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1 HOUSE OF REPRESENTATIVES COMMONWEALTH OF PENNSYLVANIA 2 * * * * 3 House Bill 1692 4 Involuntary Treatment for Drug & Alcohol Addiction 5 * * * * 6 House Human Services Committee 7 Capitol Building 8 East Wing, Hearing Room 60 Harrisburg, Pennsylvania 9
10 Thursday, June 23, 2016 - 9:00 a.m.
11 --oOo--
12 COMMITTEE MEMBERS PRESENT: 13 Honorable Gene DiGirolamo, Majority Chairman 14 Honorable Russ Diamond Honorable Joe Emrick 15 Honorable Tom Murt Honorable Eric Nelson 16 Honorable Jason Ortitay Honorable Tom Quigley 17 Honorable Mark M. Gillen Honorable Jack Rader 18 Honorable Brad Roae Honorable Craig Staats 19 Honorable Judith Ward Honorable Ryan Warner 20 Honorable Parke Wentling Honorable Martina White 21 Honorable David Zimmerman Honorable Jason Dawkins 22 Honorable Michael Driscoll Honorable Stephen Kinsey 23 Honorable Dan Miller Honorable Eddie Day Pashinski 24
25 1300 Garrison Drive, York, PA 17404 717.764.7801 Key Reporters [email protected] 2
1 INDEX OF TESTIFIERS
2 TESTIFIERS PAGE
3 Opening remarks by Majority Chairman 4 DiGirolamo...... 4
5 Opening remarks by Representative Readshaw 6
6 Doctor Rachel Levine, Physician General 8
7 Deb Beck, President...... 14 Drug & Alcohol Service Providers 8 Organization of PA
9 Dennis Troy, Mayor...... 29 Brentwood Borough 10 David Freed, District Attorney...... 36 11 Cumberland County
12
13 SUBMITTED WRITTEN TESTIMONY
14 Gary Tennis, Secretary PA Dept. Of Drug & Alcohol Programs 15 Michele Denk, Executive Director 16 PA Association of County, Drug & Alcohol Administrators 17
18 (See other submitted testimony and handouts online.) 19
20
21
22 INDEX OF REQUESTED DOCUMENTS OR INFORMATION
23 Page Line Page Line Page Line 24 (None) 25
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1 MAJORITY CHAIRMAN DiGIROLAMO: Good
2 morning, everyone.
3 (Good morning response).
4 MAJORITY CHAIRMAN DiGIROLAMO: I'd like
5 to call this meeting of the Human Services
6 Committee to order and ask everyone to stand for
7 Pledge of Allegiance.
8 (Pledge of Allegiance occurred off the
9 record).
10 MAJORITY CHAIRMAN DiGIROLAMO: Okay. In
11 lieu of taking roll call, I might let the members
12 just go around and say hello, and let everyone know
13 where they're from. I might start with Jay.
14 REPRESENTATIVE ORTITAY: Representative
15 Jason Ortitay, 46th District, Allegheny and
16 Washington counties.
17 REPRESENTATIVE WARD: Judy Ward, 80th
18 District, Blair County.
19 REPRESENTATIVE RADER: Jack Rader, 176th
20 District, Monroe County. Hello.
21 REPRESENTATIVE ZIMMERMAN: Dave
22 Zimmerman, the 99th district. That's the northeast
23 part of Lancaster County.
24 REPRESENTATIVE QUIGLEY: Tom Quigley,
25 the 146th District, Montgomery County.
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1 REPRESENTATIVE STAATS: Craig Staats,
2 Bucks County.
3 REPRESENTATIVE MURT: Tom Murt,
4 Philadelphia and Montgomery County.
5 REPRESENTATIVE NELSON: Good morning.
6 Eric Nelson, Westmoreland County.
7 MAJORITY CHAIRMAN DiGIROLAMO: Gene
8 DiGirolamo, Bucks County, 18th district.
9 REPRESENTATIVE PASHINSKI: Good morning.
10 Eddie Day Pashinski, Luzerne County.
11 REPRESENTATIVE WENTLING: Parke
12 Wentling, portions of Lawrence, Mercer, Crawford
13 and Erie counties.
14 REPRESENTATIVE DRISCOLL: Good morning.
15 Mike Driscoll, Northeast Philadelphia.
16 MAJORITY CHAIRMAN DiGIROLAMO: Okay.
17 Our hearing today, really an important issue. Just
18 a couple ground rules.
19 I understand, first, the cameras are on
20 and PCN is covering this live. Also, I'm going to
21 let the testifiers testify first. And then if we
22 have time at the end of the meeting, we will open
23 it up for questions and answers from the members.
24 We're scheduled to be here for two
25 hours. It is my hope that we can get this finished
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1 closer to an hour than two hours. Very busy time
2 for everybody around the Capitol. We got a really,
3 really good turn out today. There's something
4 called the budget I think we gotta work on today,
5 tomorrow or pretty soon. I just wanted to let
6 everybody know that.
7 Also, a couple more members have joined
8 us. Brad, do you wanna just say hello?
9 REPRESENTATIVE ROAE: Good morning.
10 Representative Brad Roae from Crawford and Erie
11 County.
12 REPRESENTATIVE DIAMOND: Representative
13 Russ Diamond, eastern Lebanon County, 102nd
14 District.
15 MAJORITY CHAIRMAN DiGIROLAMO: With
16 that, today's -- The hearing is on the involuntary
17 treatment for alcohol and drug addiction. And,
18 again, the important issue, especially with the
19 opiate and the heroin crisis that we are
20 experiencing in every one of our districts and all
21 across the State of Pennsylvania, this is a crisis.
22 A lot of people have different ideas how to address
23 this crisis and this problem.
24 Representative Readshaw is here with us
25 today, and I might ask Harry to come up. It is
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1 Harry's bill that we're doing the hearing on. It's
2 House Bill 1692. So, I would like to recognize
3 Representative Readshaw for a brief description or
4 explanation of what the bill is trying to
5 accomplish.
6 REPRESENTATIVE READSHAW: Thank you very
7 much, Mr. Chairman. I'd like to thank you,
8 obviously, and both the Majority and Minority
9 Chairs and the committee for having this hearing
10 today.
11 I won't belabor the point of what the
12 legislature is attempting to do. I'm sure
13 everyone's familiar with it, involuntary treatment
14 for drug and alcohol addiction. I would like to
15 say that this is not a first. In Kentucky and Ohio
16 had been signed -- similar legislation has been
17 signed into law. It's referred to as Casey's Law.
18 And in Indiana and Florida, similar legislation has
19 been introduced and passed into law. It's referred
20 to by Jennifer's Law.
21 I must also mention that former
22 Representative Louise Bishop began a similar effort
23 in 1990 and was never successful, or the
24 legislation was never considered. So, obviously,
25 here we are again in an attempt to allow a family
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1 to intercede in the hope of saving a life. Like
2 the Chairman said, if I may just do a little
3 editorial to maybe emphasize how important this is.
4 The incident in Florida, Orlando, where
5 49 people were killed, that was very, very tragic.
6 We all admit that, and it's a deep concern to
7 everyone. On that same day, probably more than 200
8 people overdosed in the United States of America
9 and we heard nothing.
10 So, just to put it in perspective, this
11 is an extremely serious problem. I know a lot of
12 my colleagues have legislation in an attempt to
13 bring about recommendations or resolutions to the
14 matter. But, I suppose if anyone walks out of this
15 room today, I would just like to emphasize how
16 important this is.
17 Thank you very much for your time.
18 MAJORITY CHAIRMAN DiGIROLAMO:
19 Representative Readshaw, thank you. Thank you for
20 your ongoing interest in this issue.
21 To bring to the members' attention, in
22 your packets there are written testimony from Gary
23 Tennis, who is the Secretary of the Department of
24 Drug and Alcohol Programs; and also from Michele
25 Denk, who is the Executive Director of the PA
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1 Association of County, Drug and Alcohol
2 Administrators. Some of you know 'em as your
3 county SCAs.
4 With that, I'd like to bring our first
5 testifier up, and that is going to be -- We're very
6 happy to have Doctor Rachel Levine, who is the
7 Physician General for the State of Pennsylvania.
8 Rachel, welcome.
9 DOCTOR LEVINE: Thank you very much,
10 sir.
11 MAJORITY CHAIRMAN DiGIROLAMO: And you
12 can begin whenever you're ready.
13 DOCTOR LEVINE: So, you have my written
14 comments, but I would love the opportunity to just
15 kind of summarize some of the important points.
16 So, good morning, Chairman DiGirolamo,
17 and to Chairman Cruz, who I know is not here. And
18 I would like to thank the committee for the
19 opportunity to come here today to comment and
20 discuss House Bill 1692, and the care and treatment
21 for individuals that abuse opioids.
22 So, it's well-known the scope of this
23 crisis. The Pennsylvania Coroner's report
24 indicated that almost 2500 individuals had lost
25 their lives to overdoses in the Commonwealth, and
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1 the 2016 report has every indication that it's
2 going to be worse.
3 Some of the best tools that we have to
4 address this epidemic are prevention and education.
5 So, with the Department of Drug and Alcohol
6 Programs, and the Department of Health and other
7 departments, we're working to address this. So
8 we're working with the Pennsylvania Medical Society
9 and other stakeholders on prescribing guidelines;
10 on continuing medical education for physicians and
11 other providers. We're working with the medical
12 school deans as well on education for medical
13 students to try to have less opioids being
14 prescribed in the Commonwealth for acute and
15 chronic pain.
16 One of the largest challenges that we
17 have is, we face this epidemic is lack of access to
18 care, and that includes challenges in terms of
19 capacities for drug addiction treatment whether you
20 talk about inpatient treatment; whether you talk
21 about outpatient treatment, or medication-assisted
22 treatment.
23 House Bill 1692 really has the best of
24 intentions, but we're concerned about unintended
25 consequences that could be detrimental to the
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1 overall care and treatment of individuals with
2 substance abuse. So both the Department of Health
3 and the Department of Drug and Alcohol Programs
4 have concern from a number of points of view about
5 involuntary commitment of individuals with
6 substance abuse disorder.
7 One is the possibility of having
8 unintended distrust of the treatment system that is
9 designed to help patients struggling with
10 addiction; the concerns around criminalizing those
11 who refuse treatment, which might reinforce the
12 stigma associated with this condition, and would
13 then, not necessarily, improve the clinical
14 outcomes.
15 One of the challenges that I know well,
16 having done a lot of mental health treatment in my
17 career, would be the logistical challenges of
18 committing somebody for up to 72 hours in the
19 health care system. So, if you have think about
20 this, inpatient floors and emergency departments
21 are very busy as they are.
22 And so, if you commit somebody, it's
23 going to be very difficult to keep them in the
24 emergency department. It's going to be very
25 difficult to commit them to the medical unit
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1 because those are unlocked units. If you're
2 committing someone for involuntary treatment, they
3 have to be in a locked supervised unit; otherwise,
4 they'll walk out.
5 So, if you put them in a locked adult
6 psychiatry unit, it really isn't the proper place
7 for someone struggling with addiction in terms of
8 -- in terms of treatment; but also, we have
9 difficulties with access to mental health benefits.
10 So, without an investment in creation
11 for a new system, for new facilities in the
12 hospitals, I think it's gonna pose significant
13 logistical challenges for hospitals to implement
14 this type of procedure. They really would have to
15 have some type of locked unit in a hospital. Some
16 hospitals might have 5 or 10 patients a day in the
17 emergency department with overdoses. So you can
18 think of, if they're all committed for 72 hours,
19 where are those patients going to go without severe
20 logistical challenges in the system?
21 House Bill 1692 would also place,
22 unfortunately, financial strain upon families that
23 -- requiring the security deposit and other
24 associated costs, and many of those -- these
25 families really do not have the means to do that.
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1 We do have the ability, as physicians,
2 under the Mental Health Procedures Act to commit
3 people to care, and rarely, and even in the course
4 of my clinical work, I have done that for someone
5 who posed a threat to them. So, it is possible to
6 commit -- for physicians to commit patients to
7 treatment now, and we do that on a very selective
8 basis. Doing that on a larger basis for everyone
9 that arrives with an overdose, again, would be --
10 would be challenging.
11 So, Pennsylvania needs more treatment
12 providers. We need treatment that is affordable;
13 that is available; that has excellent access to all
14 the modalities of treatment, which includes
15 inpatient, abstinence-based treatment, but also
16 includes medication-assisted treatment for those
17 suffering from opioid use disorders.
18 So, the most critical step, then, is for
19 us to work--and we're working on this--quote
20 unquote, warm hand-off. It means, if someone comes
21 to the hospital after an overdose or comes for
22 treatment, that we have a facilitated referral into
23 the treatment facilities that exists. Remember as
24 well is that, addiction -- outpatient -- inpatient
25 addiction facility, such as rehab facilities,
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1 residential facilities, they're not locked, so
2 there's no way to commit somebody to rehab.
3 There's no locked units to do that in.
4 So, if we have this warm hand-off where
5 we work very closely with the patient in the
6 emergency department on getting their acceptance of
7 the necessity for treatment, we need professionals
8 to do that, and the Department of Drug and Alcohol
9 Programs has, really, a list of different
10 possibilities of five or six that each Single
11 County Authority can do, but they have to have a
12 plan to see patients in the emergency department to
13 convince them -- to work with them and convince
14 them to go into treatment.
15 We're also working on warm hand-off
16 guidelines, standards of care for the emergency
17 department physicians about how to do that warm
18 hand-off; a clinical pathway for the physicians in
19 the emergency departments.
20 So, I would like to thank the prime
21 sponsor, Representative Readshaw, and all the
22 cosponsors and the committee, for your partnership,
23 for your leadership, for working on this critical
24 public health issue.
25 And I guess I'm happy to answer any
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1 questions now or in the future.
2 MAJORITY CHAIRMAN DiGIROLAMO: Thank
3 you, Doctor. Would you mind staying for a little
4 bit so we can ask questions afterwards --
5 DOCTOR LEVINE: Sure.
6 MAJORITY CHAIRMAN DiGIROLAMO: -- if
7 that's possible?
8 DOCTOR LEVINE: That will be absolutely
9 fine. Thank you, sir.
10 MAJORITY CHAIRMAN DiGIROLAMO: You're
11 welcome. Thank you for your testimony.
12 Next up we have Deb Beck, who is the
13 President of the Drug and Alcohol Service Providers
14 Organization of Pennsylvania. Welcome, Deb.
15 MS. BECK: Thank you very much.
16 MAJORITY CHAIRMAN DiGIROLAMO: Before
17 you start off, I would also like to recognize
18 Representative Stephen Kinsey, who's joined us,
19 from Philadelphia County.
20 MS. BECK: Good morning. I want to
21 thank the committee --
22 (Sneeze from audience).
23 MS. BECK: Bless you. Bless you, bless
24 you, and Or -- Orit (phonetic), can you say your
25 name for me?
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1 REPRESENTATIVE ORTITAY: Ortitay.
2 MS. BECK: I was really confused when
3 you were wearing Representative Rader's -- I can't
4 tell you two apart somehow. You could really mess
5 with everybody's minds by moving these around.
6 I really appreciate you taking a look at
7 this, and I want to start by thanking
8 Representative Readshaw for picking up the baton
9 from Louise Bishop. This is not an easy issue, but
10 it's one I think you need to wrestle with.
11 I often have ideas on what to do. I'm
12 not clear what to do on this, but I can give you
13 some background as a clinician that might be
14 helpful to your deliberations. So I thank you. I
15 thank the Chairman and the committee for having
16 this hearing.
17 I've been in the treating field since
18 '71, so I'm going to give you a clinician's
19 perspective. It may not be quite proper. When I
20 was working rehab day at a time, I never saw a
21 voluntary admission. I will tell you, I've never
22 heard of a voluntary admission. I want to spend a
23 moment and tell you what I mean by that.
24 President Ford's wife, Betty Ford -- Now
25 that we've all gotten older I have to say President
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1 Ford's wife, Betty Ford, because a couple classes
2 of kids didn't know who I was talking about, who
3 brilliantly broke her anonymity not only about
4 breast cancer, but about her personal recovery from
5 drug and alcohol problems. Her story includes
6 having to have several interventions. In our
7 field, Jerry Ford makes our hearts beat warmly
8 because the family staged interventions. They
9 staged interventions until she went for treatment,
10 and they saved her life.
11 So I want to say, again, I never met a
12 voluntary admission. In the treatment field, we
13 get in the habit of turning the person around when
14 they come in to see whose foot is on their
15 backside, because we may need that loving foot
16 reapplied multiple times as denial and stigma
17 reassert themselves.
18 Now, who might that be? That's kind of
19 facetious to say I've never a voluntary admission.
20 But, usually, somebody or something intervene
21 forcibly. It might be the wife; it might be the
22 husband; it might be the doctor; it might be the
23 employer who said, you can have this job as long as
24 you get clean. But until you do, very lovingly use
25 that force.
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1 The warm hand-off material, the -- I
2 always call her Doctor Rachel. Sorry -- that
3 Doctor Rachel speaks about is a great idea coming
4 from the Department of Drug and Alcohol. If you're
5 in the hospital and you've overdosed, you need
6 treatment. If you managed to overdose on a drug
7 and alcohol problem, get reversed in a hospital,
8 you're gonna need treatment.
9 So, to have somebody there -- Your
10 Single County Authorities in every county are
11 working on various strategies, but I don't even
12 want to go into those because she knows, and every
13 one is a little different, as it should be. They
14 should be tailored to the need of your county.
15 That makes perfect sense. Try to set the hawk to
16 get the patient to make the next step.
17 We -- People -- I mean, have you ever
18 known anyone to go into a public domain and say,
19 hey, guess what? I'm an untreated drug addict.
20 Right? Or, hey, guess what? I'm an alcoholic.
21 When I did clinical training in my
22 detox, I used to say, if someone came to a detox
23 and said that, they probably have a mental illness
24 of some sort, because it's not -- men and women
25 don't like to say, I have an addiction. It's
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1 something you don't get rewarded for saying. So
2 it's very hard for people to seek help; very, very
3 hard.
4 We actually negatively tell the people,
5 we tell them, no, you don't have a problem. You
6 just drink a little bit, or you just have a bit of
7 a drug problem, and it's because families think
8 it's a moral on their failing. It's not their
9 failing. The physical addiction of addiction is
10 not a moral failing; no family set up to addict
11 their kid or their husband or wife. So, enough of
12 that.
13 I've listed on my short testimony a
14 whole bunch of kinds of interventions. If you need
15 information on any of them, let me know.
16 There are formal family interventions.
17 That's what happened with Betty Ford. Those are
18 available in the State of Pennsylvania. There are
19 not enough family interventionists. It's very time
20 consuming. This is terribly hard on families; very
21 hard on the interventionists. It takes hours and
22 hours. But there are family interventions in
23 Pennsylvania who will do that; work with you.
24 If you watch on TV how to do an
25 intervention, I get scared to death, because if it
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1 hasn't been set up with the next step, then after
2 the person's ready to go, somebody can't take them
3 somewhere, I worry about the outcome. So I would
4 -- There are family interventionists. There aren't
5 enough, but they're out there.
6 Student-assistance programs have grossly
7 lost ground in PA due to funding, but they were
8 doing interventions in the schools with troubled
9 kids. These are usually much lower key and a
10 little more comfortable.
11 Employee assistance programs. Employee-
12 assistance programs in the work force, many, many
13 years ago, heavy industry came up with employee-
14 assistance program, so that, if I'm causing damage
15 to the equipment, or possibly to you on the line,
16 you could refer the person to the EAP to do an
17 intervention; figure out what the person needs;
18 send them back into treatment of whatever sort is
19 appropriate and then back to the workforce. That's
20 a good thing. That saves costs and retraining.
21 You have skilled employees. Some of your best
22 employees are people in recovery on the line.
23 And, by the way, if you hire people in
24 good recovery, they're going to drive out the
25 untreated addicted people because they can't stand
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1 to have them near them. Or they can, but they'll
2 take them out to an AA or NA meeting later and
3 start to help them begin a recovery.
4 A little bit of Act 106 of '89, that's
5 the insurance law for all group health plans here
6 in PA. It has coverage in it for family
7 interventions and also family treatment. To my
8 knowledge, that bill became law in '89. I don't
9 think anyone has used it. So we have an education
10 problem that, perhaps, this hearing will help us to
11 get the word out. There is a way you get some
12 funding for family interventions.
13 I mentioned DUI and other --
14 drug-coordinated and other criminal justice
15 interventions. Many of the laws on the books, you
16 long ago have wisely connected that if I have an
17 addiction, that in addition to whatever criminal
18 justice sanction, I'm going to need to go to
19 treatment. That makes sense to me.
20 I have many friends today, by the way,
21 who are sober and clean because of a court
22 intervention; because the criminal justice system
23 lowered the boom, but also had enough sense to
24 require treatment as part of that sentencing.
25 Putting people in jail doesn't solve an addiction.
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1 Giving people a new house doesn't solve an
2 addiction. But if you put somebody in jail and do
3 treatment, there is recovery. We need you to get
4 them to sit still long enough for us to do the work
5 with them.
6 I also want to plead with you, we really
7 need you to cut-off supply. Please, anything you
8 can do to cut off supply. We have too much -- The
9 drug and alcohol field is overwhelmed with people.
10 We can't begin to handle what we've got. Anything
11 you can do to cut off supply would be greatly
12 appreciated.
13 I want to move on quickly to resources.
14 We do not have locked facilities. We do not.
15 That's one of the problems we have. That's an
16 issue. So, if you're going to involuntarily commit
17 -- Now, I would -- I would like us to try to set
18 the hawk and maybe keep you from needing to
19 involuntarily commit.
20 However, I will tell you that
21 court-ordered treatment works, if the person can
22 sit still long enough to learn about the addiction
23 and make some changes. And that, in a way, that's
24 a form of involuntary commitment. But if they go,
25 they go. We don't have locked facilities.
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1 Medicaid expansion has been a boom. It
2 really has provided coverage for more single adults
3 with no dependents. Sometimes they're a part of
4 that group that we're talking about here.
5 The prescription drug monitoring is
6 gonna make a difference over time. You're gonna
7 crack down on this. I'm very grateful for the work
8 you've all done there.
9 Narcan you've all done -- The physician
10 guidelines coming out of Doctor Rachel's office and
11 out of DDAP will help. But your treatment field is
12 down about almost $12 million over the last 9 or
13 10 years, and it's overwhelmed with all these new
14 referrals. Two-thirds of the referrals we get are
15 not heroin or opiates, and some of the demand for
16 those services are up, and now we have this whole
17 new demand that's related to opiates.
18 I want to say briefly, treatment works.
19 Every so often I find out treatment doesn't work,
20 and that comes a shock to the thousands of
21 Pennsylvanians in recovery today. I get phone
22 calls at overnight. I get phone calls from people
23 crying over the last week or so saying, why don't
24 people get this.
25 Yes, the support of the 12 Steps Program
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1 helps, after treatment or during treatment. The
2 treatment works. There's thousands of families
3 who's gotten sober. I think it's really important
4 to tell families, people do get clean. It works,
5 but it's hard work. It's devastatingly hard work
6 for the families.
7 Yesterday there was some confusion over
8 detox. We have a huge hole in the system. I think
9 I'm quoting this right and, hopefully, the
10 Department of Drug and Alcohol Programs will
11 correct later if I misstate it. I believe what
12 they said in your prior hearing, Mr. Chairman, that
13 they surveyed all their detoxes, and 49 percent of
14 them reported being full and turning away one or
15 two a day seven days a week.
16 So, the front end, if you involuntarily
17 commit me, I'm going to need detox and rehab that
18 follows that as well. We have a resource problem.
19 You all didn't create this. We're just, it's a
20 confluence of the field being shaky, the heroin
21 problem being overwhelming, and we know what to do
22 but we're really struggling.
23 Kind of a couple of things in closing.
24 We need you to enforce the current laws. We have
25 some pretty good laws for insurance coverage here
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1 in the State of Pennsylvania and Medicaid. They
2 need to be enforced. They have not been enforced.
3 It's like bridge infrastructure. I'm feeling
4 really -- I'm feeling old because my whole pitch
5 lately is infrastructure. You know, fix the
6 bridge.
7 I was told a joke the other day. I saw
8 a comedian say, an older woman who's doing comedy
9 who said, you know you're old when your family care
10 physician is a paleontologist. So, I'm beginning
11 to feel old.
12 I would like to see the infrastructure
13 enforced. You have good insurance laws. We have
14 the Mental Health Parity Act. You heard Patrick
15 Kennedy in here. If we'd get that enforced,
16 there'd be more resources, which would help. We'd
17 also love to see the health plan be asked to create
18 an addendum on how to access your plan.
19 By the way, the other half of the
20 detoxes were saying they couldn't figure out how to
21 help people access the coverage they already had.
22 We would love to see some activity on that.
23 And finally, in closing, just please
24 continue -- Don't think for a second there's a
25 division between the treatment field and law
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1 enforcement. We need you to cut the supply; the
2 supply of opiates. I'm talking about the
3 prescription opiates that's driving the heroin
4 problem. We've got to cut the supply. We can't
5 handle what we've got.
6 I hope this is helpful to you. There
7 are intervention services. Forced treatment does
8 work. I've reviewed all the literature on it.
9 Criminal justice forced treatment works, if the
10 person then gets treatment. The problem is, they
11 often do not.
12 Thank you for your time.
13 MAJORITY CHAIRMAN DiGIROLAMO: Okay.
14 Thank you, Deb.
15 Before you leave, I'm not even sure if
16 you know this, but there's going to be, I think a
17 press conference today. Secretary Ted Dallas is
18 going to make an announcement on something. Me and
19 you --
20 MS. BECK: Yep.
21 MAJORITY CHAIRMAN DiGIROLAMO: -- and
22 Secretary Gary Tennis have been working on for a
23 number of years. And we all know that the prison
24 population is made up of anywhere from 70 to
25 80 percent of people who are there because of their
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1 drug addiction and the crimes that they committed.
2 One of the problems, and because of this
3 recidivism rate, is that, when people are released
4 from prison, whether it be state prison or our
5 county prisons, they might not have gotten drug and
6 alcohol while they're in prison. They might have
7 mental health issues and have been getting
8 medication while they're incarcerated. And once
9 they're released, they have no medical insurance;
10 no access to their medications; no ability to get
11 into drug and alcohol treatment.
12 And me, Deb and Gary Tennis have been
13 working on for years to try to come up with a
14 system that might be able to get people eligible
15 for Medicaid, whether traditional or expanded
16 Medicaid, so when they're released from prison,
17 they have that medical insurance and the back-up to
18 get drug or alcohol treatment or get their
19 prescriptions for their mental health issues.
20 So, I believe there's going to be an
21 announcement today by the Secretary, Ted Dallas,
22 that they figured a way to do this. My
23 understanding is, it's only going to be initially
24 for, if they had Medicaid when they were in the
25 prison, that it would be suspended so it can be
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1 turned on as soon as they're released.
2 I would like to see it go a little bit
3 further and have, like, a predetermination for
4 everybody before they're released to see if they do
5 qualify. I think that's really, really important
6 to do. And I think we can really cut down on the
7 recidivism rates. So I think that's starting to
8 happen. I know you're happy because I know you've
9 worked on that for a long time.
10 MS. BECK: Thank you for reminding me of
11 that. Can you imagine being diabetic and coming
12 out of prison and have no coverage? But, in this
13 case, if you were involved in a drug and alcohol
14 related offense and you come out with no coverage
15 to continue your treatment. That's a really
16 important thing.
17 You also prompt me -- I was prompted to
18 mention something else here today by one of the
19 members. There's a confusion about involuntary
20 commitment regarding kids. Now, Senator Pat Vance
21 years ago got through an involuntary commitment
22 bill for 18 -- I think it's 18 and under. You have
23 to check me on the age. So that's in place.
24 But also, there's a -- out in the world,
25 out in the hustings, there's an idea that a parent
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1 can't take their kid to treatment and make them go.
2 Yes, they can. I think it's mental health -- the
3 mental health law I think doesn't allow that. Drug
4 and alcohol, absolutely, make sure parents know,
5 they can get their kid by the scruff of the neck,
6 hopefully lovingly, and take them to treatment, and
7 they do not need the permission of the kid. The
8 kid does not need to consent to treatment.
9 The law reads the other way. The law
10 reads the other way. A kid can go to treatment
11 without the permission of their parents. What that
12 is about is, sometimes a really embarrassed kid
13 doesn't want mom or dad to know yet, but starts to
14 go to the outpatient clinic in the school or go to
15 a professor in the school, and they need to be able
16 to do that without warning that you're going to
17 call the parent right away and get them in trouble.
18 Now, all treatment programs work to get
19 the parent involved as soon as you can, because, of
20 course, the healing can't occur, unless the parent
21 is the source of the drug. Then that's a different
22 matter.
23 Thank you.
24 MAJORITY CHAIRMAN DiGIROLAMO: Okay.
25 Deb, thank you very much.
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1 MS. BECK: Thank you.
2 MAJORITY CHAIRMAN DiGIROLAMO: We have a
3 couple more members that have come in:
4 Representative Martina White's here, has joined us;
5 also Representative Dan Miller, and Representative
6 Ryan Warner has also joined us.
7 Next up, a good friend of mine, who's
8 come all the way from the western part of the state
9 to join us, and that's Dennis Troy, who is the
10 Mayor of Brentwood Borough.
11 Dennis, welcome.
12 MR. TROY: Thank you, Chairman. Good to
13 see you. You can begin whenever you're ready.
14 MR. TROY: Always a pleasure, sir.
15 Good morning, Chairman DiGirolamo, and
16 members of the Pennsylvania House Human Services
17 Committee. Your service to our great Commonwealth
18 is most appreciated.
19 I welcome the opportunity to share with
20 you my positions on H.B. 1692 and H.B. 1693, which
21 deal with involuntary commitment for drug and
22 alcohol treatment and drug offense mandatory
23 minimums, respectfully.
24 While I come before you today as a
25 public official, serving as the Mayor of Brentwood
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1 Borough located in the South Hills of Allegheny
2 County. I also represent a number of different
3 perspectives, for which I am most grateful. I'm
4 fortunate to be the father of a 12-year-old boy,
5 the uncle of three, a 20-plus-year youth baseball
6 and football coach, and a member of a wonderful
7 nuclear family.
8 As I am sure each of you can understand,
9 civic engagement, whether it be through the service
10 of an elected official or the coach of a Little
11 League baseball team, brings to real life both the
12 exultations and tragedies in life. I am here today
13 to present on the tragedies of what I believe to be
14 one of the biggest internal threats to our society
15 and country; that is, opiate drug addiction.
16 With the many hats that I wear as a
17 citizen in this great State of Pennsylvania, I have
18 attended funerals of extended family members,
19 friends, former youth sports player and others who
20 have succumbed to their war with opiate drugs. The
21 vast majority of these instances began with the
22 first battle that was initiated innocently enough
23 by injury or other medical condition that was
24 diagnosed and managed by a health care
25 professional. The health care professional, as
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1 part of their treatment, then provides legally
2 prescribed opiates to a patient. This is where the
3 war truly begins as a certain segment of our
4 society unwittingly comes to find that they have
5 yet another condition--addiction to opiates.
6 Subsequent battles involve the ever-
7 downward spiral into opiate drug addiction which
8 involves increasing tolerance to prescription
9 drugs, the expiration of medical prescriptions,
10 coming up with manners in which to secure money for
11 the high cost of these opiate drugs on the street.
12 And as many of you know, it could as much as a
13 dollar per milligram with average dosages at
14 40 milligrams, and we could be talking as much as
15 two to $300 a day.
16 In many instances, the migration to
17 heroin results. This is a much alternative -- This
18 is a much cheaper alternative to prescription
19 drugs. During this period, you find your family
20 member or friend undergo significant change. This
21 change manifests itself in numerous ways from the
22 people and places with which they spend their time
23 to the devolving physical and emotional
24 characteristics that our loved ones begin to exude.
25 While the tragedy of a loved one falling
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1 into this cycle of opiate addiction, a condition,
2 again, that is physically dependent, is tremendous
3 and all too often fatal, the impact on friends and
4 family is just as profound. Watching your spouse,
5 child, parent or other loved one heading down the
6 path of ultimate destruction just rips out your
7 heart.
8 This path of destruction is one that can
9 be visible to all with whom they come into contact.
10 While the dependent may acknowledge they have a
11 problem and are willing to voluntarily participate
12 in treatment and rehabilitation, in many instances
13 the addiction has clouded their judgment and the
14 dependent refuses or eludes such treatment. Left
15 in the wake of this destruction are the loved ones
16 who beat themselves up with the thought of, I
17 should have done more. This thought can forever
18 haunt the loved ones of the dependent for the rest
19 of their lives.
20 This condition forever impacts the
21 affected family, which the impacts on family vary
22 in many ways. The sentiment of a parent should
23 never have to bury their child is hard enough, but
24 how do we truly understand both the short- and
25 long-term impact a fatality due to drug overdose
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1 can have on a child affected by this condition,
2 particularly at impressionable age?
3 As a parent, I do my best to protect
4 from harm, both physical and emotional, my almost
5 teenage son. While I and his mother -- I and his
6 mother do the best we can in this regard, as we all
7 here do, there are certain situations, such as
8 accidents that we can't protect our children and
9 loved ones from.
10 However, when we can identify a weapon
11 to add to our arsenal protections against harm, I
12 believe it to be incumbent on us all to rally
13 behind it and advance its use as part of our
14 arsenal in this ongoing war on opiate addiction.
15 I believe H.B. 1692 to be one of those
16 weapons that allows family members to intercede and
17 help a dependent in this war. By allowing those
18 who know the dependent best to step in and help
19 provide the much needed clarity in decision and
20 action, we can start to win some of the early
21 battles in this ongoing war and onto ultimate
22 victory.
23 It should be noted that I believe there
24 are substantial provisions in 1692 that address
25 wrongful attempts or efforts of participation in
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1 alcohol and drug abuse treatment.
2 Now, in addition to H.B. 1692,
3 Representative Readshaw has also introduced H.B.
4 1693, a bill that would call for conviction of the
5 sales of highly addictive narcotics, such as
6 heroin, cocaine and prescription drugs, punishable
7 with a five-year mandatory minimum prison sentence.
8 This bill, I believe, is yet another weapon in our
9 arsenal in this war.
10 While I do not profess to be an expert,
11 or an encyclopedia of knowledge on the subject of
12 mandatory minimums and their rates of success in
13 recidivism, I do believe getting these drug dealers
14 off the streets is extremely important. As a mayor
15 working with my 14 police officers, it is important
16 for us to be able to get convicted drug dealers off
17 of our streets for as long as possible.
18 Incapacitating these dealers disrupts not only
19 their drug-life cycles, but it provides a community
20 an opportunity to extricate a cancer in its
21 neighborhoods and to restore confidence in
22 constituents that we are, indeed, doing all that we
23 can to address this overarching problem in our
24 communities.
25 My interest in this regard, quite
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1 frankly, is not about rehabilitation of the dealer,
2 nor is it with incarceration costs. It is with
3 removing the specific dealer from our community so
4 we can begin to rebuild. The harm created by these
5 drug dealers who prey on our vulnerable loved ones
6 is reprehensible. Having laid witness to what
7 remains in the wake of the action and conduct of
8 these profiteers on addiction and disease, I am
9 resolute in my support for five-year mandatory
10 minimums for the manufacture, sale and possession
11 of certain controlled substances and amounts as
12 outlined in 1693.
13 I am, however, sympathetic, of course,
14 with the stark reality that the General Assembly
15 governs in an era of austere management principles
16 and process. The cost of increasing incarceration
17 would be in the tens of millions of dollars.
18 However, this war on opiates, in my opinion,
19 requires us to utilize all viable options available
20 to us. Again, I believe mandatory minimums are,
21 indeed, a very viable option and worth utilizing in
22 our war on opiate addiction.
23 In closing, I would like to thank the
24 committee for indulging me as I present my
25 perspective and opinion on this huge problem. I
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1 also want to take this opportunity to publicly
2 commend the General Assembly and the Governor for
3 passage of Act 16 which creates a medical marijuana
4 program in Pennsylvania. I strongly believe that
5 utilization of medical marijuana is, indeed, yet
6 another weapon in our arsenal in this war on
7 opiates.
8 Mr. Chairman, this concludes my
9 testimony.
10 MAJORITY CHAIRMAN DiGIROLAMO: Okay,
11 Dennis, thank you very much.
12 MR. TROY: Thank you.
13 MAJORITY CHAIRMAN DiGIROLAMO: And if
14 you could stick around, maybe, for some questions
15 afterwards --
16 MR. TROY: Certainly.
17 MAJORITY CHAIRMAN DiGIROLAMO: -- we
18 appreciate it.
19 Our last testifier this morning is
20 District Attorney Dave Freed from Cumberland
21 County. Dave, welcome.
22 DISTRICT ATTORNEY FREED: Thank you.
23 Good morning, Mr. Chairman. I would like to say
24 what he said. Nice work.
25 It's a real pleasure to be here. I'm
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1 used to appearing in front of the Judiciary
2 Committee. So, it's nice to see some different
3 faces.
4 We have submitted written testimony, and
5 I'll refer to that. I bring greetings from PDAA,
6 President Dave Arnold from Lebanon County, and our
7 other 65 colleagues across the Commonwealth who are
8 joined together in this battle.
9 We all know this, people are dying every
10 day. They're dying in Crawford County; they're
11 dying in Philadelphia; they're dying in Blair
12 County; they're dying in Washington County; they're
13 dying in Bucks County; they're dying in Cumberland
14 County, and we are doing our level best to help
15 those people with substance use disorder who get
16 involved in the criminal justice system.
17 Part of what we have to do as
18 prosecutors is really cut through everything that's
19 out there because, listen to me, every dealer that
20 comes before the court is saying, oh, I'm a user.
21 I'm just dealing to support my habit.
22 So, part of what we have to do as
23 prosecutors is really look at the evidence and make
24 sure that we're locking up those dealers, and we're
25 treating the people who have the disorder. I think
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1 we've done that over the years. We've gotten much
2 better at it in terms of this crisis.
3 Chairman, your work on these issues is
4 so vital to this battle, and we thank you for that,
5 and Minority Chair Cruz as well.
6 I don't need to remind anyone around
7 this table about the scope of what we're dealing
8 with. We've had a 20-percent increase in drug
9 overdose deaths between 2013 and 2014. We're on a
10 record pace in Cumberland County where I'm the
11 D.A., right across the river from here, and it's
12 the same way in almost every county, and we lead
13 the country in drug overdosed deaths for young man.
14 A few weeks ago, a few of us were down
15 in Washington D.C. We were talking to Congressmen
16 and staff and then our senators. We met with
17 Senator Casey and Senate Toomey's staff. And we're
18 always asked about this crisis, what can we do?
19 One of the things that we say, certainly, is -- is
20 similar to what my good friend, Deb Beck said,
21 which is, we need help with supply, but we also
22 need treatment. That's the only way we're going to
23 get out of this.
24 We're not going to arrest our way out of
25 this. We're not going to jail our way out of this.
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1 Our jails have, frankly, become detox centers. Our
2 detox numbers in Cumberland County--it's the same
3 way across the state--are astronomical, and you'll
4 see it.
5 If you talk to the magisterial district
6 judges or municipal court judges in Philadelphia,
7 you would hear them say, we're putting bail on
8 people who are in the throes of addiction to make
9 sure they get detoxed, but then we're not
10 necessarily closing that loop with treatment.
11 Sometimes that's the only thing that we can do to
12 save a life.
13 We told our federal legislators, and we
14 say the same thing here, we have to prioritize
15 treatment, and we have to make sure that, as Deb
16 said, the infrastructure is there so that we can
17 treat people that are in the throes of addiction.
18 I understand the concerns that have
19 been addressed by Secretary Tennis, in his written
20 testimony, and Doctor Levine in her live testimony,
21 and we couldn't have better allies in our fight
22 against heroin and opiates than Doctor Levin, in
23 particular, who, I'll say it because she probably
24 can't, was ahead of her boss on these issues. He's
25 caught up, but she was out there helping us from
Key Reporters [email protected] 40
1 day 1, and we really appreciate that. And
2 Secretary Tennis, of course, has been working on
3 these issues forever.
4 This bill to us, as prosecutors, it's
5 about treatment. It's about getting more people
6 into treatment, and it's about identifying the most
7 at-risk individuals and providing a formal process.
8 You have the support of law enforcement. The Good
9 Samaritan bill and the things that we've done have
10 the support of law enforcement. But, you risk --
11 we risk losing that goodwill with police if all
12 we're doing is saving lives; bringing people into
13 the system; putting them right back out the door so
14 their lives can be saved again.
15 I'm not saying the police will stop
16 doing their jobs, because they will not. But the
17 goodwill that's out there and the understanding
18 that's out there among police, that's going to be
19 at risk if we keep bringing people in and churning
20 them back out.
21 Greg Stedman, the district attorney in
22 Lancaster County, told us a story at a meeting the
23 other day of someone who had been saved by Naloxone
24 four times in a one-week period in Lancaster
25 City.
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1 There's a story that is outlined in my
2 testimony. A few weeks ago I was at a meeting at
3 the school district where my kids go to school, and
4 I was meeting with the superintendent, the
5 principal and the police chief. I live in a little
6 town, little school district. But we had some
7 pills moving in the school and we had to have a
8 meeting about that.
9 At the tail-end of that meeting, the
10 chief, who's been there 20 years--we've grown up in
11 law enforcement together--he mentioned the name of
12 a teenager, and he said, I'm really worried about
13 this young lady. Her mother signed her out to quit
14 school. She's working, but I know she's in the
15 throes of addiction right now, and it's not going
16 to end well. That was on a Monday morning. On
17 Tuesday night, the police were called to her house
18 and administered Naloxone and saved her life. She
19 was taken to a local hospital and didn't accept any
20 treatment and she was out. Now, the next day she
21 was in a serious car accident, and that was the
22 trigger for her to get into rehab.
23 A couple weeks ago I received a copy of
24 an open letter that she wrote to her classmates and
25 the fellow students at the school outlining what
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1 she's going through and urging them to get help and
2 to not start in the first place, and it was really
3 compelling. That young lady is going to have a
4 struggle for the rest of her life. She'll probably
5 relapse, we know that, but that's the kind of
6 person we need to get into treatment. We need to
7 make sure that this treatment is happening.
8 If she hadn't had that car accident,
9 she'd probably be a statistic that I was talking to
10 you about today.
11 This idea of a warm hand-off, we
12 support. It's a great idea. It's necessary.
13 Think about it. If someone has a heart attack and
14 goes to the emergency room, doctors do everything
15 they can to save that person and move the
16 appropriate physician to treat the heart problem.
17 That's the kind of procedure that we
18 need to have occur here. The process should be
19 seamless; it should be standard, and it shouldn't
20 be optional. I would hope that we can explore
21 options with Secretaries Tennis and Dallas and
22 Murphy and Doctor Levine about how to make this
23 happen.
24 I have the occasion to work in
25 Cumberland County with a woman who is in recovery.
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1 She's been in recovery for 10 years, and she's
2 really helped me understand the disease of
3 addiction and the difference between detox and
4 treatment. I didn't understand that until the last
5 few years. We can detox people, but the treatment
6 is needed to reverse the impacts that addition has
7 wrought on the brains of the people with substance
8 abuse disorder. That's why treatment has to be
9 lengthy and treatment has to be sustained.
10 Believe me, I know it's expensive. We all
11 know it's expensive. And it's hard. Some of the
12 objections I'm hearing today are, well, this is
13 hard and maybe you shouldn't invade my turf.
14 Nobody has any turf in this battle anymore. We're
15 all in this together.
16 We had a wonderful meeting the other day
17 at the Pennsylvania Medical Society, with a bunch
18 of medical groups and prosecutors. The legislature
19 has done an amazing job of gathering information;
20 Senator Yaw, in particular, in gathering
21 information about this crisis. We've gathered a
22 ton of information. We have a ton of statistics.
23 It's time to act. We all need to act, and this is
24 one of the actions. This bill -- support of this
25 bill is one of the actions we need to take.
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1 Certainly, we know the legislative
2 process. Bills, as written, aren't always what's
3 passed. But I would hope that we all take this
4 issue to heart and work as hard as we can to make
5 sure that we can get people into treatment who need
6 it. That's the only things that's going to solve
7 it.
8 Representative DiGirolamo mentioned the
9 amount of people that are in prison because they've
10 committed crimes as a result of their addiction.
11 It's not just possession of drugs; it's not just
12 sale of drugs. It's retail theft, shoplifting,
13 burglary, bad checks, robbery; almost anything you
14 can see.
15 And true addicts; true, true people with
16 substance use disorders, when they come into the
17 system, they're not the people that are fighting
18 their criminal charge. They're coming before the
19 judge and saying, I need help. We've got to give
20 them that help. We have to do it as a system.
21 Deb Beck, we were talking about a number
22 of, you know, where are we in this -- in this
23 crisis, in this cycle right now? I said to Deb,
24 unfortunately, Deb, I don't know that I can see my
25 way out of it at this point. She's an optimist, so
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1 she sees a light at the end of the tunnel, and I'm
2 glad for that. And she's helping me to see that
3 light at the end of the tunnel. But we are joined
4 in this battle now.
5 This bill to us, the Pennsylvania DAs
6 Association, we believe that this would be yet
7 another tool in order for us to fight what is a
8 crime problem and a public health problem.
9 I thank you all for the opportunity to
10 be here, Representative DiGirolamo. You're a hero
11 in this fight, and we thank you. I'd be happy to
12 answer any questions that anybody has when the time
13 is appropriate.
14 MAJORITY CHAIRMAN DiGIROLAMO: Thank
15 you, Dave. Why don't you stay right there, and I
16 might ask Doctor Levine, and I think Dennis is
17 still here, maybe, to come up front. We can open
18 this up for questions.
19 And I get in trouble all the time. I
20 hear the problems that are out there; whether
21 you're an elected official, district attorney, a
22 statewide official. Even on this bill, I mean --
23 And I think what I'm hearing about this bill is, we
24 need capacity. We're going to need more money if
25 this became law. We need places to put these
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1 people.
2 You know, I thought that Dave Heckler in
3 Bucks County -- You know, the amount of pressure
4 that addiction is putting on county government and
5 county budget is just unbelievable.
6 My police chief in my district--And
7 Bensalem Township is my whole district, 62,000
8 people--he says right now, almost nine out of 10
9 people that they are arresting, they're arresting
10 because of a drug problem. And just like you
11 mentioned, Dave, they're committing all these petty
12 crimes: Shoplifting, breaking into homes, breaking
13 into cars. It's a tremendous financial impact.
14 Not to minimize the number of deaths,
15 because these are just heart breaking -- And to go
16 along just recently, a story, I got a call from a
17 family, and their daughter was going to be released
18 from the county prison, and they knew she needed
19 treatment, and they wanted to get her into
20 treatment or a halfway house or a recovery house
21 somewhere, and she was going to be released the
22 next day. I was working with them on trying to
23 make that happen, you know, soon after she was
24 released. She got home in the morning, left at
25 night, a friend picked her up, and they found her
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1 the next morning close to her house with a needle
2 in her arm; dead from a heroin overdose.
3 I mean, this stuff is just heart-
4 breaking. And I just say it all the time, I'm just
5 tired; sick and tired of talking to parents with
6 dead kids from this garbage, and it's all opiates
7 and heroin. And there wouldn't be any heroin
8 around if it wasn't for the amount of opiates that
9 are on the street today.
10 And where are these opiates coming from?
11 They're not being shipped in from some South
12 American drug cartel. They're coming because
13 they're being prescribed right here by our doctors
14 and they're being diverted. These young people are
15 getting a hold of them.
16 I'm going to get in trouble again. But,
17 as I hear about money that we need, I mean -- And I
18 know some of the states are starting to do this and
19 some of the cities around the country about filing
20 a lawsuit against these drug companies that make
21 these opiates. The way they misrepresented the
22 dangers from these opiates is nothing short of
23 appalling as far as I'm concerned, and they ought
24 to be held accountable and responsible and come in
25 and clean up the mess that they've created, not
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1 only here in the State of Pennsylvania but around
2 this country.
3 They're on course to make 15 to
4 $20 billion, I understand, from the sales of these
5 opiates around this country, and they need to be
6 held accountable for the misrepresentation and the
7 way they've marketed and sold these drugs to our
8 doctors across the state and across the State of
9 Pennsylvania.
10 I wish -- I wish at some point in time
11 that we could make that happen. As I envision,
12 it's something similar to what we did with the
13 tobacco companies and tobacco settlements. We'll
14 see. Anyway, I'm going to get myself in trouble
15 again.
16 We're going to open it up for questions.
17 I think we have Representative Pashinski first.
18 REPRESENTATIVE PASHINSKI: Thank you
19 very much, Mr. Chairman.
20 Thank you all for your testimony. It's
21 certainly riveting and certainly on the minds of so
22 many people today, and rightly so.
23 I basically have two comments or
24 suggestions. The first is, you know, back in the
25 early 1900s there was, -- And if I may say, we're
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1 considering this an epidemic; are we not?
2 DOCTOR LEVINE: Yes, sir. This is a
3 public health crisis epidemic.
4 REPRESENTATIVE PASHINSKI: Perfect.
5 Thank you very much.
6 Early 1900s, Doctor, and you could
7 probably collaborate this, we had an epidemic of
8 tuberculosis. And what did the country do and what
9 did the states do? They created facilities to make
10 sure you were able to take these people for
11 treatment, and also to prevent them from harming
12 other individuals in spreading the disease. I see
13 this as the same kind of emergency.
14 I think of White Haven. Are you
15 familiar with White Haven State School? That was,
16 back in the 1900s, really a tuberculosis center.
17 It started out that way, and then it began building
18 more and more buildings to take care of the people
19 that were in need of this. And then it ended up to
20 be a special needs institution.
21 So, I think Pennsylvania already has
22 facilities similar to White Haven that could become
23 treatment centers; that could become various steps
24 of treatment in helping these people. Number 1.
25 Number 2. Do we have and have we
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1 conducted an actual official commission into
2 determining how the proliferation of the opiates,
3 through the medical system, has actually led to
4 this result? If not, I'm suggesting that we have
5 an actual commission put together to identify facts
6 that contribute to this argument. And I'd like to
7 make those two suggestions.
8 MAJORITY CHAIRMAN DiGIROLAMO: Doctor
9 Levine, you might be able to answer that better. I
10 know Deb -- There's an awful lot of studies out
11 there, and I know there's national studies out
12 there.
13 DOCTOR LEVINE: Sure. Thank you very
14 much for that question in terms -- in terms of the
15 etiology of this crisis.
16 I think that there is -- there is a lot
17 of evidence throughout the country, and in
18 Pennsylvania, that the etiology of the crisis that
19 we're facing now is really the perfect storm of
20 different factors. The first was the emphasis by
21 the Federal Regulatory Authority in the '90s and
22 the early 2000s on assessing and treating pain.
23 The determination was made that we were not
24 assessing and treating pains adequately. And so,
25 all inpatient and outpatient units, hospitals and
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1 medical centers were required to make pain, quote
2 unquote, fifth vital sign; vital signs being pulse,
3 blood pressure, et cetera; that we had to assess
4 pain. And there was the underlying assumption that
5 then we would treat all acute and chronic pain, and
6 essentially eradicate acute and chronic pain.
7 At the same time, as the Chairman had
8 mentioned, there was the development of extremely
9 strong, long-acting, powerful and, unfortunately,
10 extremely addictive opioid pain medications that
11 were heavily distributed -- marketed and
12 distributed to physicians and to other providers,
13 with the idea that addiction with chronic pain
14 patients wouldn't happen. That was based,
15 unfortunately, on some -- just a handful of very
16 small studies and had not been really thoroughly
17 researched.
18 And the third, as our law enforcement
19 and colleagues have talked about, was the influx of
20 cheap, powerful and plentiful heroin from Central
21 and South America. And you put all those factors
22 together, and it has exploded into the crisis that
23 we see now. Eighty percent of people who now go on
24 to heroin have started with the prescription
25 opioids that they either received from a health
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1 care provider or have been prescribed but then
2 diverted into the system.
3 So, the reaction, and from a prevention
4 point of view, as has been mentioned, is to
5 significantly decrease the amount of opioids that
6 are prescribed by physicians and health care
7 providers.
8 To accomplish that, we are working with
9 medical schools. We're working with the
10 Pennsylvania Medical Society and other health care
11 providers and stakeholders on educating medical
12 students, physicians, other providers on the -- on
13 the depth of this crisis and how to decrease opioid
14 prescriptions. We have continuing medical
15 education through PAMED, which includes other
16 providers such as dentists, podiatrists, nurse
17 practitioners, et cetera.
18 We also have specialty, specific
19 prescribing guidelines. This is all in
20 collaboration with our other departments and DDAP,
21 et cetera. We published six of those. Two more
22 will be coming within the next month, and then this
23 is a continuing process. We're actually taking
24 those guidelines to the appropriate specialty
25 board, the professional board such as the Board of
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1 Medicine to have them affirmed and accepted, and
2 there are other federal guidelines as well.
3 There is some recent evidence,
4 nationally, that we're making progress with this.
5 There has been, for the first time, a decrease in
6 the amount of opioid prescriptions nationally. So,
7 hopefully, the medical community has gotten the
8 message, and that trend will continue to bend the
9 curve and that trend will continue.
10 DISTRICT ATTORNEY FREED: Can I add a
11 quick thought to that, just very briefly?
12 In the last Administration, Doctor
13 Levine's predecessor started to talk about this
14 issue, and I have to give Doctor Delone a
15 shout-out. She's my neighbor. And we were
16 thrilled about that, and this Administration has
17 really picked up the ball. It's not the easiest
18 conversation to have, I think, with physicians.
19 DOCTOR LEVINE: That's correct.
20 DISTRICT ATTORNEY FREED: And Doctor
21 Levine and her colleagues and the department have
22 been out there talking about this. And I really do
23 feel, and I am optimistic about it taking hold with
24 our physicians based on the conversations I've had;
25 based on the work that's been done.
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1 So, I do think it's instructive to find
2 out how we got to where we've gotten. But there is
3 -- I think we should be -- We should feel very
4 positive about the good work that's going on with
5 prescription guidelines.
6 DOCTOR LEVINE: Thank you.
7 If I may mention one other program, and
8 that's, of course, the prescription drug monitoring
9 program that you all passed at the end of 2014. So
10 I'm pleased to report that under Secretary Murphy's
11 leadership, that program will be up and running at
12 the end of August of this year. So, within several
13 months, that's going to be an extremely helpful
14 program for physicians and other providers to be
15 able to see that their patients are going to
16 multiple providers to get those prescriptions.
17 But one of the keys will be to institute
18 not just a warm hand-off, but a really firm, strong
19 warm hand-off to treatment; so that, if a physician
20 sees that a patient is getting multiple
21 prescriptions, they don't just say, please leave my
22 office. But they work with their Single County
23 Authority to get that person right into treatment.
24 Because, unfortunately, if you don't, that person
25 then will go get heroin. So, the prescription drug
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1 monitoring program is going to be a significant
2 tool in the toolbox in this battle.
3 REPRESENTATIVE PASHINSKI: As a
4 follow-up, Mr. Chairman?
5 MAJORITY CHAIRMAN DiGIROLAMO: Sure.
6 REPRESENTATIVE PASHINSKI: So, are you
7 saying that we have enough tools? And if
8 implemented, we're going to be able to address this
9 problem? Because what I'm looking for is what are
10 the areas; what are the holes in the plan?
11 The only reason why I suggested a
12 complete investigation was to emphatically
13 determine what has caused this. And if it is
14 prescription or prescribing, then that has to be
15 addressed more fervently. We can't just say we're
16 making some slight improvements. In my own family,
17 I've had certain concerns about those kinds of
18 prescriptions.
19 So, we're looking to you now, then, to
20 find the holes. And then through the efforts of,
21 like, Chairman Readshaw and 1649, maybe we need a
22 few other things as well to complete the circle.
23 DOCTOR LEVINE: I never would say that
24 we have all the tools that we need, and I really
25 don't want to claim that we have a complete handle
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1 on this program.
2 I think that Pennsylvania is ahead of
3 the curve in terms of other states on many of these
4 issues, but I don't want to claim that we have it
5 all figured out because we don't. If a commission;
6 if the Chairman and the legislature feels that a
7 commission would be helpful to study the etiology
8 better, I think that that would be fine. But there
9 has been -- there has been literature and
10 significant discussion nationally and in the state
11 on how we got there.
12 But, the prevention and decrease the
13 amount of opioids prescribed is one aspect of
14 prevention. We also need to work with our schools
15 and with other public health efforts in terms of
16 educating students, as well as adults, on the
17 dangers of addiction. And then there's the
18 referral and treatment, which is why we're here
19 today.
20 I mean, treatment is -- is present, but
21 it's not robust enough. And I think we need all
22 different types of treatment. We absolutely need
23 abstinence-based treatment and -- inpatient and
24 outpatient. But we also need medication-assisted
25 treatment. So there is certainly an emphasis
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1 nationally in terms of SAMHSA and the CDC and
2 health and human services on the utility of
3 medication-assisted treatment. That includes
4 Methadone, Suboxone, Buprenorphine, other
5 compounds, as well as long-acting Naltrexone, which
6 is Vivitrol.
7 There are indications -- individual
8 indications for each of those type of medications.
9 And, of course, there's $34 million in the budget
10 for the Medicaid Centers of Excellence, which would
11 provide quality of care with tracking of outcomes
12 for treatment, particularly with medication-
13 assisted treatment again with federal matching --
14 federal dollars -- not completely matching, but
15 federal dollars available to make that even more
16 robust. So, we certainly need more treatment
17 options and more treatment centers.
18 The issue here is how to get people into
19 treatment. As Deb said, there is no magic to this,
20 getting people into treatment. What Secretary
21 Tennis and I have been doing is trying to make the
22 warm hand-off a little less warm and fuzzy, and to
23 make it a firm, strong warm hand-off both in the
24 emergency department with law enforcement, et
25 cetera, to get people into some type of treatment.
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1 REPRESENTATIVE PASHINSKI: Thank you
2 very much. Thank you, Mr. Chairman.
3 MAJORITY CHAIRMAN DiGIROLAMO:
4 Representative Zimmerman.
5 REPRESENTATIVE ZIMMERMAN: Yeah. In Deb
6 Beck's testimony, she mentioned that there's a need
7 to enforce some of our current laws. And so, my
8 question revolves around, if that's the case, what
9 are some of those laws that could be enforced that
10 might help get our arms around this drug issue?
11 DISTRICT ATTORNEY FREED: Did Deb leave?
12 MAJORITY CHAIRMAN DiGIROLAMO: I mean, I
13 could maybe take a shot at that, and Rachel maybe
14 help me out.
15 We have -- We have the best insurance
16 law in the country. It's called Act 106. I
17 believe it was passed back in 1986, and Deb was
18 around then when it was passed and really pushed it
19 through to get it passed. What it says is that, if
20 you have a group health insurance policy in the
21 State of Pennsylvania, that it's mandated that you
22 have -- you're able to get detox and 30 days of
23 residential rehab in the course of a calendar year.
24 So, at times we do have problems getting
25 that enforced because insurance companies try to
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1 cut back on the length of stay. And as you heard
2 from the testimony, appropriate length of stay is
3 really, really important especially when it comes
4 to opiates and heroin addiction. So, I think we're
5 doing a pretty good job of enforcing that law, but
6 I don't think it gets enforced all the time.
7 I think the one law, and, Rachel, maybe
8 you want to pop in here, the federal Parity Act
9 that was passed, the Mental Health and Drug and
10 Alcohol Parity Act where substance abuse or drug
11 and alcohol addiction has to be treated as a
12 disease, just the same way as diabetes is treated
13 or heart disease or cancer, and you can't
14 discriminate.
15 And, Rachel, maybe you want to pick up a
16 little bit. That's the main one, I think, that she
17 was talking about; making sure that we're enforcing
18 that.
19 DOCTOR LEVINE: That is exactly correct.
20 I believe that Deb Beck was speaking about coverage
21 for treatment, both for Medicaid but also for
22 private insurance, is that --
23 As the Chairman said, sometimes under
24 cost pressures, there is the tendency to cut back
25 on the length of stay for substance abuse disorder.
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1 That can also happen in the mental health field. I
2 think we have very good laws for substance abuse to
3 try to prevent that, as well as it is for mental
4 health conditions.
5 Clearly, for -- if you're having
6 abstinence-based treatment in rehab, clearly, you
7 know, 15 days and some people would even argue
8 30 days is not enough. Statistics would show that
9 probably you're going to need 60, 90 days of
10 treatment, sometimes even longer than that, to
11 successfully treat someone for an opioid use
12 disorder with that model.
13 So, patients who go home in 15 days is
14 really, unfortunately, asking for a relapse. And
15 then, of course, the cost of relapse is frequent
16 overdoses and sometimes death.
17 For mental health parity, I have faced
18 this in my practice at Penn State Hershey. Of
19 course, I saw teenagers and young adults with
20 mental health problems, particularly anorexia
21 nervosa and bulmia nervosa. And those are also
22 medical conditions. They have a psychiatric mental
23 health component, but they're medical conditions.
24 And we would, unfortunately, sometimes have to
25 fight for every day of day treatment or inpatient
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1 treatment where -- and sometimes people would,
2 quote unquote, max out their benefits.
3 Well, if you have cancer, you don't max
4 out your benefits. The insurance company doesn't
5 say, I'm sorry, you've finished your benefits so
6 you don't get those three rounds of chemotherapy.
7 But they do, unfortunately, for mental health
8 treatment. They would say, you've had a 30-day
9 admission. That's all we'll pay for in this year,
10 and the mental health parity laws was supposed to
11 prevent that.
12 So, we're still working on the
13 successful implementation of those statutes and
14 making sure that people get the treatment that they
15 need.
16 REPRESENTATIVE PASHINSKI: Thanks,
17 everyone, and thanks, Mr. Chairman.
18 MAJORITY CHAIRMAN DiGIROLAMO:
19 Representative Miller.
20 REPRESENTATIVE MILLER: Thank you, Mr.
21 Chairman.
22 And thank you to everyone who talked
23 today. In particular to District Attorney Freed, I
24 very much appreciate. I think you had said, we
25 can't arrest our way out of this problem, which is
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1 something I really appreciate and believe in.
2 My friend had mentioned the TB crisis a
3 hundred years ago or so, or whenever. And one of
4 the things that, of course, was different was, we
5 didn't criminalize the people with TB the way that
6 we would criminalize people who are arrested and
7 then processed through the system for a drug
8 charge.
9 My friend from Brentwood--I'm from Mount
10 Lebanon, so I appreciate seeing you here--
11 referenced felony charges for drug dealers and how
12 we need to toss drug dealers away. Not your words,
13 I apologize.
14 But I would also say--perhaps the
15 district attorney can help me with this--where I'm
16 from, if an individual is found with 10 stamped
17 bags of heroin, they're being charged with a
18 felony, intent to deliver. Is that how it is in
19 your county as well?
20 DISTRICT ATTORNEY FREED: Those cases
21 all depend on the circumstances and the evidence.
22 Speaking personally, that goes to what I addressed
23 when you talk about trying to find the difference
24 between somebody with the substance use disorder
25 who -- who possesses that and maybe shares it as
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1 part of -- of their subject abuse disorder, their
2 addiction, and somebody who's in the for-profit
3 drug dealing business.
4 To charge as a felony, that would be
5 possession with intent to deliver, so we'd have to
6 show there are other indicia of intent to deliver.
7 I have to say, in 2005, 10 stamped bags
8 probably would have been pretty good evidence of
9 intent to deliver. In 2016, I don't think that's
10 necessarily the case.
11 REPRESENTATIVE ZIMMERMAN: Okay. So, in
12 your county, 10 stamped bags is not a bright line
13 for charging a felony?
14 DISTRICT ATTORNEY FREED: Yeah, I don't
15 have every bright lines, no. Every case is done on
16 its own.
17 REPRESENTATIVE ZIMMERMAN: All right.
18 Have you heard of such bright lines?
19 REPRESENTATIVE ZIMMERMAN: I haven't.
20 REPRESENTATIVE ZIMMERMAN: You haven't,
21 okay.
22 I was a public defender for seven years.
23 I have. But I would agree with you that we're,
24 obviously, also looking for, perhaps, some indicia
25 as well.
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1 DISTRICT ATTORNEY FREED: Right.
2 REPRESENTATIVE ZIMMERMAN: And somewhere
3 in there is where plea deals come up. So, if
4 somebody comes up here and says, I found 10 stamped
5 bags and looks like you may have given one to a
6 friend, I'll give you the possession if you plead
7 off a felony, right?
8 DISTRICT ATTORNEY FREED: Right.
9 REPRESENTATIVE ZIMMERMAN: All right.
10 One of the things that concerns me,
11 obviously, is the criminalization aspect of what's
12 going on now when we have somebody who is an
13 addict, as well as, with all respect, the issues of
14 where mandatory minimums become effective and
15 don't. Some of us would have strong concerns or
16 doubts as to what the effectiveness is.
17 A mandatory minimum for a drug kingpin,
18 which is something that this body has discussed
19 recently, is one thing. And then somebody charged
20 with a felony, intent to deliver charge with 10
21 stamped bags, is another.
22 DISTRICT ATTORNEY FREED: Right.
23 REPRESENTATIVE ZIMMERMAN: Because, as
24 you mentioned, again my words, perhaps 2005, 10
25 stamped bags would have been a stronger indicia of
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1 something as compared to what it is now. Now, I
2 think we all know that many people who are addicted
3 with heroin, 10 stamped bags could take you through
4 the weekend or day and you're not giving it away.
5 You did something very hard to get that.
6 DISTRICT ATTORNEY FREED: Right.
7 REPRESENTATIVE ZIMMERMAN: And,
8 obviously, we would admit that the majority of the
9 crimes we're talking about here; the majority, and
10 you referenced retail theft, burglary, and
11 everything else that comes in with it, you're
12 either talking about a drug addiction and/or mental
13 health -- undiagnosed or untreated mental health
14 issue as well, some degree of overlap --
15 DISTRICT ATTORNEY FREED: Right.
16 REPRESENTATIVE ZIMMERMAN: -- the vast
17 majority of it.
18 Here's the problem that I keep -- that I
19 saw. When you have somebody being convicted -- In
20 my county has done some great work. My district
21 attorney has done some really good work with drug
22 court.
23 DISTRICT ATTORNEY FREED: Right.
24 REPRESENTATIVE ZIMMERMAN: But one of
25 the big problems that's come up is how the silos
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1 don't connect. So, you would sit there with a
2 probation officer who is supposed to connect you
3 with a county health service or an insurance
4 coverage that would take you through four different
5 offices and a series of phone calls in a service --
6 in an arena that generally is not funded well.
7 And the problem that I was seeing was,
8 the -- an outdated model to which was not bringing
9 those services into a one-stop shop, if we are
10 criminalizing these people at all. But if you're
11 bringing them in there and you're saying, you've
12 just been found guilty. I'll tell you what, go do
13 this program. I hope you get in, and you have a
14 probation officer. Good luck with that.
15 Would you not agree, or is it your
16 experience that, perhaps in your county maybe,
17 there is no problem with connecting those services,
18 or do you believe that how we are connecting people
19 to services is something that should be
20 prioritized?
21 DISTRICT ATTORNEY FREED: Wow, there's a
22 lot in there.
23 There's a problem all over the
24 Commonwealth with connecting people with
25 appropriate services. And we can go back and forth
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1 all day on what we think about criminalizing and
2 not criminalizing. I think most prosecutors would
3 say, possession of heroin is a crime and retail
4 theft is a crime. The addiction or the substance
5 use disorder may explain the behavior, but it
6 doesn't necessarily excuse the behavior.
7 Having said that, the reason that
8 special courts work -- specialty courts work and
9 treatment courts work, drug treatment court in
10 particular, and I know the work that Steve Zapalla
11 has done on these issues, they do connect people,
12 and that's why they work. Plus, it's intensive
13 supervision and it's a smaller group.
14 I'll go even one better on some of the
15 stuff you said. I don't think most of our judges
16 necessarily understand when they tell somebody, you
17 go get treatment, I don't think they understand
18 what that means. I don't know that they have a
19 great idea of what the resources are out there even
20 within the counties.
21 So, what we try to do, as an example, we
22 all have our criminal justice advisory boards that
23 we do for criminal justice planning. We have a
24 smaller steering committee that includes the public
25 defender, district attorney, prison warden, head of
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1 probation, sheriff, criminal justice planners. We
2 spend a lot of time on our intermediate punishment
3 program. We try -- We try to use our intermediate
4 punishment program, which is treatment based and
5 has treatment dollars to make sure those people get
6 connected and to make sure those probation officers
7 that are working within that system know how to get
8 to the resources.
9 A vital member of the steering committee
10 on the Criminal Justice Advisory Board is the head
11 of our SCA, the head of the Cumberland-Perry Drug
12 and Alcohol Commission, Jack Carroll. So, our drug
13 and alcohol commission is a key player in
14 everything we do in criminal justice. That's the
15 sort of team effort that I'm talking about -- I was
16 talking earlier about in my testimony. We have to
17 be in this together, because it's not working if we
18 all stay in our own little lanes and do it like
19 that.
20 So while we can have some serious
21 disagreements about things like what's
22 criminalized; mandatories, in particular. There's
23 a mandatories bill in the Senate that actually
24 increases the amounts for certain drugs, while
25 trying to preserve some others, which I think is a
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1 pretty reasonable compromise. We can always
2 disagree on those issues, but we can still work
3 together on making sure that people are getting
4 connected appropriately with services, and I think
5 is an excellent point.
6 REPRESENTATIVE ZIMMERMAN: Well, thank
7 you. I would definitely -- I would definitely say
8 that, you know, I appreciate your comments here
9 today. I think there has been a lot of progressive
10 action in how things, perhaps, were in 2005 or 2002
11 versus where the things are today.
12 My main point, obviously, in that regard
13 is just that, sweeping into what is a felony drug
14 trafficking charge, possession with intent to
15 deliver, can encompass a heck of a lot of people.
16 One of the things that bothers me so much is taking
17 tools out of your hands.
18 What I find personally is, listen, if
19 every defense -- public defender out there wanted
20 -- said, we're going to trial on every case, the
21 system collapses. If every district attorney says,
22 I'm not making a deal on cases, the system
23 collapses.
24 The system, as it is, in my opinion,
25 largely not funded properly to have a full
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1 exploration of the issues that we -- that you are
2 dealing with as they sweep up. So, I appreciate.
3 The last comment I just would make is
4 that, somebody had mentioned schools. I think very
5 much, our definition of schools has changed much
6 like, I think, how some people are looking at law
7 enforcement -- not law enforcement -- district
8 attorney's jobs, in particular, in the courts.
9 And even with schools, we're seeing
10 schools having to do more and more to keep children
11 safe and educate on what is a relatively small --
12 I'll say a more limited budget with a limited
13 amount of days.
14 But one could really talk about those
15 sort of community schools, I think some other
16 people have been talking about, where you basically
17 build in health centers and other community needs
18 into that school. The school becomes much more and
19 is resources staffed much more than just saying
20 somebody checks in at the bell at 8:10. Instead,
21 that school has resources throughout the day that
22 could cover a variety of needs. I think that same
23 sort of silo breakdown in schools that some people
24 are talking about, the same thing we need to be
25 sure is happening in the criminal justice system.
Key Reporters [email protected] 71
1 DISTRICT ATTORNEY FREED: I think
2 everything is related. I've been doing this, it's
3 hard to believe, I'm in my 11th year as a district
4 attorney. Certainly, there has been a change in
5 the role of the D.A. I think as a group, we
6 recognize the vital importance of treatment.
7 Now, people are at different ends of the
8 spectrum. Certainly, in a group of 67, people are
9 on different ends of the spectrum legislatively,
10 just as we are on things like expungement and
11 second chance. But, as a group, we do recognize
12 the value of things like that. I do believe that
13 we all work together much better, perhaps, than we
14 did before, and we're going to need to continue to
15 do that. So thank you.
16 MAJORITY CHAIRMAN DiGIROLAMO: Okay.
17 Thank you. Representative Quigley.
18 REPRESENTATIVE QUIGLEY: Thank you, Mr.
19 Chairman.
20 This is for the district attorney.
21 There was an article on the front page of today's
22 Wall Street Journal about Fentanyl and the
23 influence of China sending this over in either, you
24 know, its original form or the chemicals that are
25 used to make that.
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1 We just had a briefing in Montgomery
2 County last week with our district attorney about,
3 you know, overall briefing of what offices are
4 doing, but this was one of the topics.
5 Have you seen in Cumberland County an
6 increase in Fentanyl-related incidents?
7 DISTRICT ATTORNEY FREED: Yes.
8 Now, I can't recall if you were in
9 session last week or the week before, that there
10 were something like 15 overdoses in Harrisburg in
11 one night. And I haven't heard--Doctor, I don't
12 know if you have--if they've determined whether
13 that heroin was -- contained Fentanyl as well.
14 DOCTOR LEVINE: I haven't heard
15 definitively.
16 DISTRICT ATTORNEY FREED: We then, as
17 often happens, it trickles either way. So into
18 Lebanon and Lancaster, across the river to
19 Cumberland County where I am, and we actually had
20 -- on that Friday night we had two overdose deaths
21 in Cumberland County. And I'll be very surprised
22 if there's not a Fentanyl component.
23 We're also hearing, and you probably
24 heard this from Kevin and his staff in Montgomery
25 County, we're hearing that it's in Mexico, and it's
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1 being manufactured into the heroin in Mexico before
2 it ever gets here. We've had cases where it's been
3 mixed here at home or at a distribution point in
4 the U.S. But, my firm belief now is, it's being
5 mixed in Mexico and then sent here.
6 And think about this. Fifteen overdose
7 deaths -- or overdoses; not deaths, necessarily.
8 Fifteen overdoses in one night in the City of
9 Harrisburg. You would think, wouldn't you, that
10 people would say, my goodness, I need to stay away
11 from that stuff. But as we know, it's, I've got to
12 get me some of that stuff because I need -- my body
13 -- my brain and my body need -- I want to find the
14 strongest stuff I possibly can to get back to that
15 feeling.
16 That's how it gets used in Lancaster,
17 Lebanon and Perry and the surrounding community.
18 So, while it's certainly troubling, it wasn't
19 surprising.
20 REPRESENTATIVE QUIGLEY: And that's
21 exactly what District Attorney Steel said, is when,
22 they see the different packaging with, I think it
23 was something like, real death or something like
24 that, he said the guys say, that's the drug we have
25 to get a hold of.
Key Reporters [email protected] 74
1 DOCTOR LEVINE: May I make a comment?
2 The Fentanyl, of course, is 50 to a hundred times
3 more powerful than Morphine. The presence of
4 Fentanyl in the compounds that we're talking about
5 would significantly increase the risk of a fatal
6 overdose. It highlights the importance of the
7 public actually getting the Naloxone, another one
8 of your bills, Act 139 from 2014. And because
9 Fentanyl works so powerfully and so quickly, that
10 often -- in fact, usually, first responders don't
11 have the opportunity -- whether they're the police
12 or EMS, don't have the opportunity to save the
13 person's life.
14 So, if the public has Naloxone based
15 upon your statute, and then based upon the standing
16 order that I wrote to try to, you know, to
17 distribute Naloxone even more efficiently, it
18 highlights the importance of a family member having
19 the Naloxone, because it will take immediate action
20 to save someone's life.
21 REPRESENTATIVE QUIGLEY: Just a quick
22 follow-up. One of the things that was mentioned by
23 some police officers that was in this meeting is
24 that, and to your point about the police with
25 repeat -- bringing people back three or four times
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1 is that, in addition to that, it's also that, a lot
2 of times when these individuals are revived,
3 they're like in a very combative mode, too. Have
4 you heard -- Are you getting the feedback from your
5 law enforcement?
6 DISTRICT ATTORNEY FREED: Yeah, and
7 they're pretty well trained on it. But that's one
8 of the potential danger points for the law
9 enforcement when they administer it.
10 And I've been really thrilled with the
11 response of law enforcement to this. The speed
12 with which we've gotten Naloxone into the hands of
13 trained police officers through using it is really
14 pretty amazing in Pennsylvania, and you have to
15 credit our law enforcement officers for that.
16 But, certainly, we have examples. I
17 think, since we started carrying it in Cumberland
18 County, I think we're 20 out of 22. So it's been
19 administered 22 times and we saved 20 lives out of
20 22. And of those, there are at least five or six
21 where the person comes out of it and they're
22 combative.
23 My concern with law enforcement, and I
24 think we do need to address, and we're certainly
25 going to suggest as an association, we need to
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1 address our Good Samaritan Law to see if there's
2 some leverage in there to -- I think Doctor Levine
3 called it a firm hand-off. We've been calling it
4 the hot hand-off in the DAs Association, to maybe
5 leverage those saves into treatment, which is why
6 we're supportive of legislation like this. I think
7 we do need to see if there's room, and we're going
8 to suggest that within the Good Samaritan Law to
9 see if we can leverage that.
10 REPRESENTATIVE QUIGLEY: All right.
11 Thank you. Thank you, Mr. Chairman.
12 MAJORITY CHAIRMAN DiGIROLAMO: Okay.
13 And, Doctor Levine, your work on this Narcan -- I
14 mean, that that standing order was so important,
15 especially to the families -- struggling families
16 around the state that are now able to keep -- get a
17 prescription over the counter, as I understand, in
18 a lot of places and keep that Narcan on their own.
19 DOCTOR LEVINE: Thank you.
20 MAJORITY CHAIRMAN DiGIROLAMO: Thank you
21 for your good work. And I know Secretary Tennis
22 has also been going around the state talking about
23 it; trying to get police departments and as many
24 communities involved in doing this also on their
25 own.
Key Reporters [email protected] 77
1 Just to touch on something that Dave
2 said. And, again, when you study and look at this
3 terrible disease; when it comes to the Fentanyl, it
4 is again amazing. And what Dave said -- Back in my
5 way, there was, I think about a year ago, a large
6 number of Fentanyl deaths in our area across the
7 river in Camden, New Jersey. Again, you would
8 think the addicts would say, hey, people are dying.
9 I'm going to stay away from there. It's exactly
10 the opposite.
11 People from the suburbs, from the city,
12 they were so attracted there, they're chasing that
13 high that they got the first time that they can
14 never get again. And when they hear about people
15 dying they're saying, exactly right. That's what I
16 want. I need to get a hold of something like that.
17 It's just amazing how terrible this disease is. It
18 really is.
19 I think we're ready to wrap up. I'm
20 going to let Representative Readshaw for questions.
21 REPRESENTATIVE READSHAW: Thank you, Mr.
22 Chairman. I don't have a question.
23 But I just wanted to remind the
24 committee members and everyone gathered here, that
25 yesterday, in the House of Representatives, we
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1 unanimously passed House Resolution 873. Part of
2 that resolution was the fact that -- requested an
3 investigation, if you will, an opinion about
4 opening or reopening state hospitals where we would
5 provide rehabilitation. So, I just wanted to
6 remind everyone that that could be another facet of
7 consideration.
8 Thank you, Mr. Chairman, and I thank you
9 for having this hearing.
10 MAJORITY CHAIRMAN DiGIROLAMO: Okay.
11 With that, I want to thank the three of
12 you for being here and for your really compelling
13 testimony.
14 With that, I will adjourn this meeting
15 of the Human Services Committee. Thanks, everyone,
16 for being here.
17 (At 10:22 a.m., the hearing concluded).
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1 C E R T I F I C A T E
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3 I, Karen J. Meister, Reporter, Notary
4 Public, duly commissioned and qualified in and for
5 the County of York, Commonwealth of Pennsylvania,
6 hereby certify that the foregoing is a true and
7 accurate transcript, to the best of my ability, of
8 a public hearing taken from a videotape recording
9 and reduced to computer printout under my
10 supervision.
11 This certification does not apply to any
12 reproduction of the same by any means unless under
13 my direct control and/or supervision.
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17 Karen J. Meister Reporter, Notary Public 18
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