House Public Health Committee
January 28, 2025
Representative Mary Bentley [00:00:10] Chairman and committee, can you guys hear me okay? All right. Thank you so much. And, Chairman, with your permission, I'd like to have a little lady here at the beginning of this and just have a little history on this bill. Because maternal health is such a huge topic in our state. And this bill discusses that. So for our new members of this committee, I'm going to give a real quick, quick history on what we've done to where we get to this point today with this bill.
So House Bill 1181 is going to amend a bill that this committee passed in 2021 to give full scope practice to certified nurse midwives in the state. This is a group of people that has been shown across the nation to improve maternal health. And so this committee was gracious enough to be the first ones to pass that bill. But I want to go back just real quick for this committee to hear, and for those around us, that in 2019, we had a bipartisan bill passed in this committee and in the Senate to establish the Maternal Mortality Review Committee and Infant Quality Review Committee.
And if you guys have not, in this committee, read this here, this review from the Maternal Mortality Review Committee, get with Laura Shue in Department of Health, and she can get a copy of that bill for you in there. It shows why women in this state are dying in maternal health. We can't fix the problem if we don't know why. And that's why we established that committee. So the number one cause of death of women in our state, maternal wise, is older women that have hypertension, diabetes and those comorbidities that make being a mom a little more difficult. Those are the women that we are losing in our state.
So I think it's really important for you guys to read that bill and understand why people are saying, what in the world are you doing for maternal mortality in Arkansas? We're doing a lot of things, but we had to start and find out why it's happening. So this committee has steadily done things to improve what's happening in our state. And I know it looks bad, but we're heading in a good direction. I really feel confident that Arkansas is moving in the right direction. So a number of the members of this committee have been with the Maternal Health and Child Fellowship to learn what other states are doing across the nation. What are other states doing that have great maternal outcomes and infant mortality? What are they doing?
So we found that one of the biggest things they're doing to decrease maternal deaths is that we have certified nurse midwives. And real quickly, a certified nurse midwife is much different than a midwife that we have. We have what we call lay midwives. A certified midwife has just received training to be a midwife. A certified nurse midwife is someone who gets a bachelor's degree in nursing. She gets over 840 hours. And then she goes in for her two and a half years to complete her master's and then her doctorate.
So a certified nurse midwife is much more trained and she mostly operates in the hospital. So real quickly, I am probably the only one on this committee that's had-- I've delivered two babies with a certified nurse midwife and two babies with a physician. And I found the certified nurse midwife to be much better. But she left after my first two, and so there was none left in the state. As a mom at 30, I had no idea why.
But Arkansas has been the most restrictive state in the nation when it comes to certified nurse midwives. We had the most regulations, made it nearly impossible for them to practice here in the state. That's why, when the certified nursing midwife that I had left, there was no more to be found in the state. So I went to the hospital and delivered there. So what we're trying to do here today is to rectify what I didn't do when we passed that bill. When we passed that bill, I did not put admitting or discharge privileges in there for the midwives. I just assumed that was part of giving them full scope of practice. It was not.
So today's bill is a very simple thing. All it does, for all the certified nurse midwives in our state that are doing it, we need them-- again, this committee passed a bill to allow to us to establish a nurse midwife program at UAMS. It will start next year. So when we get done paying for these nurses to get trained, we don't want them to be leaving to another state. We want them to practice right here. So everything that we can do to make their practice possible will be helpful and so we can decrease the maternal mortality in our state. And that's the whole goal of this bill and our efforts on this committee.
So if you guys will look at the bill, all it does is add to allow these hospitals where they are privileged to get that right from the hospital to be able to admit and discharge and to work on the birth and death certificates, which from the hospital administration. I'm sure we added that. So with that committee, I will take any questions that we've got.
Representative Jeff Wardlaw [00:04:10] Any questions from committee on the presentation? Representative Ennett, you're recognized. And Representative Rose, I have your motion at the proper time.
Representative Denise Ennett [00:04:22] I thank you, Mr. Chair. I have one question, Representative Bentley.
Representative Mary Bentley [00:04:27] Yes, ma'am.
Representative Denise Ennett [00:04:28] Can you provide evidence that CNMs have shown to be effective in spotting the signs of emerging postpartum emergencies and have demonstrated knowledge of when it may be necessary to hold a mother for continued observation?
Representative Mary Bentley [00:04:46] Sure. That's part of their training. I mean, they are nationally board certified to be able to recognize that. I've got some documentation here, but I can show you after the committee if you'd like to see it. Happy to do that.
Representative Denise Ennett [00:04:55] Thank you.
Representative Mary Bentley [00:04:56] And there again, I will say the March of Dimes is hugely in favor of this. I think that's a group that would definitely not support what we're doing with certified nurse midwives if the March of Dimes did not support what we're doing today. Any other questions from committee?
Representative Jeff Wardlaw [00:05:12] Seeing no other questions, is there anyone in the crowd to speak for or against the bill? Seeing no one, what's the pleasure of the committee? I have a motion from Representative Rose for do pass, I presume. Any discussion on the motion? All those in favor say aye. All opposed? Ayes have it. Congratulations. Your bill has passed. And we'll move on to 1183. And that's the bill that has an amendment. So if you would, let us take up the amendment prior to the bill, Representative.
Representative Mary Bentley [00:05:44] Yes, sure. Thank you. And staff is going to hand out the amendment to you, colleagues, on this bill. So I want you to know that I have worked on this bill diligently with the medical society, with so many people. I think I have amended this bill more than any other bill I have ever worked on because I want everybody to be on the same page. I do not want this to be controversial.
I'm a person who wants to be transparent and make sure that we're taking care of the patients in Arkansas. And the whole purpose of this bill is to get good patient care. At the end of the day, we want our patients taken care of. Also, everybody in here knows that we have a huge nursing shortage, so we want to make sure the nurses in that building are being used to the best potential and that they're taking care of things that only they can take care of. So what we have here is an amendment. Has everybody got the amendment before I-- okay. So a simple change.
The medical society asked that we make a change to make this registered. And that's really all this amendment does, is to change the wording there to add registered on this bill. So, any questions on the amendment? And then I'll go into the full bill after the amendment is passed. This is on another bill for next week. Sorry.
Representative Jeff Wardlaw [00:06:48] Any questions on the amendment? I have a motion to adopt the amendment. All those in favor say aye. Opposed. Ayes have it. So with that, you're now recognized to present your bill as amended.
Representative Mary Bentley [00:07:04] Thank you. Thank you, colleagues. Thank you, Chairman. I appreciate that. So Arkansas has 2,500 residents right now that are in kidney failure and receive dialysis treatment daily-- not daily, some weekly. But if you've not had an opportunity to go and see those dialysis rooms, I would recommend that you go. It's really amazing what they're doing. And it'll also give you a quick reminder of why you don't need to be eating sugar. I can tell you that after you get out of there.
So right now in Arkansas, the patient care techs are highly trained. They get 18 months training. They're trained by that facility to do specifically what a position has designated for them to have done each day. So the safety protocol is set up, again, to make sure that they're doing exactly what was designed at that particular place where they work to get the dialysis treatment done each day. These PTT tech are really amazing. When I went to watch them, when they were put in the canulas in and they're taking care and their knowledge of the dialysis machine and everything that happens. They're very highly trained folks that take care of these patients all the time.
So what we've seen in Arkansas is that, unlike 34 other states, they're not allowed to use heparin. And if you think about motor oil and engines, heparin is to a dialysis machine. If you have no motor oil, the engine is going to seize up. If we don't have heparin in the dialysis machine, the same thing is going to happen. The blood is going clot. So it's very important. So again, just think of heparin like motor oil and an engine. Heparin is to the dialysis machine to make sure. So these people, specific things they look at the blood pressure, what's going on to make sure the heparin is given correctly and a bolus is given.
So right now, what they have to do is stop and find an RN. And there's only four RNs to 12 patients there. So they have to find the RN to come over there and give that bolus, which other states they're allowed to do it right there, for the patient care techs to give it. So this will allow them, for the RN to delegate, yes, you can do that. They're right there on the premises. If there's an issue, there is someone there to immediately take care of it.
This will allow them to do what they do in 34 other states, to give the heparin as needed as set out in policy and for them to be designated to do that. So it's really a simple bill. It sounds like a lot. But again, I want to make sure. It's important that the wording is correct. It's important that the Board of Nursing can have a registry of these people so we know who is actually operating in the state of Arkansas.
If there is an issue, they can be reprimanded if needed to be. So It puts them under the Board of Nursing. It gives safety protocols like they have in other states. And I do talk quick, so I will take questions if anybody in this community has some questions as we go along.
Representative Jeff Wardlaw [00:09:19] If you all got all that, you're way better in this old dumb plowboy up here. Any questions from the committee> seeing none, anyone in a crowd to speak for or against the bill? Seeing none, what's the pleasure of the committee? Do pass by Representative Gramlich here. Discussion on the motion? All those in favor say aye. Opposed. Ayes have it. Congratulations, your bill passed. We'll move on. And as amended, correct, Representative Gramlich? We'll move on to House Bill 1214. Representative Bentley, you're recognized. And that's the bill that has a hand out, Correct?
Representative Mary Bentley [00:10:00] Sorry for the confusion. That handout is for next week, but it's a really important bill. So whenever we have scope week. So the handout is for scope week. It's an informational packet for our new colleagues to hear about that program. So that's just for their information for another meeting.
Representative Jeff Wardlaw [00:10:13] Do you want it handed out today or you want to hold it to scope week?
Representative Mary Bentley [00:10:16] I think it'd be great for us to hand it out when this meeting is over, if that's okay.
Representative Jeff Wardlaw [00:10:19] That's fine with me.
Representative Mary Bentley [00:10:20] Thank you, sir. I appreciate it immensely. So this last one is a very important bill. As I was in nurse's training in 1980, I had the pleasure of working at a nursing home. And so when I got done, I was the director of nursing there. So taking care of the clients of nursing home are very important to me. They're patients that need to be taken care of well. There are our moms and our grandmas and we want those patients, those patients taken care of very well.
So I put a pretty restrictive bill in place to make sure that our CNA instructors knew what they were doing. And it was every five years they had to have worked a year in a long term care facility to make sure that they knew the up and coming things that were going on to make sure we had good instructors. That's the only way we're going to get good CNAs is if we had good instructors. Well, maybe I went a little bit too tight on that bill. So we've expanded it to go that the CNA instructor must have had one year of experience in a long term care setting within ten years.
So some of my colleagues have asked to expand that a little bit. So on behalf of Representative Robin Lundstrum, I'm presenting this bill today to make sure we go to 10 years. And also in place of that, it will require eight hours of continuing education that's performed by the Arkansas Health Care Association. So they are getting online eight hours continuing education to know what's going on to make sure that our patients are being well taken care of, because, again, our elderly are very vulnerable. And want to make sure they're well taken care of. And CNAs are very important to be trained correctly.
So this instructor bill gives a little bit of leniency, but in return, it requires them to do eight hours every year of continuing education that is free to them online, that they can take to make sure they're up and coming on what's going on in the state to make sure our vulnerable patients are being taken care of. So with that, I would be happy to take any questions on the CNA instructor bill.
Representative Jeff Wardlaw [00:12:00] Seeing no questions, is there anyone in the crowd to speak for or against the bill? What's the pleasure of the committee? Do pass, Representative Allen. Any discussion on the motion? Seeing none, All those in favor say aye. All opposed. Ayes have it. Congratulations. You have passed your three bills today.
Representative Mary Bentley [00:12:20] Thank you, Chairman. Thank you, committee. I'll try to slow down next committee.
Representative Jeff Wardlaw [00:12:26] Members, to kind of go over the agenda real quick. Shanice and I worked on this a lot this last weekend. The reason we set this agenda up this way is so everyone is aware of what's coming and when it's coming. We will absolutely only hear scope bills on February 13th and we will hear those first. If you do not present your bill on February 13th and it's in that box, that is the first strike. You will get another strike the following Tuesday and another strike that Thursday and it goes on deferred. So we will take those bills up first in those following three meetings before we move to the regular agenda. It's the way I'd done it, I guess it was about ten years ago when I sat in this seat. And we just keep that same method going forward. So with that, any questions on the way the agenda is set up? Yes, sir. You want to hit your mic?
Representative Fred Allen [00:13:20] Thank you. What's the process of getting it off deferred?
Representative Jeff Wardlaw [00:13:24] Notify Shanice with an email. And I think the rules say, we were just talking about that a few minutes ago, I think it says it has to have two days notice. So if you ask for it to be off today, it could be off for Thursday. And we were going to look at the rulebook and make sure that was correct. But we think it's two days. Any other questions? Seeing no further business, we stand adjourned.
