 And welcome back to the House Human Services Committee from our brief break. And we're now going to talk about where we are with S74 or if we have questions for legislative council. And two of our members will come up as soon as they can or we will call them. Two of our members are in another committee reporting on our actions on the breach of bill that the Senate is taking up and so we'll be here back as soon as they can. But so first I wanna ask if there are any questions for legislative council in terms of what words mean or in terms of concepts. Yes. One question I had in my head was the addition of the definition for healthcare services and sort of the relevance of that or like maybe why that wasn't there before or why it's particularly important now. And could you draw our attention to? It is right on page one. It's the first thing, section one. Yes. Jennifer Kirby, legislative council, again for the record. Yes, this is actually pretty easy one for me because it is defined, the definition is added as a new subdivision 11 there in full list because the term new term, excuse me, defined term telemedicine in the next provision says it's the delivery of healthcare services. Okay. So then it's the definition. I see, I've referred to something, right. Okay. And this is the same definition that is in other healthcare bills. The definition of healthcare services is the fairly, yes, I took it from, I don't remember specifically which statute, but it's a fairly standard one that we've used in many other statutes. Thank you. Carl. Thank you. Does it address, I can't think of where it was in the bill because does it address who can pick up the medication? As I know, one thing is documented. I just looked up talks about rezoning and then somebody indicated there's only one pharmacy in the state of Vermont that dispenses. So would the patient themselves have to go pick up that medication or somebody else pick it up? I'll use the brand as it is addressed in the underlined. So we can't see it in the bill that it is. Yes. So in the long list, I don't think we can see it in the bill, in the long list of the requirements for prescription and documentation that you can see much earlier. So you can see some of it in the bill. So if you look on, it's not gonna help you entirely, but if you look on page three, you can see that there's one of the items on the list is that the physician either dispensed the medication directly and then it's to the patient or and then you can't see what is an existing law, but it's with the patient's written consent contacted a pharmacist and informed the pharmacist of the prescription and delivered the written prescription personally or by mail or facsimile to the pharmacist and then who dispensed the medication to the patient, the physician or an expressly identified agent of the patient. Okay. So that's what it says. And I think it's a lot of what we talked about here is trying to put in telemedicine, which would help patients not having to go long distance. So I was just curious if they would have to look up and they have to travel to that one pharmacy personally, you know, an expressly identified agent and pick it up. And I do recall that we're just having a discussion. We're just having a discussion. I do recall the pharmacy testinizing that they actually drove it to the patient. And that seems even more relevant to me given the fact that there's only one pharmacy in Vermont that does that. So I was struck by the fact that the pharmacist was willing to do that. Yeah, I mean, I just, I'm in a concern of mine. There are other reasons I'm not for this to gather, but, you know, looking at other issues I was concerned about the fact of the relationship of the initial doctor to the examination and the rest of the procedures. So I have some, you know, again, I'd probably be against it anyway, but I'm just pointing that out. And I think that is an issue that it seems like there should be a very strong relationship between the prescribing physician and the patient. And the telemedicine aspect sort of separates that a little bit, compared to me. You know, you make a good point and I can understand that. And in the last two years with COVID and I am not, I have to rely on Topper and others and Taylor, I am not very facile with computers and things like that. And as a person living alone in the last two years, I was able to maintain contact with friends and actually have formed some closer relationships with people based on communicating through Zoom. And I think that is somewhat, what happens with telemedicine is that people have figured out the way how to communicate. And I'm not trying to persuade you at all, but my guess is, if you're going to be working with someone to say, this is a decision that I have made and programmed my own decisions around end of life and having a life-threatening terminal condition, my guess is that's a relationship that can be formed more stronger and more quicker based on the topic that the people get. I want to say like this committee gets closer, not just because we're here all the time, but sometimes when we're doing issues that we all are involved with. And, you know, but I hear what you're saying. And I think it's a term might be degrees of separation. Okay, and other people talk about me we're separating the process from that intimate relationship of saying, but I mean between the doctor and the patient or you could, it doesn't obviously could be in telemedicine with the doctor you're working, but it just, it sort of enters a degree of separation. You know, I hear that, I hope my doctor doesn't hear this, but my primary care physician probably eight years ago I walked in, you know, and you have to fill out all these stupid forms every time you go for your, and I was in a bad mood. We all know I'm never in a bad mood. And so I wasn't filling it out. And I came and I sitting in my office in his office he comes in and he goes, hi, nice to meet you. And then he says, why didn't you fill out the forms? And I said, what did you just say when you walked in the room? And he said, hi, nice to meet you. And I said, I've been your patient for five years. And he didn't know that because the first thing that was on his sheet was I've been seen by someone else. So even though this person had been my physician for a long time, we did not have. So I guess what I'm saying is I'm not sure face-to-face does it either. Yeah. It's just interesting because it's just popped into my head as you folks are having that discussion and it brought me back to, I mean, we all have personal experiences that we reflect on, especially in legislation like this. And I remember my mother who had cancer and in the, let's say, a hospital called Comfort Room where you're essentially not going home and they're trying to make you as comfortable as possible and make your family as comfortable as possible. And her oncologist who she had been with for many years and who had seen her through a remission and then the recurrence 14 years later, which was like one of his, he was quite surprised at recurrence so long after her remission and tried everything that he could because my mother was one of those people just wanted to live forever as long as she could and an acute event ended up in her emergency room and she ended up unconscious. And I remember the fact that the doctor that she had had this intimate is not a bad word. I mean, it's very close relationship. And she got the world of this doctor and he of her, he couldn't come into her room in her last days. He stood at the door and he couldn't make an assessment. And I don't know if it was because, they've had such a long relationship or what, but I was grateful at the time for the palliative care physician who was on staff. And she died naturally, but I guess I'm just offering that I think when I heard Dr. Barnard's testimony and the experiences that she has had and the insights that she's had into this and her experiences with patients and knowing that there are not, it's not your everyday physician who's going to take this on because it involves a lot of different stuff. It doesn't bother me. I thought maybe originally it was going to, it doesn't bother me because I feel like they have developed the kind of relationship and knowledge to be able to make that assessment very carefully. And I think, thinking back to people who have physicians who have a close relationship with a patient it's sometimes difficult actually for them to do this. And even though they might in fact tell you what your options are, but they're not able to do it. And they're not required to. And they're not required to. And I think that that is fine. I just, I don't have the concerns about the telemedicine thing that I thought I would, after this thing to all the testimony. I appreciate your thoughts on that though. And I appreciate your voice, I really do. Well, as you know, I mean, are we talking about why we're for or against this bill? Yeah, we were right, or bringing up questions. So I mean, obviously the underlying reason I'm against this or the initial legislation is my belief in God and that he created life, he gave us life as a gift. And it's not in our jurisdiction to take that life. I mean, that's really it. And even though I mean, in your testimony there was extremely moving, I still can't think that it was for me. Okay, for me, I couldn't say that as a right decision. So, so I mean, as far as I'm concerned, I'm not probably going to vote against this as a result, even if some of my other issues were more mundane and natureless. Yeah. And Carl, this is never, this is not an issue or a vote that I would be saying, Carl, can we go outside and should we talk? And is there something that, you know, and if, you know, would you do this for me or, you know, you know, I haven't put any pressure on you, obviously. Yeah. I mean, you know how much of control I have in this community. So thank you. Yeah, thank you. We're just having an open discussion and also legislative council is at the witness chair in case we have any questions in terms of what's in the language. We're not, I've not heard anyone propose any changes to the language. And I don't know whether we have, if there's other things that people want to say at this point in time. You know how, I mean, I sort of cried my way through it, but I'll support if I can move this for so many reasons because I just believe that I've seen it the other way and it felt really unfair and wrong and I wanted to help my mother and I couldn't. And she suffered with her illness for five years and then the last month was terrible. And I also thought, I know that this is a little bit different but I thought about representative McFawn's question about making sure that someone's a Vermonner. And I get that and I think we've put a good, you know, having the physician be able to say that, but I also think about my children who maybe move away for a couple of years and when they become sick, they probably would come home and wanna be taken care of in my living room and in with the physicians that they grew up with and that they, so I guess, I don't know, you can understand where I'm going on that but Vermont is their home and they would wanna be here. So I just don't understand why we would worry about that in any way. But it's a hundred and 16 people, you know, 16 since 19, since 2013. So this doesn't impact, it probably impacts more people than that than who actually use it based on it's something for people to think about. But for those small number of people in comparison to the population of the state, I think the impact is profound and it is not something that is forced upon anyone else. And so for those that it is important to have that, that control, that choice at the end of how they will lead this world and may have a life-threatening terminal illness, for me, this is important. Representative McFawn and then Representative Small. Thank you, Madam Chair. Jessica, the reason I brought up the Vermont residency is because it's part of the act. You have to be a Vermont resident. That's why I brought it up and I felt that the way having a doctor determine that, I didn't think, I think that's pretty loose. That's why I brought it up. I'm doing it to people who want to use this. I brought it up to see if there was any way we could clarify that. So that could be taken care of in a different way. It's part of the law. They have to be a resident and that's why I brought it up. Thank you. Yes. I might add now that I have the floor. I might add that if an individual wants to know about this, the doctor must tell them or figure out a way to get the information to them. And I think it's important that we understand that. A person in this situation has the right to understand all options. And lastly, I would like to say that I have been involved personally, personally in the room with individuals that are dying. And I have personally provided relief to those people working with a hospice person. So I know that you can make somebody comfortable. What tears my heart apart is someone with Lou Gehrig's disease that is not able to take this unless they do it early. And this is a tough one for me, one way or the other. I know you can make people comfortable because I've done it personally. And I know this helps people too. So I guess I'm just going to keep quiet and then make up my mind what I'm doing. Thank you. Thank you, Chopra. Thank you, Madam Chair. I think what has highlighted most for me through this bill is just what we've seen about telemedicine and the importance, especially during this pandemic and access here in the state of Vermont. And recognizing the significant barriers, especially for someone at end of life with the time constraints of six months with a critical diagnosis. I think it is so important when we're talking about access to recognize the barriers that we hear about so often here in the state, whether it's transportation, the stories that we've heard from folks about being able to get their loved ones into the car to be able to show up in person for these appointments. I think I'm very much in support of this bill and very grateful that we have this offering here in the state of Vermont. I wish it was there for my own grandfather who passed away from Lou Gehrig's disease. It was a really hard time. It was not comfortable for the family. It was not comfortable for him. And yeah, I'm very proud of the work that has been done here to update this and thankful for folks who came before us to do this work. Can I make a motion that we support each, I mean, S, I forgot the number, 74, I would like to make a motion. There's a motion on the table that we support S74. Is there a second? Final second on the chair. There is a second by representative Small. Is there further discussion? Yes. Not to, is there a change in the agenda where this family member tomorrow is not coming? Correct. They're not okay. Okay. Because it turns out that family, it turns out the circumstances of that family member were not the same circumstances under discussion right now. And I just want to make sure. Yeah. Because I didn't want to cut people off. Absolutely. Thank you for clarifying that. I just want to really say, I really appreciate all the witnesses that we've heard from. This is my first experience with this. I remember when it was initially passed, I was happy and supportive of something like this available to our monitors. And I really appreciate the work that's been done to update the legislature and to make it more accessible for people. Thank you. The clerk shall begin to call the roll. Representative McFawn. You can't hear your chopper. Yes. Representative Wood. Yes. Representative Small. Yes. Representative Rosequist. No. Representative Garfano. Yes. Representative Whitman. Yes. Representative Payella. Yes. Representative Griguar. Yes. Representative Noyes. Yes. Representative Bromstead. Yes. Representative Pugh. Yes. On a vote of 1010 passes. Thank you, committee, very much. We will be reporting this on the floor. I will be the reporter of the bill. We will be reporting this next week on Wednesday and Thursday. And this has been a big morning, well, an emotional morning. And I would say that this ends our committee meeting this morning and we will come back at 1.15. Let me ask, will your event be over by 1.15? Not my event, so I don't know. I would expect. Yes. Okay, yeah. And at 1.15, we'll ask for some feedback, some updates in terms of how it went, in terms of the presentation of, to reach up bill below and where we've been trying, whether or not we've been able to get some witnesses for some other bills before us.