Senate Health, Children, & Social Services Committee Meeting Official Minutes 149th General Assembly First Session

Committee Meeting Wednesday April 5th, 2017 2:30 p.m. Senate Hearing Room

Meeting Attendance

Committee Members: Present: Senator Bryan Townsend [email protected] 302-744-4165 Senator [email protected] 302-744-4164 Senator [email protected] 302-744-4138 Senator Ernie Lopez [email protected] 302-744-4136

Absent: Senator [email protected] 302-744-4137

Other Legislators Present: Senator Bruce Ennis [email protected] 302-744-4310 Representative David Bentz [email protected] 302-744-4028

Staff: Annie Gould [email protected] 302-744-4059

Attendees: Organization: Phone:

Dave Humes atTAcK Addiction 302-593-0949 Julie Price League of Women Voters 302-734-2561 Cheryl Heiks Connections 302-563-3273 Julie Wenger DFIL 302-545-8305 Pam Price Highmark BCBS 302-421-2172 Mike Malkiewicz DTLA 302-670-5307 Mary Davis Ned Davis Associates 302-670-5307 Drew Wilson Morris James 302-650-3971 Teresa Avery Autism DE Pat Maichle DDC 302-739-2232 Wayne Smith DE Healthcare Assoc. Jamie Mack Division of Public Health 302-744-4951 Joanne Finnegan DHSS 302-255-9880 Janneen Boyce Division of Social Services Takeya Perez Division of Social Services Nicholas Brock State Senate 302-744-4056 Lexi West Division of Research Jessica Stump Division of Research Anna Keleher State Senate 302-744-4063 Tanner Polce Lt. Governor David Mangler Division of Professional Regulation

Agenda:

SB 24 SB 35 HB 11 SB 44 SB 45 SB 48 HB 21 w/ HA 2

Senator Townsend brought the meeting to order at 2:34 p.m.

Members approved the previously circulated minutes from the committee’s last meeting on January 25, 2017.

SB 24 (Henry) AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO MEDICAL MARIJUANA

SYNOPSIS- This Act removes the requirement that a psychiatrist be the physician who signs the written certification in support of an applicant's application for medical marijuana and adds anxiety to the list of debilitating conditions which a person can have to be eligible for medical marijuana. This Act also makes technical corrections to the statute.

Nicholas Brock, Legislative Assistant to Senator Henry, introduced the bill stating that it expands upon HB 400 from the 148th General Assembly also known as “Bob’s Bill.” He provided the impetus for the bill and an explanation of the need. He stated that five other states have added PTSD to the list of conditions that would qualify someone to be eligible to receive medical marijuana.

Jamie Mack, Policy Lead and Technical Advisor to the Director of the Division of Public Health, discussed a possible amendment that the Director’s Office has been working on with Senator Henry’s office. The amendment would address the concern that the Director’s Office has in expanding the prescribing capabilities beyond psychiatrists.

Senator Hansen shared that she had a concern and a question about the bill. Her daughter, who is a psychiatrist and in that role works with members of the armed forces, recently shared with her a Yale Medical School study that showed that marijuana adversely affected veterans with PTSD. She said that she would be remiss if she did not share that with the committee and that she also likely would not support the bill given that the latest evidence shows that medical marijuana is harmful to veterans with PTSD.

Jamie Mack assured Senator Hansen that there were several psychiatrists and physicians involved with drafting the bill and that the conversations were not over. The team would continue to look at the latest evidence.

Nicholas Brock reminded the committee of the state’s opioid crisis and the role that medical marijuana could play in mitigating that crisis.

Senator Poore asked for clarification on the timeline for the potential amendment from DHSS. She also thanked Senator Hansen for sharing the information from the Yale study.

Jamie Mack said that the Director’s office hoped to have the proposed amendment language to Senator Henry’s office by the beginning of the following week.

Senator Poore asked if the committee would be receiving any testimony from psychiatrists or physicians.

Nicholas Brock stated that Rich Jester, an advocate who worked on HB 400, was not able to make it to the committee meeting, but that he had submitted written testimony.

Senator Townsend said that he would be distributing the written testimony via email and also would provide hard copies to the committee members.

Drew Wilson, on behalf of the Medical Society of Delaware, stated that the Psychiatric Society of Delaware and Medical Society of Delaware oppose the bill because of a lack of evidence and even evidence that medical marijuana could be more harmful than helpful for individuals with PTSD. He stated that this position was a departure from the Medical Society of Delaware’s neutral position on all preceding medical marijuana expansion bills.

Pat Maichle, a representative of the Delaware Disabilities Council, stated that she could not speak to the effects on veterans or others with PTSD, but that medical marijuana has helped a number of children with autism who suffer from anxiety.

Wayne Smith, on behalf of the Delaware Healthcare Association, stated that the association is opposed to SB 24 because of the evidence from the Yale study and others like it, which showed that cannabis could be harmful to veterans with PTSD. He noted that there are over 80 strains and there is not enough known about the effects of the different strains. He also said that the Association hoped that the amendment to the bill suggested by DHSS would include non- psychiatric professionals who have been through certain training programs focused on prescribing medical marijuana.

SB 48 (Townsend) AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO NALOXONE

SYNOPSIS - Under this Act, a pharmacist who dispenses naloxone under an established set of circumstances is not subject to disciplinary or other adverse action under any professional licensing statute or criminal liability, or liable for damages related to injuries or death sustained in connection with administering the drug, unless it is established that the pharmacist caused the injuries or death wilfully, wantonly, or by gross negligence.

Senator Townsend, introduced the bill and explained that unlike the doctors who prescribe naloxone and the police officers who administer it, pharmacists do not currently have immunity in the Delaware Code. He then invited Dave Humes to provide testimony on the bill and stated that questions from the other senators and additional public comment would follow.

Dave Humes, an advocate with aTAcK Addiction provided background on the opioid crisis in Delaware and the history of use of naloxone in Delaware. He stated that expanding the use of naloxone is critical to saving lives and provided figures to demonstrate how many lives were saved in Delaware in the last year through the use of naloxone. He explained that the bill was created after the Delaware Division of Public Health spoke with their counterparts in the Commonwealth of Pennsylvania regarding their successful implementation of allowing naloxone to be sold in pharmacies. Pharmacists in Delaware requested immunity as a condition of their support. He emphasized that all other individuals involved in the purchase/administration of naloxone are guaranteed immunity under the 911 Good Samaritan bill.

Julie Wenger, from DFIL, who represents CVS, Walgreens, Rite Aid, and other supermarkets with full-service pharmacies, said that the organizations that she represents fully support the bill. She said that they look at this bill as a “loophole closer.” She also shared a story of a situation in which a young Delawarean passed away of an overdose because her friend could not get access to naloxone quickly enough.

Mike Malkiewicz, Co-Chair of the legislative committee for the Delaware Trial Lawyers Association (DTLA), stated that DTLA is opposed to the bill to remain consistent with their opposition to any bill that guarantees immunity. He mentioned that there hasn’t been an explanation as to why Walgreens, Rite Aid, and CVS have insisted on this protection for their pharmacists, which makes the organization question if the drug is actually as safe as it is advertised to be. He hoped that the State of Delaware would not bend to corporate interests.

Senator Townsend stated that he did not remember DTLA’s opposition to immunity clauses during the debates surrounding the 911 Good Samaritan bill, but he appreciates the group’s thoroughness and consistency is opposing any immunity bill, even one granting attorneys immunity. However, he believes that due to the grave nature and consequences related to overdoses that a carve out in the association’s immunity objection might be warranted. He then asked if any members of the committee had questions related to the bill. Having none, he announced that he would circulate both SB 24 and SB 48 for signatures.

HB 11 (Bentz) AN ACT TO AMEND TITLE 31 OF THE DELAWARE CODE RELATING TO ELIGIBILITY FOR PUBLIC ASSISTANCE

SYNOPSIS - This Act removes the prohibition against receipt of Temporary Assistance for Needy Families (“TANF” also referred to by the name Aid for Families with Dependent Children or “AFDC”) funds by persons convicted of a drug felony, so long as that person is otherwise eligible or TANF assistance. Even though federal laws such as PRWORA passed during the War on Drugs frequently prohibited access to public assistance for persons with drug felonies, these laws also gave states flexibility in determining eligibility for food aid and cash assistance for families with children when applicants had a criminal conviction. The majority of states have limited the federal bans in whole or in part. In 2011, Delaware opted out of restrictions on food aid, but it has not opted out of or limited federal restrictions on TANF—the cash assistance program that is the principal form of assistance available to most families in poverty to pay for things like electricity bills or school supplies. Under existing law, individuals convicted of any state or federal drug felony, including possession of marijuana (which can be a felony under federal law), are ineligible for TANF for life. Although the children of a parent convicted of a drug crime can still receive assistance, the family’s overall award is significantly reduced, and in practice this affects the well-being of families and children.

Representative Bentz introduced the legislation to the committee and provided a brief history of the bill.

Senator Poore asked how many families in Delaware this legislation would affect.

Representative Bentz said that he did not have the exact number; he believed it was approximately 30 families. He said that individuals from DHSS might be able to answer that question.

Takeya Perez, Chief Policy Administrator for the Division of Social Services, stated that 49 families would be impacted by the legislation.

Senator Poore asked if the Division had data from the last five years.

Janneen Boyce, TANF Administrator for the Division of Social Services, stated that they did not have data for the last five years, but 32 families were denied last year because of previous drug felony convictions. She stated that the families who have been denied would receive an additional $69 with each TANF check they receive had they been eligible. These families meet all other requirements for the TANF program.

Senator Lopez and Senator Poore asked to be added as co-sponsors to the legislation.

Julie Price, representative of the League of Women Voters (LWV), stated that LWV is very supportive of the bill. She noted that a marijuana conviction is one of the convictions that could currently prevent a family from receiving TANF benefits and in a few years marijuana could be legal in the State of Delaware.

Representative Bentz emphasized that only individuals with drug felonies are subject to the lifetime ban. Individuals with violent felonies or other types of felonies are not.

Senator Townsend circulated HB 11 for signatures.

SB 35 (Ennis) AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO THE ADOPTION OF THE RECOGNITION OF EMERGENCY MEDICAL SERVICES PERSONNEL LICENSURE INTERSTATE COMPACT ACT

SYNOPSIS - This Act enacts the Recognition of Emergency Medical Services Personnel Licensure Interstate Compact Act ("REPLICA"). With REPLICA, EMS personnel will be able to respond across state borders within the provision of their duties on a short term, intermittent basis on a privilege to practice under approved circumstances. REPLICA promotes compliance with the laws governing EMS personnel practice in each member state, home and remote, and gives states the ability to hold providers accountable from both. EMS personnel covered by REPLICA include those responding to calls for assistance across state lines as part of their duty, covering large scale planned events such as staffing concerts, sporting events, or large scale unplanned events where federal agencies are dispatched to support details, for example, wildland firefighting teams. REPLICA comes into effect on the date on which the compact statute is enacted into law in the 10th member state. Seven states have enacted REPLICA, including Virginia. Benefits of REPLICA include: REPLICA extends the privilege to practice under authorized circumstances and on a limited basis to EMS Providers; REPLICA enables the ready exchange of information between states through a Coordinated Database regarding EMS personnel licensure, adverse actions, and significant investigatory information; REPLICA promotes the highest level of public protection to patients and to EMS personnel in our state’s EMS System. State EMS Offices will now know who is coming into their state; and REPLICA provides a unique opportunity to support members of the military and their spouses with a clear and timely pathway by which to become licensed.

Senator Ennis, introduced and explained the impetus of the bill. He also explained that the bill cannot be amended as it is a multi-state compact. If Delaware does not adopt identical language to other states, then the compact would be void.

Senator Poore asked if EMS professionals crossing the border into the State of Delaware would need to pay any sort of licensure fees.

Senator Ennis said that the intent is for assistance to be made available on a short-term basis. The compact requires ten states in order for it to go into effect. If the bill were to pass in Delaware, the number of states who have signed on would increase to eight.

Senator Poore related the bill to an experience she had while working with a non-profit that served as a home for medically fragile children. The organization moved across state lines and in order to transport the children, they need to pay licensure fees in the new state. She asked if it would be reasonable to have a fee for EMS professionals responding to a call in Delaware.

Senator Ennis stated that he is of the opinion that if other states in the compact are not charging Delaware professionals, then the State of Delaware should not charge professionals in other states.

Senator Poore asked what would happen if the states within the compact had different requirements for licensure.

Senator Ennis responded that every EMT in the State of Delaware is already nationally registered, so it would make sense that they would be eligible in every other state.

Debbie Gottschalk, Legislative Attorney with the Division of Research, first reiterated that the language from the interstate compact must match the language from all of the other states that adopt it. She said that she looked through the Delaware Code to find other interstate compacts to see if the issue related to immunity had arisen before. She found two other compacts with the exact same immunity language. She said that Delaware has adopted much broader immunity clauses in other interstate compacts.

Mike Malkiewicz, Co-Chair of the legislative committee for the Delaware Trial Lawyers Association (DTLA), stated that the DTLA opposes all immunity provisions in all Delaware laws; therefore they are opposing this bill. They recommend that lines 301-307 be stricken from the bill.

Senator Ennis stated that he opposes any changes to the bill as seven states have already approved the language.

Senator Townsend announced that he would circulate the bill for signatures.

SB 44 (Townsend) AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO THE UNIFORM CONTROLLED SUBSTANCES ACT.

SYNOPSIS - This Bill clarifies that every prescriber holding a controlled substance registration must be registered with the Prescription Monitoring Program. Further, prescribers who receive a CSR (controlled substances registration) for the first time must register with the Prescription Monitoring Program within 90 days.

David Mangler, Director of the Division of Professional Regulations, explained the SB 44 closes a loophole that was inadvertently created when the Prescription Monitoring Program was last amended.

Cheryl Heiks, representing Connections, stated that the organization supports the bill.

SB 45 (Townsend) AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO THE UNIFORM CONTROLLED SUBSTANCES ACT.

SYNOPSIS - This Bill adds 3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide (U- 47700) to Schedule I of the Uniform Controlled Substances Act. U-47700, also known as “Pink,” is a synthetic opioid recently encountered by law enforcement and public health officials and is being abused for its opioid properties. It is available over the Internet and is marketed as a “research chemical.” The safety risks to users are significant and the public health risks include large numbers of drug treatment admissions, emergency room visits and fatal overdoses. On November 14, 2016, the Federal Drug Enforcement Agency temporarily placed U-47700 in Schedule I for a two-year period, finding that this synthetic opioid has a high potential for abuse, no currently accepted medical use in treatment in the United States and lacks accepted safety for use under medical supervision. By Emergency Order dated December 15, 2016, the Secretary of State temporarily placed U-47700 in Schedule I. This Order is effective for 120 days. The permanent addition of U-47700 to Schedule I is required in the interest of public protection.

David Mangler, Director of the Division of Professional Regulations, stated that this bill came from the Office of Controlled Substances after news accounts of adolescents having been found dead in their bedrooms by their parents after they had purchased a drug known as “Pink” or “Pinky” over the Internet. Jeffrey Bullock, Delaware’s Secretary of State, signed an emergency order placing this drug on the list of Schedule I drugs in the regulations and this bill would add this drug to Delaware’s Uniform Controlled Substances Act, which lists all of the Schedule I drugs. The Federal government has placed the drug on Schedule I.

Senator Townsend circulated the bill for signatures.

HB 21 w/ HA 2 (Heffernan) AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING NONDISCRIMINATION IN ACCESS TO ORGAN TRANSPLANTATION.

SYNOPSIS - This Act takes steps to ensure that individuals with disabilities are not denied access to organ transplant procedures based solely on their disability. Historically, individuals with disabilities have sometimes been denied access to life-saving organ transplants based on assumptions that people with disabilities are less worthy of care, or assumptions that the lack support services and/or the ability to follow post-transplant treatment plans. This bill prohibits denying a person with a disability a referral, evaluation and recommendation for transplantation solely on the basis of a non-medically significant disability and notes that persons who have the necessary support system to comply with post-transplant medical requirements should not have the inability to independently comply with those requirements held against them. The Act does not require referrals, recommendations or performance of medically inappropriate organ transplants. It affirms the state's commitment to the elimination of discrimination on the basis of disability.

Senator Townsend introduced the bill to the other committee members on behalf of Senator Poore who was the main Senate sponsor, but had to leave to attend another committee meeting.

Pat Maichle, representative of the Delaware Disabilities Council, stated that the Council is supportive of the bill. She also spoke on behalf of Teresa Avery and Autism DE and that organization is also supportive of the bill. She mentioned that nationally individuals with Down syndrome and autism have been targeted and have not been able to get equal access to organ transplants.

Senator Townsend circulated the bill for signatures.

The meeting adjourned at 3:30 pm.

Committee Minutes were prepared by Annie Gould on April 7, 2017 This meeting was recorded and an MP3 audio file is available upon request.