S.B. 96 Opioid Fatality Review Amendments: transcript

Yes. I would like to, uh, make the motion that we substitute sub one in body and title for initial Senate bill 96.

Okay. Uh, as I did before, I'd, I'd like to clarify why sub one came into being, and this came up just in the last little bit. We, um, in the process of, of putting this bill together, have engaged a whole lot of stakeholders. And we heard back from some of the partners at DCFS, especially in the, uh, administrative space. And there were a couple of clarifications they wanted us to add that would make implementation easier for them. So this was, uh, about, there was one space where we had said that a local authority may engage with, uh, an animal control to start with an MOU. He said, that actually makes it stickier for us. So we took the MOU language out while still allowing for the kind of relationship to develop. So it was just a couple of, um, things that smoothed the proverbial waters, um, for them. Um, this bill came at me from a couple different angles, and it is interesting in your life where your silos line right up together. And I, I work in the pediatric emergency department up at Primary Children's with, um, kids who've been ill or injured. Sometimes they're just fine and everybody needs a little reassurance. Those are my favorite kids personally. 'cause we get to say, you're, you can go home, you're just fine. Um, and, and as a part of that, you see things that, that, you know, that happen in our society that I wish didn't and that I wish no one had to see them. But more importantly, I wish no child ever had to experience them. And that is the child abuse cases and the neglect cases. And one of the goals, I think, for all of us is to minimize any of the suffering or things that could happen to our most vulnerable to our kids. And when we find a way that we could potentially have an impact in then to move if there's a way on it. And so then, you know, I happen to be an animal lover, uh, rescuer have a, have a heart for the young little things in the world, as it were. And, uh, some folks who work in the animals welfare spaces had also brought up this, what we call a link between, um, child abuse and animal abuse. And it is, oh, I forgot. Can you spend, can you get these? We made some little graphics for, you'll have him pass these out as well. There is this link that exists between, um, unfortunately animal abuse and child abuse. Senator

I'm on Senate bill one 15. Right. But we, the one before we substitute was 96. Yeah, look at that. Wouldn't you know that one 15 also has a sub? So look at me going down all the paths. So do you want me to keep going with one 15 and we change the numbers?

Look at me. But hey, you know, it's all good. So we will, uh, We're gonna take a little break from the stuff that makes our hearts hurt. Okay. That, that stuff that, that was just a little take a pause A little. I see what did a little break. It was like a little, it's like tantalizing. It's like, Ah, some things are better in small bites. This, this is one of 'em all. Now we're gonna, well, thank you for catching that. We're, yes. Lemme go back to 96. You had a little, little preview of one.

Uh, 1596 is again, another bill that came out of that NCSL um, conference. And so I don't need to say name the same task of players or list of players, but interestingly, a gentleman by the name of Bill Newell, who leads the Governor's Fentanyl task force was also there and called it the STP seven 10 people. 'cause you know, we were the same 10 people who were really engaged and, and always thinking and talking about these issues and the STP. And as part of the group, we talked about Naloxone access, we talked about treatment, we talked about all so many other angles of places that were overlapping. But one thing that was made, uh, brought to our attention and made clear to us was, came from the Office of the Medical Examiner. And that is that they are diligently in many spaces trying to take what information they can gather after we've lost somebody. And they do this in, um, suicide fatality reviews. They do this in maternal mortality reviews. They do this in child fatality reviews, and they also do it in opioid fatality reviews. And the hope is that you can learn something from the loss of, of an individual that you're thinking about or learning about that may prevent the loss of somebody else down the line. Um, and one of the areas that they had identified. So if you can imagine I'll just specifically focus in on the opioid fatality space. Is there something, say somebody had just been released from incarceration or someone had just been re released from hospitalization or someone had, uh, just been out of treatment. Is there something that we could have potentially flagged and done something differently? Is there something about the prescribing patterns that Uintah these folks? Is there something about the, the resources that were available to them that could have been enhanced? And these groups get together, these fatality group review groups get together and they review the cases. There's someone from the HA health systems that reads through the charts. There's someone from law enforcement who reads through criminal records. There's someone who looks at what jail records they've had. There's people who look at the Doppel records for what's been prescribed as far as controlled substances. And an area that could not be gotten into was their treatment records. And there's a reason for this. Uh, the, the, the federal government has set up, I think, an appropriate amount of guardrail and extra precaution around people's treatment records because there's a lot of stigmatizing things that can happen when you learn somebody has been in, uh, drug treatment or serious mental illness treatment. There, there's things that can come out of that that may influence the way somebody's treated in the criminal justice system or in the healthcare system. And so there's these extra kind of protections. When I'm in the er, I can pull up somebody's chart and it'll show me their last ER visit. Maybe if they've had a surgery, it'll show me an x-ray. It'll show me just the regular mental, or, excuse me, medical record. But their treatment records, if they've had mental health treatment, that gets an extra layer of protection, rightfully so. I think when someone has passed though, that piece of extra protection, it, it takes on a different meaning because you're, you're, I understand the need to still protect something that's sensitive, but I also want us to have a, a better honest look at what our systems are. And if there are spaces within the treatment that need to be identified, we need to see those records. The, the Office of the Medical Examiner needs to see those records. And so working with the ags office that the ag that represents for the Office of the Medical Examiner, working with their epidemiologist, with Megan Brockmeyer, with, uh, some of the, the docs and the clinical folks in there working again with the people at the office of substance use, use and mental health. We feel like we carved it out in a way to make it clear that they can be accessed for the purpose of gathering this information. Uh, a good point was brought to me today by Nate Mutter and the LELC folks, and they said, we wanna be clear that this doesn't give them some sort of power to supersede like that the D-H-H-S-O-M-E, uh, investigative stuff would supersede the criminal justice systems. So that was what the substitute did, was it entered in this clarifying kind of couple of lines to be certain that we were not trying to make this supersede what happens in other investigative spaces, but that it was allowing clarity around this so that there wasn't worry from within the O-M-E-D-H-H-S or from within the ags office that, that we were stepping outside of, or we, as the opioid fatality review boards were stepping outside of what 42 CFR would allow. Um, I've had broad support for this and, and I'm grateful to the folks who brought up the things that we should fix and change. And I am, uh, hopeful that you all agree this is something that will help us hopefully protect some people heading down the line. So with that, I'm open to questions.

I motion that we pass this bill.

or, oh, I just waive.

So I just didn't, if you promise we don't, we don't need to go through the whole speech again. Yep. I'll just pick up pretty smart before it was. Okay.

Um, 96. Okay. So Senate Bill 96 is, um, I don't know if you all remember when I talked to you about the same 10 people, the STP that Uintah the, um, NCSL fellowship that we did on preventing opioid overdose deaths. So this was another thing that came out of that with the same 10 people, which included Senator Vickers and Representative Gwynn and myself and Lisa Sorenson was actually there. We had representatives from DPS and from DHHS and the Office of the Medical Examiner. And we were trying to brainstorm about ways that we could make improvements in the opioid fatality space. And one area that came up from the office of the Medical examiner was that in the unfortunate event that we lost someone that was deemed related to an opioid, we have something that's called an Opioid Fatality Review Committee. Um, and that's actually thanks to the good Representative Ellison. We have similar in other spaces where you're trying to learn enough that you can perhaps prevent the next one from happening. We have it in maternal mortality reviews, we have it in child fatalities. We have their suicide fatality review boards. And one of the pieces that they were really and are continuing to really run into struggles with is after you've lost someone to an opioid overdose death and you want to have access to what sort of treatment they were getting, where are the gaps potentially in their treatment process, where they were getting treatment, what it was looking like. And they were finding that largely because of the 42 CFR regulations that were put into place to protect at an extra layer of protection for people's mental health records. And I'm, I'm actually a big believer in those. I I think that, for example, if someone came in to see me in the emergency department, I shouldn't necessarily be able to delve into the depths of someone's mental health records. That isn't necessarily what I need to do. And there's also concern about stigmatization and, and things that have happened to people in the past related to their mental illness and as well, um, treatment records. So once someone's gone, you have a little bit different threshold there because if you actually wanna find where the gaps are to avoid future deaths, you, you actually need to look at all of it. And they had worked with OME had worked with the ags office and they felt like they really needed some in increased clarity in our code to allow them to access those records. There's nothing here that would put someone perhaps, uh, in, in a, in a treatment space that they would need to worry that they were at risk, that they were going to be, you know, audited or this was something that was going on at a witch hunt. This is truly a way for this to be a part of that fatality review to see what we can learn in that space. So, um, same 10 people. There's, it's truly some of my favorite work because it's a lot of folks that wouldn't necessarily sit around a table. And it turns out when you do that, you come up with some good ideas and, and that's essentially the genesis and what this bill does. That's it. Awesome.

Thank you, Mr. Chair and thank you Senator Plumb. So if you're, are you on the Opioid Fatality Review group?

So I participate in the conversations, but I'm not in any of the data abstraction groups. So that's usually people either from the, uh, representatives from law enforcement who will dig into the clinical record part. There's people from Intermountain Healthcare as well as the University of Utah that will get into the medical records parts. Um, there's folks that'll look through, um, DCFS and, and child welfare involvement. They, they're, they have kind of different folks. So I sit there as a contributor, but not as a data abstractor.

Got it. Well, and that was, that was really my question is just, so if it is, if, if now we're clarifying that these treatment records are protected under the CFR, how would they, how would they get them? Would it be like a,

Uh, oh, it's, it's actually opening them up a bit. Okay. So that they can, they can be used in this fatality review process by the appropriate folks who have access to the records. But there's just that little extra protection that the ags office and the OME wanted to make sure that we as a state were okay with them looking through. So it, it actually grants increased access to use that piece as part of the review.

Okay. Thank you. You Bet.

So how long have you sat on the Overdose Fatality Review committee? Oh

My gosh. It's been pretty recent. I would say. Uh, in fact, I think you and I did not cross paths. Um, 'cause I know you were there in the early days and then I've probably been about a year or so, and I understand it's been quite an evolving process. Do you feel like you could give any examples of improvements to the process that came out of those cases? Of from what just of you observed what information came up? I mean Yeah. It seemed to me when I was there that like at lot of times there were some vague recommendations or recommendations that it wasn't clear how you would go about implementing them that were, I mean, honest recommendations from terrible, I mean, every case it starts by definition is horrible.

Right. Yeah. But do you feel like you've seen some success changes to policy from your involvement that you could give an example of?

You know, it's, um, I, from my understanding, again, not having been there in those early years, from my understanding, there's a much more defined process that's been coming together. There's a woman named Casey Robinson who has, um, kind of shepherded the Child Fatality Review Board, which, which I've actually been on for a number of years. Apparently. I like some of these spaces that are a little, or I'm drawn to some of these spaces that are a little less uplifting, but je hope uplifting comes out of them. Right. Um, and I think that they are, from my understanding from the other folks who've been there longer, there is definitely more organization and there is more attention to, at the end of every case, they almost make like a round the table recommendations. Like what would you say we've learned outta this case? What would you like to go in, uh, to further conversations about this? I have noticed, um, in the cases that I've been watching and in the conversations that I've been having, um, there have been increasing recommendations about harm reduction. So things like access to syringe services, current clean needles, ways to prevent overdose. I, I've seen that happening more. And that's not me from, from me mentioning it's from me noticing that happening. And this policy piece in and of itself is, I think come out of, uh, more direct off to the medical examiner control over that. So I wish I had more concrete examples, um, but I hope that there will be more in the future.

Thank you. Then I would like to make a motion that we favorly recommend Senate Bill 96 for substitute. That motion is in order, would like to speak to it. This is a small change, but this is information that is central to the kinds of things that this committee looks at.

Uh, I'll waive. Okay. We'll place the motion, which is

Thank you Mr. President. I, I neglected to include Representative Gwynn as part of the STP and my good sponsor, my good floor sponsor for these bills. Uh, when I mentioned them before, this is the second of the STBP bills, the bills that came out of us trying to find state solutions or at least move, uh, down the field a bit on this. And our office of the Medical examiner who does opioid fatality reviews, they do these in other tragic situations where we've lost folks in the hope that we can come up with information that may help us protect others. So in the suicide space, it does also happen in the mortality of moms space and CHI child fatality spaces. These are spaces where we really want to have as much information possible with the hope that we can prevent further, um, harms to Utahans. And they had identified a spot within the office of the Medical Examiner when they're performing these reviews where they couldn't access treatment data. And that was because of something called the, uh, 42 CFR, uh, reports, which are part of the, excuse me, sorry, that are part of the Federal regulations on protections required for treatment records. And while someone's in treatment, I do think it's important that we have an extra layer of protection on those. So for example, if I'm in the ER and I pull up someone's medical record, their treatment records aren't going to show up there. And I do think that's appropriate. But once somebody's passed, including that in the overall evaluation of what got them to that unfortunate place, feels like it is the right thing. We've worked on this with the medical examiner's office, with the ags office, with the Department of Health and Human Services, and again, with the STP and this will help them provide even better information in their fatality reviews.

No, I'd waive summation and call the question again. Thank you, sir.

Senator Vickers Baldy Lewin Aye. Brammer bus Colmore Aye. Escamilla Aye. Fillmore Grover Harper Aye. Kins Aye. Ipson Aye. Johnson Aye. Quan Aye. McKay? Aye. Mikel Milner Musselman Owens pitcher Plum I Rebe Sandal Stevenson Stratton Bickers Aye. Bier Aye. Wilson Aye. Winterton Aye. President Adams Aye. First substitute Senate Bill 96 7 received 28 yay votes. Zero na votes, one being absent Shall be read A third time

Senator Plumb. Thank you, Mr. President. This was the second of the, uh, NCSL projects that we worked on together with multiple stakeholders. And this allows our opioid fatality review process that happens within the Office of the Medical Examiner to feel that they have clarity to use treatment records from folks that we've, uh, unfortunately lost. The goal is that we can learn from those and, and hopefully help people in the future not repeat those mistakes. It's pretty simple. Bill,

Uh, thank you, Mr. President. I would waive any summation and call the question.

Thank you Mr. Chair. ProAm colleagues, uh, this bill came out of a working group, uh, myself and a few other Senator Vickers were on, uh, working through NCSL on this opioid, uh, epidemic that we have in our country. And as we've reached out to other states and policymakers, what we found in Utah is we're actually ahead of the curve as it relates to combating, uh, opioid overdoses. Um, but what we also found is while we have a lot of strategies and entities in place, we're not very good at actually communicating with one another. We're territorial. We interpret laws in various ways. And so that hinders progress and communication. And so what this bill essentially does is says the Medical examiner's office, the Department of Health, they have the onus of conducting post fatality reviews. And why is this important? The more information we can get as it relates to where, uh, these overdoses are occurring, the frequency of which they're occurring, the history of the patient before the overdose, we can use that information to try and keep other addicts alive long enough for them to make the decision that they want to change their ways. And so, again, it clarifies that, uh, the Department of Health and the OME have the responsibility of conducting these investigations. And because of that, they have the ability in compliance with HIPAA to reach out to other organizations such as treatment clinics, uh, mental health providers to receive the records that they need in post fatality investigations so that information can be used to hopefully prevent future fatalities. That's all this bill does. Mr. Speaker Pro Tem. Thank you, Representative Gwynn discussion to the bill.