H.B. 339 Street Medicine Amendments: transcript

Thank you so much. I have a pretty good Senate sponsor in this legislation, So here we go again. He's a cool Guy. Um, we have a PowerPoint, but in the interest of time, I will email you the PowerPoint if you'd like to see more. Um, street medicine has been around for, uh, many years. It's, uh, it was, I guess, formalized by, um, uh, a doctor in, in Boston who was being put on the, uh, rotations doing the, for the Boston Healthcare for the homeless program. And he realized many of his patients didn't want to come inside, and so he took medicine on the road. Um, with me today is, uh, Jaida Emerson from the Fourth Street Clinic here in Salt Lake City, our largest street medicine provider, um, and probably the longest, um, in the state of Utah. They do a fantastic job. The bill is simple but important. It defines street medicine and code. The reason for that is when we're serving people, um, when we're, uh, serving people with healthcare, we don't want this to become a a Boy Scout project. We need to make sure that it has guardrails and so that, um, if it's your loved one who's out on the street, that they're getting the highest standard of care possible. And, um, as I've had the opportunity to go out, uh, visit the Boston Healthcare for the Homeless program and other street medicine programs, there's no one better than Fourth Street Clinic. And they treat each patient with dignity, respect, and they make sure they get the healthcare they deserve. The second puzzle piece of the bill is making sure that our street medicine providers can provide long-acting injectables for individuals with mental health challenges that are living unsheltered homelessness. The reason for that, I would say it's somewhat of a, a circular logic there, but recognizing that there's people who are living on the street and they may not recognize that they're mentally ill, and so making sure that they can get the healthcare, um, that they need, uh, as appropriate from our street medicine providers. I just want to give, uh, Ms. Emerson a minute to introduce herself, share a little bit about, um, what, what they're doing, and then we have a handout as well.

Um, thank you so much. I'm Johnny Dot Emerson. I am the CEO of four Street Clinic. Four Street Clinic serves as Utah's primary healthcare provider for individuals experiencing homelessness, providing integrated behavioral health pharmacy, outreach, care coordination services across both, um, our clinic and our community setting. In 2024, we serve 6,600 individuals through more than 30,000 visits with 96% of those patients experiencing homelessness and nearly half uninsured. Um, we have provided a one pager, which gives a little bit more information on the street medicine model and the other services at the clinic. I really appreciate the committee's consideration of HB 3 39. It focuses on strengthening and coordination support for individuals experiencing homelessness with complex medical and behavioral health needs. From our perspective, the intent of the legislation reflects a really important operational reality, which is that for individuals experiencing homelessness, healthcare access, behavioral health treatment, case management system navigation aren't separate needs. They are interdependent. A key component of that coordination is street medicine. Our medical outreach street team provides behavioral health case management directly in encampments and other community locations, reaching individuals who have not yet engaged in traditional care settings. Last year, the team saw 443 patients through nearly 8,000 outreach encounters, finding urgent medical needs, managing chronic conditions, and connecting individuals with ongoing care. From assistant perspective, the street medicine serves several important functions. It allows healthcare providers rather than emergent responders and law enforcement to address non-emergent healthcare concerns early. It improves situational awareness for medically vulnerable individuals living outdoors, and it supports continuity of care by ensuring people don't fall through the cracks outside of the healthcare system. But critically, it creates a structured pathway for individuals to come into clinic-based services when they are ready to receive ongoing treatment, medications, and additional care. Many patients who are now stable, being seen within our clinic, first engaged through street medicine. And in that way, street medicine operates as an entry point, helping move individuals from episodic crisis driven systems into lower cost settings. At Fourth Street Clinic, the average cost of a comprehensive medical visit is about $550 compared to an emergency room visit, which ranges between 1500 to 3000. Improving access across the outreach to clinic continuum really supports both clinical outcomes and is responsible use of public funds. Our current facility and program has served, uh, Salt Lake County for over 30 years. And as the state considers policy approaches such as HB 3 39, we're also working with community partners on plans to expand integrated healthcare capacity. So the infrastructure exists to support the outcomes the legislature seeks to advance. We view policy development, outreach engagement, and service capacity as complimentary efforts. So thank you for your time and for your consideration of this bill.

And all I want to do to end cap, uh, Johnny does great presentation. I'm gonna do my best Billy May's impression. If you like the bill, you're gonna love the funding request. If you're on EAC, we're working on, uh, separate funding requests to expand the clinic downtown Salt Lake that we think will be a huge cost savings when it comes to the public safety and crisis care. So, um, hopefully I did Billy Mays and honor there. Wonderful. So with that, that's our presentation, Mr. Chair. Thank you.

Senator Plumb. You know, I I'm in big support of all the work that you've done over the years, as well as what you're thinking policy wise. Um, Representative Clancy, I also think there, there's likely a crucial piece here in that with populations that are a bit more vulnerable, that putting some things with guardrails on is smart. I, I know that in the time that I've felt adjacent to the work you do, there are a, a lot of folks who say we're gonna go out and do some medical things out there. And, and that's, that's not the solution that it really, I think does need to have those guardrails in place and have it be more about tourism than it is about providing good care. So I, I think you're on the right path with this.

Thank you Mr. Chair. I would move that we favorably recommend substitute number one of House Bill 3 3 9, forward to the full body of the Senate.

Just say if you have more questions or you'd like to visit, uh, the Fourth Street Clinic, I think it'd be well worth anyone's time on this Health and Human Services Committee. They're doing great work in the community and, and really, uh, benefiting, uh, yes, the taxpayers, but more than anyone, they're benefiting the individuals who need help the most. I thank you. And my wife works there many, many, many years ago.

Good with that. Yeah. And I, i, I just wanna flag for Madam Chair and for, uh, trooper Terry. There's a suspicious figure in the back. Not Provo Police uniform. I don't, I don't know. He's, see if I can plug my piece in here. And then do you wanna introduce yourself for the committee?

Yes. Good afternoon. My name is Janice Olson. I'm the Chief Operating Officer at Forest Street Clinic. Hi. Okay. And then, uh, Corinne or Lisa, is it possible I could share my slides here with the, on the computer? I've got it plugged in. Oh, there we go. Well, thank you committee for hearing us out. We're gonna be speaking to substitute one. This was mostly about a data sharing piece, making sure that hipaa, uh, HIPAA compliant, um, organizations like the Fourth Street Clinic and Street Medicine providers can get the information from Hemis, the Homeless Management Information System, and, uh, not vice versa, that we would be sharing HIPAA information with non hipaa. So that, that, that substitute one.

Um, this bill is very simple. Uh, it's important, but, but simple. It's, uh, define street medicine and make sure that we can, uh, build, build on the existing success that our providers are doing. So I'll briefly go through these slides and then, um, we'll hear from Janice as well. Um, so the history of street medicine is, is quite simple for individuals who are unsheltered home homeless, um, many times they lack the, uh, um, the, the motivation or the trust to engage with traditional healthcare providers. So, uh, this is a picture of Dr. Jim O'Connell with the Boston Healthcare for the Homeless Program. He was, uh, working in a, uh, homeless healthcare program through the University of Boston Hospital system. And he recognized that the, uh, a lot of individuals that he was supposed to be serving didn't feel comfortable coming into the clinic for, for this or that reason. And so they took their, uh, took the medi medicine on the road, and they began, um, essentially building the plane in the air. Since then, the program of, of street medicine has grown across the country. And here in Utah, we're blessed to have one of the best street medicine providers in the fourth Street Clinic, downtown Salt Lake City. And so, why, why does this matter? Um, this is opportunity to meet people where they are, to give them the care, uh, that they need, even if that's on the Jordan River Trail, under a bridge on a sidewalk, making sure that we're building those trusted relationships and getting people the healthcare that they need. Um, so why do we need to define street medicine? Well, when you spend time, there's a, there's street medicine providers in Ogden, obviously, we've talked about the Fourth Street Clinic. You'll see that this is absolutely a very professional organization. They give the absolute highest level healthcare that you would expect in a clinical setting, uh, in, in a park. Um, however, it, we have decided that it's important to define street medicine because what we don't want is individuals who, for a, for lack of better term, for a service project, I'm gonna go and splint Mr. You know, representative Abbott's arm on the side of the road with no medical training, right? And so we wanna make sure that street medicine really is healthcare, and it's not, we're just, uh, firing from the hip there. The other piece in this, uh, legislation that's very important to, uh, uh, street medicine providers, that will be a, once again, an important access point is making sure that our street medicine providers can provide long-acting injectables on the street. So, once again, individuals that are experiencing a deep psychosis many times, are gonna be struggling to, uh, have the, the trust to come into a clinic to receive mental health care. If the provider has, if they, if they're prescribed a long-acting injectable, this, this bill is going to make sure that our street medicine providers can meet them where they are and get them the care they need. So, um, if you're interested in more research, there's a broad, uh, literature review about the importance of street medicine and the really positive outcomes that it has for individuals who are unsheltered homeless. And then finally, uh, this is a opportunity I got to visit the Boston Healthcare for the homeless, uh, project downtown Boston, and then our great team at the Fourth Street Clinic who took us out, um, with their street team all over downtown Salt Lake City. And so, um, want, uh, Janice to have the opportunity to share her insight and then be open for any questions. Okay.

Thank you. I'm gonna keep my comments brief. I have our medical director here with us today, and I'd like him to be able to share his perspective with you all. Um, so for those who don't know, four Street Clinic is a community health center. We're dedicated to serving individuals experiencing, sorry, can you introduce yourself first too? Oh, I'm so sorry. That's Denise. Denise Olson, chief Operating Officer at fourth Street. Thank you. Um, so we are, we serve individuals experiencing homelessness. Uh, in 2024, we served over 6,600 individuals through more than 30,000 patient visits. And it's important to know that about 96% of our patients, um, experience homelessness and over half are uninsured. So our care model is intentionally integrated and flexible. We operate what's called a hub and spoke model that includes a downtown clinic, that's our main hub, a mobile clinic at partner sites, and a street medicine team, uh, that brings licensed medical, behavioral health and, and case management services directly to encampments and other unsheltered settings. In 2024, our street medicine team served 443 patients through nearly 8,000 outreach contacts across more than 100 known encampments. We provided healthcare services, uh, through licensed providers that delivered services where patients actually are, and for people who are otherwise disconnected from traditional systems, house Bill 3, 3 9 is helpful because it brings clarity and guardrails to work that is already happening. It defines street medicine and statute, it reinforces existing licensure requirements and directs the Department of Health and Human Services to develop best practices in collaboration with providers doing this work. And now I'd like to turn the time over to our medical director, uh, to share his perspective with you.

Hello, chair, vice Chair and committee. My name is Van Aston. I'm the medical director at Fourth Street Clinic. Thank you for taking the time to hear from us today. Um, I had the, uh, opportunity to work with our street medicine team for well over two years. And I can speak directly to one. The need that is out there amongst our community. Homelessness is at the forefront of many conversations. In particular, how to work with patients that are experiencing severe persistent mental illness. But first we need to talk about the fact that Fourth Street values how we practice medicine. We operate within legal and ethical boundaries, particularly with our street medicine team. And we take pride in the kind of care that we can provide to those patients that are living on the street. As far as long-acting antipsychotic, injectable medications, they're a huge benefit to our patients. Many folks come to our clinic to access care with these medicines that don't require a daily pill to take. Many of us here that take medications often forget to take our morning or our afternoon pill. Many of the people that are living on the street lose track of what day it is during the week, let alone what time it is. Many of them don't have a traditional bedtime, or they don't go to work as a time to remind them to take their medications. And when we're talking about the complexities of schizophrenia, bipolar, and other significant mental health disorders, the benefits that they get from a medication that is injected one time a month allows them to stabilize their mental health and help to organize other goals and other things that they're working on. We're excited for the opportunity to really enforce how important this medication is. Also, how important street medicine is to our community and to those individuals on the street experiencing homelessness. Thank you for your time.

Uh, thank you. I know that long-acting injectables are extremely effective. Uh, some of the best ones are also extremely expensive. Could you just clarify if three 40 B uh, is a, a, a funding source that helps, uh, fund these types of, uh, medications?

I can't speak to all of them. I know that there are some that our three four B pharmacy is able to work with. Um, we also have some, um, partnerships with some of the, um, manufacturers themselves. There's ways to get access to these medications that aren't necessarily through the free three 40 B program. Um, but we evaluate any patient we think would be a good, um, candidate for them and send them to our pharmacy, and they work with them in any way possible to get access to those medicines. Thank You.

That, that concludes our presentation. Thank you, Madam Chair. Okay,

Thank you, Madam Chair. Are there any downsides to these long acting medications? Like possible drug interactions or, I don't know, just is, is there any, anything that could happen that would be a negative from this?

Any of these medications, um, will have some version or some form of side effects. Um, the way we operate though, is we make sure there's medical providers and psychiatric per prescribers that are on board for these treatments so that we can monitor any potential side effects, any potential drug drug interactions, or other things that could potentially happen with these medications.

Thank you. Mm-hmm. Thank you.

Um, our street medicine team consists of the Street Medicine supervisor, an EMT that goes out with the team. We have a, uh, CHW that comes with us as well, a case manager, a medical provider. So that is, um, a physician, a pa, an np. Um, and then we have a, uh, behavioral health provider, so a therapist that goes out with them pretty consistently every week. Um, and that's currently where things are at.

The team goes out all day, all day, every day of the week. Five days a week. Okay. Five days a week. So not on the weekends? Not on the weekends, no. Okay.

Afternoon, everyone. Um, sorry, I'm not there in person, but as you can tell, I've got quite the cold, so I'm not sharing with the rest of you. Um, I just wanna thank the sponsor for this bill. Um, I, I think it's important to understand what street medicine does. It keeps these people out of the emergency room. And the emergency room is where our costs go way up. They're not insured, you know, all of those things. So, I mean, we, the street medicine is really, they're sort of the angels on the street, um, in the healthcare world. So I strongly support this, and we have, we have no concerns whatsoever, and we think this is the right path. Thank you.

a sub representative Tiano Motion to adopt first substitute house bill 3 3 9.

I think it's great. Okay. I'm not seeing any comments.

I'll waive. Thank you. Okay. All right.

I'd move that the committee, uh, advance house bill 3 3 9 for substitute with a favorable recommendation.

Yes. I just kind of wanna emphasize how, um, I strongly support this. I want to thank Rep Clancy for this. Um, I used, when I worked with the homeless population, I was the director of homeless outreach for a while. And I cannot tell you how important this part of providing services is to getting people off of the streets and the number of people that we help because, um, the medicine outreach medicine was so important. Um, and when we were encounter people along the river who were having medical emergencies or something going on medically, but because of their mental health, refused to go into the hospital, but still needed, um, still needed that care, how important it is. And not only that, but the rapport that the medicine team built with these individuals where they trusted them, um, where they wouldn't trust other doctors. And sometimes us, when we show up and would say, um, could you call so and so? And we knew to call somebody in the medical team. So, um, I just wanna emphasize how strongly I support this, and thank you for bringing this forward.

All. All I would say is that while I appreciate Representative Hollins comments, I think that's more of a reflection of the good work being done in the community. I think this legislation, we can put four corners around it and support the work being done, but at the end of the day, all the credit lies with those who are doing the hard work day in and day out. And, uh, proud to, uh, support these, these great champions.

Is there any final word? I'll waive. All right. Okay.

Thank you, Mr. Speaker. Pro tem colleagues. Our homeless population is a group of individuals who we have spent in this body a significant amount of resources, time, energy, and effort because we all have someone in our life, or we know someone who is experiencing homelessness for whatever that reason might be. Particularly for individuals who are living unsheltered homelessness. So living under a bridge, living in a park, living on the tent in a sidewalk, many of these individuals can experience severe, um, health challenges, things like necrosis, gangrene or, or even more mundane things that you or I may need to do routine checkups with. However, due to the complexity of unsheltered homelessness, many times individuals who are homeless, uh, lack the trust in the system or the, or, they're dealing with different challenges when it comes to mental health that they are not confident enough to walk into a clinic or to a hospital or to an emergency room to get the healthcare that they need. So in the late eighties, a program was started, um, across the country called street medicine or mobile medicine. This is where individuals of I would say angelic providers take that healthcare and they hit the road, they go out on the street, they meet people where they are, and they try to deliver that kind of healthcare. This Bill Codifies Street Medicine. And you might ask why Mr. Speaker reports him why that would be important. Well, if it was you or i's loved one that was on the side of the road experiencing and being in crisis and needing healthcare, we wouldn't want individuals going out and splinting someone's arm because it's a service project. We need to recognize that this is a form of healthcare. The other piece of this, make sure that, um, street medicine providers can give long acting injectables, antipsychotics for many, particularly those experiencing what's called noia. They're so mentally sick with mental illness that they don't recognize they need the help. And so it would be counterintuitive to prohibit our street medicine providers from giving people the medicine they need when they're already out there doing the work. This bill has a zero fiscal note, and we've worked with our street medicine providers from Ogden to Salt Lake City to across the state to make sure that this makes sense. Um, and I would appreciate your support, Mr. Speaker proto.

I'll waive. Thank you. Mr. Wade.

Yes. Thank you. This bill, uh, is exactly what it says. Talk about street medicine. When you think of street medicine, if you're familiar with the fourth Street clinic here in Salt Lake, that might come to mind. There are very few other providers for street medicine. What is street medicine? They offer, uh, medical service for the unsheltered individuals in our communities. Uh, typically they're not likely to go into our standard medical facilities. And it's also, uh, recognized an evidence-based outreach model that reduces er overuse, preventable hospitalizations, and a strain on the public system. So that's your street medicine. And what this bill does is it asks the Department of Health of Human Services to develop a guide for street medicine providers so that they are every bit is legitimate and they are as any other provider. And they also a grant the department rule making authority. And then one important aspect of this bill is it provides permits a street medicine provider to dispense administered long acting injectables. And that is Bill.

Uh, thank you Mr. President and, and more, uh, than a question. I, I really just wanted to voice support for this bill. This is a space that, um, the people who do it well do it so well. And there are some folks who perhaps, um, have good intentions but don't do it well. And I think that this is the way to ensure we have some guardrails in place. As well as that folks are all for focusing on the same mission. Uh, I I support this bill. Think it's a great bill.

Yes. And just a summary just for information all. So I learned long act, long acting and injectables. Are medications often used for schizophrenia, bipolar, or opioid? Opioid jewish disorder that last weeks and or months? Because sometimes, uh, unsheltered individuals struggle to get into facilities they need to perhaps on a more frequent basis. And with that, I would ask, I'd make a motion that first substitute ha house bill 3 39 passes to the third being calendar.

Ipson Baldy Lewin brammer. Us cullimore escamilla Aye. Aye. Fillmore Aye. Grover Harper Kinins Ipson Johnson k Juab McKay Mikel Milner Musselman Owens pitcher Plum Rebe Sandal Stevenson Stratton Bickers Byler Weiler Aye. Wilson Winterton, president Adams

Okay. Thank you. Sorry. He's on the phone. Okay. This is the, uh, street medicine bill that we talked about and we have, again downtown. We have the Fourth Street Clinic and we have other people that are trained to attempt to provide street medicine. And what this bill does is ask the Department of Health to be a little bit more involved in that. So the quality of care that's delivered to our unsheltered individuals is, uh, as good as it can be and with the proper guardrails and, and taking care of them, it also, uh, makes it possible for these patients to ter to receive long-term injectables in which they can current not currently not able to do. And that's the bill. Sorry,

Senator Vickers. Baldy Lewin Aye. Brammer Aye. Thus? Aye. Fillmore Es. Camilla Fillmore Grover Aye. Harper Aye. Kins. Aye. Ipson Ipson Aye. Johnson Juab McKay Aye. Al Aye. Mikel Aye. Milner Aye. Musselman Owens pitcher Plum Rebi Sandal Stevenson Stratton Vickers Weiler Wilson Winterton, president Adams

Thank you Mr. President Pro Tem.