SENATE COMMITTEE ON HEALTH POLICY

January 23, 2003 Hearing Room B

1:00 PM Tapes 4 - 6

MEMBERS PRESENT: Sen. Bill Morrisette, Chair

Sen. Bill Fisher, Vice-Chair

Sen. John Minnis

Sen. Frank Shields

Sen. Charles Starr

Sen. Vicki Walker

STAFF PRESENT: Marjorie Taylor, Administrator

Saranelle Allen, Committee Assistant

MEASURE/ISSUES HEARD : Informational Meeting

These minutes are in compliance with Senate and House Rules. Only text enclosed in quotation marks reports a speaker’s exact words. For complete contents, please refer to the tapes.

TAPE/#	Speaker	Comments
Tape 4, A
003	Chair Morrisette	Calls meeting to order at 1:04 p.m. and opens information meeting on Overview of Health and Mental Health Services. Introduces invited witnesses.
INFORMATIONAL MEETING
007	Grant Higginson, MD, MPH	State Public Health Officer. Gives an overview of Public Health and Mental Health Services on the State side. Introduces Ann Brand to review the Mental Health side.
016	Higginson	Begins with a review of what Public Health services are in Oregon, with the primary reason to prevent health issues. Asks for committee to consider his offices a health agency with wide range of responsibilities. Elaborates on areas of human death, and how it impacts public health.
089	Sen. Minnis	Asks if a chart is available on cause of deaths in the U.S.
090	Higginson	Replies that he will see that Sen. Minnis receives one.
104	Higginson	Reviews Mission/Goals of the Public Health Department, and advises this framework is part of a bill being prepared for submission this year.
141	Higginson	Reviews organization of Health Services, and advises a major reorganization has taken place.
173	Chair Morrisette	Asks Dr. Higginson to return on another occasion to assist the committee in understanding the new organization, and requests a hard copy of his presentation.
174	Higginson	Agrees to request, and reviews the recent budget. Reviews percentage of availability of funds for the Department.
200	Sen. Minnis	Asks what the relationship of these dollars is to local public health.
201	Higginson	Replies with explanation of how money is delegated.
224	Chair Morrisette	Asks for an example of direct state services as opposed to county services.
230	Higginson	Responds regarding specific direct services, using environmental services as an example.
240	Chair Morrisette	Asks if he could have that information breakdown as well.
244	Higginson	Reviews Oregon’s Public Health System, and relationships with smaller groups and organizations, specifically local health departments.
		Advises that the state level is very small.
275	Higginson	Reviews areas of Bio-Terrorism and Preparedness for Public Health Safety, after 9/11, and the anthrax scare. Explains upgraded preparedness in the state for such response.
304	Sen. Minnis	Asks what the assumptions were in respect to hospital preparedness, and related queries.
317	Higginson	Responds with need for regional support.
322	Sen. Minnis	Asks question on capability of Salem Hospital being prepared.
324	Higginson	Advises department is working statewide on preparing hospitals, and financially will experience shortfalls. Hospital support is being considered by the Federal Government.
347	Chair Morrisette	Wanted to know which Regional hospitals, and will there be planning and regional training.
366	Higginson	Replies regarding procedures currently in place. Didn’t feel biologically the State was very prepared, and that was the current focus area. Reviews Focus Areas of the Federal BT Preparedness Grants.
Tape 5, A
020	Sen. Minnis	Asks where the money is for training first responders.
065	Higginson	Responds with further details on the financial breakdown. Reviews getting dollars at local and Federal levels.
068	Sen. Minnis	Comments on having equipment but no training, feels bureaucracy gets ahead of themselves.
075	Higginson	Responds that some clinic training on handling a smallpox outbreak has taken place.
082	Chair Morrisette	Questions getting rural areas trained, and subsequent costs.
092	Higginson	Replies regarding awareness of this issue.
110	Ann Brand	Administrator, Office of Mental Health & Addiction Services. Gave out Overview of Public Health and Mental Health Services. (EXHIBIT A)
139	Brand	Provides overview of current systems prior to the new budget constraints. Actions are not yet finalized, so information will be primarily what was, and not what will be. Reviews variety of chronic mental health areas of responsibility for Mental Health Coverage.
161	Sen. Minnis	Question on numbers in hospitals, and what hospitalization types are being discussed.
173	Brand	Replies it was people who had been admitted to Community hospitals and further reviews details on charts, specifically how funds are directed.
204	Chair Morrisette	Raises questions on what procedure is in place to assist mental health clients when economic downturns are happening and impact liabilities.
225	Chair Morrisette	Further raises question on working with insurance carriers to mitigate some of the rates, lack of insurance, or assistance, possibly develop some sort of a pool.
243	Brand	Responds that she shares his concern and will check into assistance with insurance alternatives.
254	Sen. Walker	Raises question on changing particular clients from one environment to another, (primarily forensic patients) at a lesser cost than currently being spent, per an email she received from a medical provider.
	Brand	Asks if she could get a copy of this email from Sen. Walker to be able to reply. Would hope to identify who these patients are the email writer is concerned about.
277	Sen. Walker	Asks what a forensic patient is.
278	Brand	Replies it is a patient who has been adjudicated as having committed a crime and is mentally ill.
283	Brand	Reviews some problems in forensic situations to handle housing costs.
288	Chair Morrisette	Asks if this is the worst kind of insurance risk.
300	Brand	Requests a copy of the email from Sen. Walker.
301	Sen. Minnis	Asks if anyone is looking into the state indemnifying some of these facilities, and possibly self-insuring some of these cases.
310	Brand	Replies, as far as she knows, no one has.
384	Brand	Reviews further problems with these client’s ‘spend-down’ eligibility for these funds. Lots of factors now coming into play on being able to operate the system. Brand continues her wrap-up on current challenges.
438	Sen. Minnis	Asks if we’ve ever thought about indemnifying these groups and to see how liability effects local budgets, and if the state could look at that for costs savings.
444	Brand	Expresses concern for the health crisis on the horizon, and feels more accountability is needed within the system.
448	Chair Morrisette	Asks if outcomes are based on measurable performance goals.
452	Brand	Concurs.
455	Sen. Minnis	Asks who takes data, sampling on each occurrence of mental illness in our communities.
570	Brand	Response is that Survey Data is used for sampling, but also has an analysis evaluation unit that uses the most recent epidemiologic data.
572	Sen. Minnis	Asks if there is anything unique about Oregon in mental illness as compared to other states.
582	Brand	Some things are unique to the youth, but not in terms of the adult population, and there is a high incidence of suicide.
Side 4, B
52	Higginson/Brand	Suicide not only in Oregon but other states of the Northwest, and the feeling is that it’s more related to income than geographic area.
56	Sen. Walker	Comments on health assistance some years back when Senator Fisher was chair of the Health Committee and helped with getting a bill passed to set up a Youth Suicide coordinator who works with the Health Department. She feels we’ve done a very good job at Suicide Prevention in our state.
63	Brand	Suggests review final pages in back of packet on what an ideal system would look like.
65	Chair Morrisette	Thanks Ann, and advises would have her back.
67	Vice-Chair Fisher	Asks question on suicides happening on recent letter sent out, wanted to know if there was any data in Higginson’s office, and whether unusual in this instance. Expresses would like to be able to verify or put it to rest.
87	Brand	Said she knew of 3 suicides – one may be related to recent letter, still doing an investigation on whether any of the other is true. She will be glad to forward any reports that she receives.
97	Vice-Chair Fisher	Just would like verbal, and not necessary for any paper.
98	Brand	Thanks Senator for the inquiry. Said as far as she knew only 3.
101	Chair Morrisette	Welcomes local Public Health guests: Dr. Alan Melnick, MDMP – Clackamas Health Dept. and Karen Gillette, Chair, Coalition of Local Health Officials.
115	Dr. Alan Melnick	Introduces self and addresses several questions from Sen. Minnis on issues in relation to Bio-Terrorism, and Chair Morrisette on questions on designated hospitals.
137	Melnick	Gives response and current plans on above two questions, on preparedness in Oregon.
156	Melnick	Advises there are still major funding shortfalls from Federal Government, but more time is now being spent on preparing for bio-terrorism. States there are still financial gaps due to the problem of staff shortages. Reviews other areas of shortages for medical help.
205	Chair Morrisette	Asks Dr. Melnick to supply some written information on ‘gaps’ in what isn’t being met. He felt this was essential information that could be of value to committee.
210	Sen. Walker	Asks question on whether or not long time small pox vaccination is still of value.
212	Melnick	Advises she is at risk and also advises risk of taking today’s vaccination due to side-effects.
244	Sen. Walker	Thanks for information.
250	Karen Gillette	Chair, Coalition of Local Health Officials and Program Manager of Lane County Health. (EXHIBIT B) Reviews services of Public Health Authority, and public health as an assurance system.
371	Chair Morrisette	Asks question on West Nile Virus preparedness for animals.
378	Melnick	Explains how the virus is transmitted and vaccination of animals does not protect the human populace.
385	Gillette	Reviews information on coordination of mental health and communicable diseases.
430	Chair Morrisette	Welcomes Sharon Guidera
440	Sharon Guidera	Executive Director of Mid-Columbia Center for Living (EXHIBIT C)
Tape 5, B
56	Guidera	Reviews impact of recent cuts being proposed. Also reviews who and what is classed as mental illness.
93	Guidera	Wrap-up by reading a letter from a CEO of Mid-Columbia Center.
112	Jeff Davis	First Vice President of the Association of Oregon Community Mental Health Programs, and also the Administrator of Marion Co. Health Department in Salem, OR.
	Davis	Further elaborates on issues expressed by Ann Brand, and Sharon Guidera. Reviews various issues in the current system and advises problems with geographic locations between patients and family.
	Davis	Mentioned that new medications were really helping and is very concerned about people who are losing this assistance.
137	Davis	States that currently in the PSRB Group Homes in Oregon, the state does provide liability insurance for these programs.
201	Chair Morrisette	Question on group foster homes within state.
	Davis	Discussed back and forth current rulings
220	Sen. Minnis	Comments on insurance for some group homes.
233	Davis	Further comments on group homes/how covered by various agencies.
245	Sen. Minnis	Felt state could provide some sort of incentive on coverage.
246	Chair Morrisette	Advises Mr. Davis he will be in touch. Chair reintroduced Grant Higginson to review patient safety.
254	Grant Higginson	Reviews document on Medical Error Prevention, (EXHIBIT D) and patient safety. Explains recent formation of a large coalition to add assistance. Explains that this group is working on developing legislation on patient safety.
425	Chair Morrisette	Raises several questions as to whether filers were involved and are there any models in place for use in our state. States he is glad to know we are focusing on patient safety. Asks for an explanation of the role of Higginson’s department.
445	Higginson	Stressed promotion of patient safety.
479	Scott Gallant	Director of Government Affairs for the Oregon Medical Association, and represents over 6600 physicians. Gives an overview of principles in public safety that the OMA believes in and adheres to. States this is not a new issue and they have been addressing it for some time. (EXHIBIT E)
Tape 6A
118	Sen. Minnis	Asks Dr. Higginson a question on how many people have died in the last year due to medical errors.
132	Higginson	States he currently does not have any numbers.
138	Sen. Minnis	Requests information on how families are advised in these deaths.
143	Dr. Gallant	Responds on current procedures in place, such as a “review” on patient death.
160	Sen. Minnis	Further conversation on information availability on medical errors/deaths.
184	Sen. Minnis	Responds further in dialogue on questions/replies on how many deaths are due to medical error, versus extremely poor health.
194	Higginson	Replies further to Sen. Minnis, that we do not currently have a reporting system to explain these deaths, preventable or not.
211	Vice-Chair Fisher	Expresses concern over what is a definition of human error.
274	Higginson	Expresses that systems could be further fine tuned to insure safety is more effective.
285	Gallant	States the need to prioritize what to focus on, and understand trends of patient safety.
345	Sen. Minnis	Further expresses disagreement that systems were not in place to correct medical errors.
357	Gallant	Gives further rebuttal, concerning wide ranging aspects and complexity of these problems.
386	Higginson	Feels goal similar.
395	Vice-Chair Fisher	Meeting adjourned at 3:18 p.m.

EXHIBIT SUMMARY

A. - Overview of Public Health and Mental Health Services, Ann Brand, 28 pgs.

B. - Public Health Authority, Karen Gillette, 3 pgs.

C. - Mid-Columbia Center for Living, and AOCMHP News, Sharon Guidera, 13 pgs.

D. - Medical Error Prevention Activities (OMA), Grant Higginson, 5 pgs.

E. - Senate Health Policy Committee Testimony and AMA Patient Safety Testimony,

Scott Gallant, 15 pgs.