populations. Thank you for all you do!
HB1542 - Child abuse and neglect; mandatory reporters, statute of limitations, penalties.
I would like for the committee to consider the the bill on the table today. So many individuals incarcerated are far removed from the people they were 10, 5 ,20 years ago.
HB323 - Interstate Massage Compact; authorizes Virginia to become a signatory to Compact.
See attached letter on behalf of the AMTA
The Federation of State Massage Therapy Boards (FSMTB®) is a not-for-profit corporation with membership comprised of massage therapy regulatory boards and agencies in the United States and its territories. The mission of FSMTB is to support its member boards in their work to ensure that the practice of massage therapy is provided to the public safely and competently. FSMTB is writing to clarify some of the education hour requirement language contained in the bill. A misunderstanding around the bill incorrectly implies that a state must require 625 hours of massage education to be eligible to participate in IMpact. The 625 hour requirement applies only to the individual therapist seeking the multistate license, NOT the member state. The provision specifically incorporates “substantial equivalent” language to accommodate future rulemaking to allow for the hours to be met by initial education, continuing education, or a combination thereof. This section does not change the statutory minimum hours of education required for licensure in a state, nor is it a requirement for a state to be eligible to join the compact. The IMpact model legislation is intended to be flexible, long-lasting, and adaptable as the massage therapy profession evolves. The threshold of 625 hours comes from a research project conducted by the Coalition of National Massage Therapy Organizations*. One of the goals of this Entry Level Analysis Project was to identify the minimum number of hours of initial education that massage schools should teach to prepare graduates for the safe and competent practice of massage therapy. In addition, in 2021, FSMTB surveyed roughly 1,000 massage schools. The results revealed the mean number of hours of education that massage therapy students were receiving was 723. This is well above the 625-hour minimum set forth in IMpact. Thus, the 625-hour requirement is an empirically-based standard that both current and future massage therapists should be able to satisfy to obtain the privilege of a multistate license. Thank you for the opportunity to assist you with making fully informed decisions. Should you have any questions about IMpact or the information above, please contact me at ahernandez@fsmtb.org or (913) 681-0380.
Dear Chair Price and Members of the House Health and Human Services – Health Professions Subcommittee: The Federation of State Massage Therapy Boards (FSMTB®) is a not-for-profit corporation with membership comprised of the massage therapy regulatory boards and agencies in the United States and its territories. The Virginia Board of Nursing is a member of the FSMTB. The mission of FSMTB is to support its member boards in their work to ensure that the practice of massage therapy is provided to the public safely and competently. FSMTB supports the adoption of the Interstate Massage Compact (IMpact). IMpact is supported by FSMTB, the Council of State Governments, and the U.S. Department of Defense (DOD). The compact has been thoughtfully developed by a working coalition of subject matter experts representing massage therapy professionals, educators, employers, professional associations, consumers, attorneys, regulators, and legislators. The IMpact language also took into consideration feedback from a three-month public comment period. IMpact supports the relocation of military families by establishing a formal relationship between the states, easing the burdens of relocation both financially and professionally. The DOD believes interstate compacts are the best solution for recruiting and retaining our military forces. IMpact benefits massage therapists by expanding employment opportunities and facilitating professional mobility for licensed massage therapists. This specifically is advantageous for massage therapists engaged in seasonal work in the hospitality and spa industries. IMpact promotes workforce development by reducing regulatory burdens. Impact will increase consumer access to quality healthcare. IMpact protects consumers by permitting only qualified practitioners who complete education, pass the legally defensible and psychometrically valid national licensing exam, and have no disqualifying criminal history, to obtain the multistate license. This improves workforce mobility and the ability of states to protect the health, safety, and welfare of the public. IMpact benefits massage regulatory authorities through its centralized data system to facilitate sharing of licensure and disciplinary data between the states. This information sharing may also mitigate human trafficking and illicit massage by facilitating and improving collaboration between regulatory authorities and law enforcement, to better identify trafficking networks. Finally, IMpact preserves state sovereignty as it retains a state’s jurisdiction over individuals practicing in their state. Thank you for the opportunity to assist you with making informed decisions. Should you have any questions about IMpact or the information above, please contact Ashley Hernandez, Government Relations Specialist, at ahernandez@fsmtb.org or (913) 681-0380. Sincerely, Debra Persinger, PhD, CAE FSMTB Executive Director