1 1 DELAWARE HEALTH FUND ADVISORY COMMITTEE 2 DELAWARE HEALTH AND SOCIAL SERVICES 3 4 PUBLIC HEARING 5 DelTech - Owens Campus 6 Georgetown, Delaware 7 Monday, November 29, 1999 7:10 p.m. 8 BEFORE: 9 GREGG C. SYLVESTER, M.D. 10 Chairman 11 JOSEPH LIEBERMAN, III, M.D. Member 12 CHARLES SIMPSON 13 Member 14 THOMAS GRABOWSKI, SR. Member 15 SENATOR DAVID McBRIDE 16 Member 17 VIVIAN LONGO Member 18 CHARLES F. REINHARDT, M.D. 19 Member 20 21 TRANSCRIPT OF PROCEEDINGS 22 23 WILCOX & FETZER 1330 King Street - Wilmington, Delaware 19801 24 (302) 655-0477 2 1 CHAIRMAN SYLVESTER: Good evening. I'm 2 Gregg Sylvester, and I'm the Chair of the Delaware 3 Health Fund Advisory Committee, and you hopefully have 4 received some information, and you can see that some 5 of us happen to have our name tags in front of us, but 6 the entire list of the committee is available for 7 you. If you haven't picked it up just as you walked 8 in, there's a list out there. 9 You may have also had an opportunity to 10 pick up a couple other pieces of information, and I'd 11 just like to talk about those just for a minute before 12 we get started with the public hearing. 13 For those that are going to get up and 14 may want to talk extemporaneously and if afterwards 15 you want to put pen to paper, you still have 10 days 16 to submit something so it becomes a formal part of the 17 record. So we actually have a list, an address and a 18 deadline of December 10th to participate. 19 If you are going to speak this evening 20 and you actually have written testimony, please be so 21 kind to make sure that we all get a copy, as well as 22 the woman that's doing the transcription for tonight. 23 That will make it easier for us and we will make sure 24 we're getting exactly what you want us to record. 3 1 And then the two other pieces of 2 information that I have is that Senate Bill 8, and we 3 will talk a little bit about that, that's the bill 4 that actually created the health fund, actually there 5 were eight purposes for that and we have written those 6 eight purposes down so that you can read them or you 7 can review them as you're listening to the various 8 testimonies and as well as you're trying to formulate 9 how you would like to speak on that testimony, you can 10 have that right there. 11 Then finally we have a little bit of 12 guidelines for tonight so we can stay on track. 13 Although it says that the hearing is to start at 3:00, 14 they did start today at 3:00 in Dover. Obviously this 15 will go from 7:00 to 9:00 this evening. 16 We are going to have the people that 17 have called up ahead of time speak first and then 18 those afterwards will have an opportunity to talk. We 19 actually had plenty of time for that to occur up in 20 Dover today. 21 We would like to try to keep it to about 22 three minutes, and I have invited Pam Murray, who's my 23 secretary, up from New Castle with me and she will 24 actually have cards and when you hit the two-minute 4 1 warning, she will put up a nice little yellow card to 2 remind you you have a minute to sum up. At three 3 minutes she will show you a little red card. Thus far 4 we haven't yanked anybody off and we have let you 5 continue. We have been cognizant of the time so we 6 stay on schedule. What the committee members have 7 done on some people, they have actually entered into a 8 little bit of dialog and asked some questions. If you 9 will stay up there if there are some questions we 10 could ask. We can do that. We would do it 11 immediately after your presentation and not after 12 everybody has gone through. 13 Let me just say that I want to welcome 14 the committee members that have made it throughout the 15 state for coming here. I want to welcome you all for 16 taking the time this evening to come and provide us 17 with testimony, good public hearings on what's going 18 on. We had a wonderful turnout in Dover, and it looks 19 like we have got another good turnout tonight here in 20 Sussex. I want to thank you for coming. 21 I want to tell you a little bit about 22 what's going on. November 23rd, about a year ago, 23 last week the attorneys general from the states signed 24 on to the Master Settlement Agreement which was 5 1 against the four largest tobacco companies and making 2 a deal with them that we would get certain monies for 3 forever. But our actuaries and our auditors came up 4 with 26 years. They went out 26 years on how much 5 money could potentially come to Delaware with 6 $775 million. There's a lot of offsets of that. If 7 the smoking rates go down in Delaware, the rate of 8 money goes down. The excise tax. But the bottom line 9 is that there's an opportunity for us to get a lot of 10 money over the next 26 years. 11 We believe that we will get as much as 12 $9 million in the next month and maybe as much as $25 13 million in the early part of next year. The General 14 Assembly has already tagged that the first portion of 15 that will go towards what we affectionately call the 16 Pill Bill, helping seniors and people with 17 disabilities with their prescription coverage. But 18 then there's still some money left over that we're 19 asking for your input on so that we can make 20 recommendations to the General Assembly and the 21 Governor. 22 Senate Bill 8 was introduced last year 23 by Senator Blevins and Representative Miro, and it 24 went through the system and it got passed and the 6 1 Governor signed it into law last July. 2 That bill did two things. It created a 3 health fund so all this tobacco money actually shows 4 up in a health fund, does not go into our general 5 fund, and that after that it created an advisory 6 group. You have got a list of all the members, and 7 some of the members are sitting in front of you now. 8 What our purpose is is to be advisory to the General 9 Assembly and to the Governor on making recommendations 10 on how the money ought to be spent. 11 During that process we thought it was 12 extremely important before we put pen to paper to hear 13 from you. That's what this is all about. We had met 14 this afternoon in Kent County, tonight here in Sussex 15 and Georgetown. Tomorrow we will be in the city of 16 Wilmington and tomorrow evening we will be up at 17 New Castle County listening to people around the state 18 talk about how they believe that our tobacco 19 settlement money ought to be spent. 20 There are some ground rules, and I 21 talked to you a little bit about them. There are 22 three pieces of paper up above me or behind me that I 23 just thought you could look at as we go through the 24 evening. A little bit of our guidelines. The idea 7 1 that those that have signed up will go first; those 2 afterward will go after. 3 We're going to keep you to three 4 minutes. Pam is going to help us do that. If you're 5 from a large organization -- today the American Heart 6 Association spoke at Kent County. One person spoke 7 for them. And they had a lot of people there 8 supporting their thing, but only one person spoke for 9 them. It helped us get through all the people. 10 The health fund does have some guiding 11 principals and those are directly over me. Those are 12 the type of things we're looking at as we go through 13 thinking about the money. Remember, there are eight 14 purposes that you have got in front of you on how the 15 money should be spent the way it's been written in 16 legislation. Here are some of the guiding 17 principles. We want to make sure it was flexible that 18 we could think about our future citizens and all 19 that. You can read that. 20 Finally, there are some contact points. 21 We have a Web site for those that have computers and 22 feel comfortable in getting on the Internet. We also 23 have an e-mail address. Those that still enjoy 24 writing, then we also put our address up there. By 8 1 all means we want to hear from you, not only tonight 2 but if there are other things that we have missed, we 3 want to hear from you in the next couple days. 4 Certainly we will add anything up to December 10 to 5 our public hearing process if you submit it during 6 that time. 7 I think with that, I will once again 8 welcome you. I want to thank the committee members 9 for coming, and we will go ahead and get started, and 10 I'll ask Stephanie McClellan, staff to the committee, 11 she will start reading off the names and you will know 12 when to come up. 13 Thank you. 14 MS. McCLELLAN: We have Lloyd Mills. 15 MR. MILLS: Good evening. My name is 16 Lloyd Mills, and in these parts I'm known as the 17 Health Care Cassandra. I run a small business, and 18 I'm here because I'm tired of issuing a health care 19 credit card in my name to over 100,000 uninsured 20 people in this state. And I think this may be the 21 group that can do something about that. 22 I think we agree that our goal is to 23 have everyone covered and everyone paying their fair 24 share. However, given the path we are following, 9 1 we're just not going to get there from here. There 2 are too many players with conflicting financial 3 obligations to expect much more progress towards 4 universal coverage. 5 Let's look at the trends. Provider 6 collection ratios are down. I just read the data. 7 Beebe's collection percentage is down to 55 percent. 8 It's impossible to run any other business that way. I 9 don't know how health care is delivered like that. 10 Medical costs are accelerating again 11 after plateauing for a few years. Copays, 12 deductibles, premiums, they're all up. Employers are 13 adding more benefit caps, carve-outs, dependent 14 exclusions, and there's more demand for charity here. 15 There's an increase in the uninsured rate and a 16 decline in employer plan take-up rates. All this is 17 occurring in a flush economy and in spite of the 18 much-heralded initiatives like Diamond State and 19 CHIPs. 20 It doesn't take a rocket scientist to 21 see where these trends are leading us. A trend that 22 can only be accelerated when we enter the next 23 economic down cycle. We are in the midst of a 24 slow-motion train wreck. 10 1 On this issue I must agree with 2 Ernie Dammerman that it will have to get much worse 3 before we muster the will to make the necessary 4 changes, changes that all other 28 member nations of 5 the Organization for Economic Cooperation have already 6 made. 7 As Churchill said, "Americans can always 8 be counted on to do the right thing but not until they 9 have tried everything else." You have an opportunity 10 to see that Delawareans don't suffer unnecessarily 11 while we're trying everything else. 12 Our priority? The clue was contained in 13 the Health Care Commission's cost shift counts which 14 found that 6 percent of the self-pay largest uninsured 15 represents 68 percent of the state's hospital revenue 16 shortfall. 17 The study went on to recommend that the 18 state, quote, increase efforts to expand the current 19 provision of less expensive preventive services to the 20 uninsured, which brings me to suggestions. 21 One, the situation is going to continue 22 to deteriorate. As such, let's bank as much as we 23 possibly can. We're going to need it. Let's make it 24 a rainy-day fund. 11 1 Two, preventive care. We must stop 2 those without access to basic medical services from 3 appearing at the doors of our emergency rooms on an 4 acute-care basis. Some real preventive care. Not 5 just in addition to a dietician at Pellport. We need 6 where-rubber-meets-the-road programs. Explore the 7 idea of Dimer-staffed clinics and storefront nurse 8 practitioner facilities in underserved areas. Induce 9 current providers to offer more pro bono preventive 10 service. Let's be aggressive about this and let's use 11 some imagination. 12 Three, expand access. This could 13 include raising income limits on Diamond State Health 14 Plan. You might want to investigate the ideas similar 15 to the Massachusetts uncompensated care pool or 16 New York's Family Health Care Plus. 17 Four, let's be cautious about tobacco 18 education programs. While they may be politically 19 necessary, I doubt they will give us the biggest bang 20 for the buck. Is an antismoking billboard a better 21 investment than an immunized child or some diabetes 22 screening or a periodic mammography? Help me out. 23 Let's get these people out of my pocket. 24 Thank you. 12 1 CHAIRMAN SYLVESTER: Any questions? 2 MS. McCLELLAN: Matt Rose. 3 MR. ROSE: Good evening, everybody. My 4 name is Matthew Rose, and I'm a senior from Seaford 5 High School. I represent Delaware Kick Butts 6 Generation, which is primarily a youth-run 7 organization dedicated to the prevention and control 8 of tobacco among Delaware youth. 9 Recently the following question was 10 proposed to me about what we should do with all this 11 new tobacco settlement money. The question was why 12 should tobacco settlement money be appropriated to a 13 tobacco comprehensive plan. And I just wanted to read 14 you my response. 15 Why? Well, it just makes sense. First, 16 there's the simple irony of using the tobacco 17 industry's money to help shut down the tobacco 18 industry. But that isn't really the point. 19 The point is in order to create and 20 maintain effective campaigns to keep our children from 21 lighting up, we need three things. We need good 22 programs, we need good people, and we need money. It 23 doesn't get much simpler than that. We have good 24 programs. We see solutions in prevention campaigns 13 1 like Teens Against Tobacco Use, or TATU, and cessation 2 programs like Not On Tobacco. And we have dedicated 3 people who put in thankless hours to fight tobacco 4 because of their drive to help in any way they can. 5 The major problem we have is a financial 6 one. Now, speaking as a member of the teenage 7 generation, and most of you who have teenagers in the 8 house will probably agree, we don't always get things 9 the first time around. I'm sure it's one of the most 10 frustrating things of being a parent. My dad has to 11 tell me to take out the trash about three or four 12 times before I finally remember to do it. More often 13 than not, I need to be beat over the head with a 14 message before it finally sinks in. I'm not alone. 15 Now, to reach an audience, it's hard to 16 communicate with a teenage one, we need advertising, 17 promotion. We need to beat our message repeatedly off 18 the people's heads who don't want to listen. The more 19 money we get, the more wax we'll beat out of their 20 ears. That's a rather crude and simplistic way of 21 putting it. 22 I can read off numbers about tobacco use 23 and trends and demographics, but I know you have 24 already seen them. Simply knowing that tobacco is 14 1 dangerous isn't enough. I hoped it would be, but we 2 all know that despite admissions even from the tobacco 3 industry itself, smoking has continued at an 4 unsettling pace. What we have been doing hasn't been 5 enough, and I think this money might finally turn the 6 tide our way. For the sake of my generation, I hope 7 you do, too. 8 Are there any questions? Thank you. 9 MS. McCLELLAN: Laura Morris. 10 MS. MORRIS: Good evening, Dr. Sylvester 11 and council members. I'm Laura Morris. I'm with the 12 Council for Aging and Adults with Physical 13 Disabilities. Tonight I'm representing 14 Lucien Ferguson, who is our president or our council 15 president, and she is unable to be here this evening 16 due to illness. 17 What I'm going to be reading is material 18 that was prepared by Lucien and again was approved by 19 the council. I'll start. 20 Ms. Ferguson was recently elected 21 chairperson of the Governor's Advisory Council on 22 Services for Aging and Adults with Physical 23 Disabilities. On behalf of the council, she would 24 like to thank you for already allocating $5 million 15 1 from the tobacco settlement to fund the Pill Bill. It 2 will benefit more than 6,700 people. 3 The purpose of our advisory council was 4 to promote and advocate for the benefits of the 5 elderly and adults with physical disabilities. We're 6 asking you to strongly consider their needs. 7 American history has been marked by 8 revolution. The American Revolution was the highlight 9 of the Eighteenth Century. Nineteenth Century saw the 10 industrial revolution. The Twentieth Century saw the 11 information and technology revolution. And the 12 Twenty-first Century will be marked by the dramatic 13 aging of our population. A demographic revolution. 14 It is projected that between the years 15 2000 and 2020 Delaware's population of those 60 and 16 older will increase by approximately 50 percent. 17 While we can't predict the number of people with 18 disabilities, we know that this population is also 19 increasing. Advances in technology and medicine are 20 allowing more people to survive serious accidents. 21 For example, there was a 22 percent decline in the 22 traumatic brain injury-related death rate between 1979 23 and 1982. 24 We all want to live in our own homes and 16 1 have control over our own lives for as long as 2 possible. Surveys show that it's much more 3 cost-effective to keep a person in the community 4 rather than a nursing home. Home- and community-based 5 services are the answer. We must think about 6 redirecting our focus of services from a medical model 7 to a social model. We must develop and support 8 policies that provide assistive devices or home 9 modifications. We must assist older persons, adults 10 with physical disabilities and their families to 11 choose creative alternatives to institutional care. A 12 waiting list already exists for these services. For 13 example, personal care and housekeeping, 210; 14 assistive technology and home modification, 30; and 15 attendant services, 70. All of those people are on 16 the waiting list so far. 17 Cost per unit of services are going up 18 while Delaware's economy is good, and the cost of 19 living continues to be a problem for many who used to 20 volunteer their services. They can no longer afford 21 to work without compensation. Employers are vying for 22 service workers, offering higher wages for employees 23 in areas that are less demanding than care for the 24 elderly and persons with physical disabilities. 17 1 Unfortunately, 94 percent of the 2 smoking-related deaths are to persons ages 50 and 3 older. They have the highest smoking rates of any 4 generations in the United States' history. Since most 5 of the profit realized by the tobacco industry seems 6 to have come from our senior population, it seems only 7 ethical and sensible to return it for their benefit. 8 We are so fortunate to live in an age 9 where advances in medicine and technology allow the 10 elderly and persons with physical disabilities to live 11 longer. These persons can improve their own health if 12 they begin to take charge of their own lives. 13 We strongly recommend developing 14 programs related to prevention on how to manage 15 chronic diseases. Wellness and prevention activities 16 need to be developed and promoted in order for people 17 to have a better quality of life. The alternative is 18 the high cost of caring for this population. 19 We realize that no one can foresee what 20 the future return will be for the tobacco industry, 21 but in your long-range planning, please don't forget 22 this population. We must not forget that we are a 23 nation that was built on dreams and we continue to 24 dream of communities enriched by and for the people. 18 1 Thank you. I want to mention I do have 2 copies of my text that I will have available at the 3 conclusion of the meeting. 4 MS. McCLELLAN: Max Hoyt. 5 MR. HOYT: I thank you for the time and 6 consideration to allow me to testify about the issue 7 of smoking in Delaware. 8 My name is Max Hoyt, and I am a 9 volunteer with the American Cancer Society in Sussex 10 County, and I am also currently serving as a chair of 11 the American Cancer Society's Delaware Government 12 Relations and Advocacy Committee. 13 I am also a tobacco-related survivor and 14 as a volunteer of the American Cancer Society of 15 Delaware, I have spoken to over 1,000 young people 16 this year about the hazards of tobacco use. I have 17 seen firsthand the effect that tobacco has added upon 18 our fellow citizens. 19 On an average day in the United States 20 about 3,000 young people will start to smoke. In 21 Delaware about 35 percent of our high school students 22 are current smokers. 16,000 of our Delaware children 23 under 18 are estimated that they will die prematurely 24 from smoking if this current trend continues. The 19 1 studies have shown that 90 percent of the smokers 2 start before the age of 18, before they can legally 3 purchase cigarettes. Smoking is the number-one 4 preventable cause of death in the nation as well as 5 here in Delaware. 6 We must fund a statewide tobacco control 7 program like those seen in Massachusetts, Florida, and 8 California and recommended by the Centers for Disease 9 Control. By funding this comprehensive, multiphase 10 program at the appropriate levels, Delaware can become 11 a nationwide leader in tobacco control. If we stop 12 our children from smoking, they probably will never 13 begin and they will have a much greater chance of 14 never contracting heart disease, lung disease, or 15 cancer. 16 Secondly, we must go to our communities 17 and empower them with tobacco control. This agency 18 recommends in its best practices to push a good 19 percentage of this money into the community via local 20 tobacco control coalitions and other organizations 21 that have long-standing relationships and reputations 22 with the community. Many groups around this state do 23 outstanding work in a very cost-effective manner and 24 just require a little more funding to build upon their 20 1 success. Tobacco use prevention should start at the 2 grass roots community level. I believe that community 3 is the key to our success. 4 For these reasons, the American Cancer 5 Society strongly supports that a Tobacco Control Plan 6 developed by the Impact Delaware Tobacco Prevention 7 Coalition. The American Cancer Society has been a 8 member of this coalition since its inception, and the 9 volunteers of the American Cancer Society believe that 10 fully funding this proposal is the best means to try 11 and reduce the burden of cancer in Delaware in the 12 future. The opportunity we have before us may never 13 come around again and we must capitalize on it. 14 Thank you. 15 MS. McCLELLAN: Leon Calabrese. 16 MR. CALABRESE: Good evening. Thank you 17 for this opportunity. My name is Leon Calabrese, and 18 I'm representing AARP of Delaware. I wish to thank 19 you for this opportunity. 20 AARP's testimony will be presented 21 verbally on November 30th at Glasgow High School by 22 Delaware AARP state president, Richard Johnson. I 23 have copies of that statement for the committee and 24 for some of our attendees if they would like to have a 21 1 copy, in order to make our position known throughout 2 the state. 3 We do support the use of tobacco funds 4 for health care, and you have already heard several 5 good uses and I'm sure you will hear more. 6 Basically, AARP, in a nutshell and in 7 our testimony that you will hear tomorrow, is to 8 improve the quality of Delaware's nursing homes and 9 secondly to increase the home and community support 10 for Delaware's elders as they age in their home. 11 I thank you very much for this time, and 12 I will leave the copies for you and for the 13 stenographer. 14 CHAIRMAN SYLVESTER: Thank you. 15 MS. McCLELLAN: Jim Walston. 16 MR. WALSTON: Good evening. My name is 17 Jim Walston, and I represent the Sussex County 18 division of the American Heart Association. 19 Unfortunately, heart disease continues 20 to be the leading cause of death in Sussex County, 21 claiming about 500 lives in 1997. We believe there 22 are both long-term and short-term solutions to this 23 problem. We have long known that cardiovascular 24 disease is a disease of life-style and that several 22 1 risk factors for CVD exist that we have personal 2 control over. 3 However, of all these risk factors, 4 cigarette smoking is the most important risk factor 5 for coronary heart disease in the U.S. Cigarette 6 smoking also acts with other risk factors to greatly 7 increase the risks for coronary heart disease and 8 stroke. 9 We don't need intensive research or 10 surveys to tell us that tobacco use is a problem in 11 Delaware. You see it at the red lights. You see it 12 in our schools. You see it while you're waiting in 13 line at the Wawa. Until we eliminate Sussex County's 14 number-one public health problem, we can expect heart 15 disease and stroke to remain the number-one and 16 number-three leading causes of death in our county. 17 For this reason, we support establishing 18 a comprehensive, sustainable tobacco control program 19 in Delaware based on the Centers for Disease Control 20 and Prevention's best practices as a way to support 21 the long-term risk reduction of heart disease and 22 stroke in Sussex County. And in the short-term we 23 need to focus on increasing the survival rate from 24 sudden cardiac arrest which currently hovers near 23 1 4 percent. 2 In order to do this, we must strengthen 3 the chain of survival to insure that victims of 4 cardiac arrest are treated as quickly as possible. 5 Each of the four links in this chain, early access to 6 emergency care, which is calling 911, early access to 7 CPR, early access to defibrillation, which is the use 8 of AED, and early access to advanced cardiac care, is 9 vital. By increasing the survival rate from 4 percent 10 to 24 percent, we could save almost 150 lives a year 11 state-wide. 12 This problem is multifaceted and there 13 are no silver bullets. However, early defibrillation 14 is often called the critical link in the chain because 15 it's the only known therapy for cardiac arrest. Due 16 to the extended EMS response times in Sussex County, 17 we must turn to more nontraditional first responders 18 for support. Increasing nontraditional first 19 responders like law enforcement agencies, security 20 officers, events management people that are trained in 21 the use of AEDs and equipped in places like malls, 22 fitness clubs, stadiums, conference centers can 23 significantly decrease response times and boost the 24 survival rate. 24 1 For this reason, we support reducing the 2 death rate of sudden cardiac arrest by taking action 3 to support a strong chain of survival. 4 Any questions? 5 MS. McCLELLAN: Linda Wolfe. 6 MS. WOLFE: Good evening. Perhaps I 7 shouldn't have chosen such a seat so far away. 8 My name is Linda Wolfe, and I work in 9 the Department of Education as an educational 10 specialist in health services. I'm the state school 11 nurse consultant. 12 I'm also a resident of Georgetown, and 13 as a native Sussex Countean, it's an honor to welcome 14 the Delaware Advisory Committee here in Georgetown and 15 to Sussex County. You happen to be in the heart of 16 Delaware's best-kept secret I think and that is the 17 wonderful life and land of Sussex County that doesn't 18 touch the ocean. 19 Before I came tonight I want to tell you 20 that I visited downtown Georgetown. You may not be 21 aware that there's a downtown Georgetown, but there 22 is. It's where the circle is, and on the circle is 23 our infamous Brick Hotel, but there's another little 24 house that you might not have noticed because it only 25 1 shows up in December, and this house is only occupied 2 during certain hours in December, and it's best known 3 to the children of our community and that's Santa's 4 House. 5 I took my wish list to Santa and he was 6 unable to help me, but he suggested that I come and 7 speak with you all tonight. 8 So my wish tonight is for children. I 9 join many, many other individuals and organizations 10 who care about the health of children and 11 adolescents. If we want to improve their lives, their 12 health, their future, it will take a dedicated effort 13 and it will take money. Not only are health services 14 for children essential but health education is 15 essential to all aspects of prevention. 16 Data from the Delaware Youth Risk Survey 17 indicates that students often lack skills to make 18 decisions that are in their own best interest. Data 19 from the most recent count indicates that some of the 20 poor decisions they are making are resulting in 21 compromising their health and their future. 22 I attend a lot of meetings on prevention 23 activities and one of the solutions that most people 24 believe in is education. We need coordinated school 26 1 health programs. We need family education. We need 2 community outreach. Children need to learn to set 3 goals, to make healthy choices. They need to learn on 4 how to navigate the health care system. They need to 5 learn how to advocate for their own health and their 6 surroundings. Tobacco use prevention activities are a 7 prime example of how we can best take care of our 8 children by teaching them to care for themselves. 9 On my wish list tonight is my wish that 10 as a society we would value our children enough to 11 invest in them. Invest our time, our talents, and our 12 money, for they are Delaware's future. 13 As members of the Delaware Health Fund 14 Advisory Committee, I wonder if you don't feel a 15 little like Santa as we all come before you with our 16 wish lists. I do not envy you your immense work. I 17 know that the decisions that you make on how to use 18 the tobacco settlement monies have the potential to 19 safeguard and even elevate the health status of 20 Delaware's children. It is an awesome 21 responsibility. 22 My request is that you think of the 23 future, not your future or my future, but of our 24 children's future and that of our grandchildren. 27 1 Thank you. 2 MS. McCLELLAN: Gail Short. 3 MS. SHORT: Committee members, I thank 4 you for permitting me to speak before you this evening 5 to talk about secondhand smoke in Delaware. My name 6 is Gail Short, and I am a school nurse at Woodbridge 7 Middle/Senior High School. I am a member of the 8 Delaware School Nurse Association that is a member of 9 the Impact Delaware Tobacco Prevention Coalition. 10 My student population is ages 12 to 18. 11 I see students daily in the nurse's office with red, 12 irritated throats from smoking or exposure to tobacco 13 smoke. 14 Tobacco smoke contains about 4,000 15 chemicals, including 200 known poisons. Every time 16 someone smokes, poisons such as benzene, formaldehyde, 17 and carbon monoxide are released into the air, which 18 means not only is the smoker inhaling them but so is 19 everyone else around them. 20 Each year 3,000 nonsmoking Americans die 21 of cancer because of exposure to secondhand smoke. 22 Married persons living with a smoking spouse increase 23 their risk of heart attack by about 20 percent. The 24 EPA classifies secondhand smoke as a group A 28 1 carcinogen. They cause cancer in humans and is 2 classified with the most dangerous cancer-causing 3 substance in our environment. 4 Secondhand smoke has an especially bad 5 effect on infants and children. 6,200 children will 6 die each year in the United States because of their 7 parents' smoking and millions more will suffer from 8 ailments such as ear infections, respiratory 9 infections, and asthma that are triggered or 10 aggravated by their parents' smoking. 11 In order to make a difference and fight 12 unnecessary illness and death from secondhand smoke, 13 Delaware needs to have a comprehensive, sustained 14 control plan such as those in California, Florida, and 15 Massachusetts. Comprehensive, sustained control plans 16 do work. Their success can be seen with your child 17 when he buckles up when he gets in the car. It can be 18 seen for the first time in a long time with a decrease 19 in teen pregnancies. 20 We have an opportunity to make Delaware 21 a healthier place to live and breathe. As my students 22 would say, let's do it. 23 I appreciate the time you have allotted 24 me to give testimony for a cause that is of utmost 29 1 importance to the wellbeing of our families, 2 especially our children. 3 Thank you. 4 Dr. Sylvester, I only made one copy. 5 DR. REINHARDT: What was that statistic 6 about 6,000 children dying from something? I missed 7 that. 8 MS. SHORT: 6,200 children will die in 9 the United States because of their parents' smoking 10 and millions more will suffer from ear infections, 11 respiratory infections, and asthma. 12 CHAIRMAN SYLVESTER: Is that 6,000 13 number the number of SIDS cases in the United States? 14 MS. SHORT: I don't know. 15 MS. McCLELLAN: Betsy Wheeler. 16 MS. WHEELER: Hi. My name is 17 Betsy Wheeler, and I'm here tonight representing the 18 Southern Delaware Community Health Partnership. The 19 partnership was formed in 1996 with leadership from 20 what was then Milford Memorial Hospital, now 21 BayHealth. 22 At that time Milford Memorial had 23 recognized the need to get out into the community and 24 learn community members' needs and to be able then in 30 1 turn to empower communities to help themselves towards 2 more healthful living. We completed a community-wide 3 needs assessment at that time. Over a thousand people 4 from southern Delaware participated either in a 5 written survey or a focus group, and many community 6 issues were identified, the top three of which we have 7 used as the foundation of our partnership, and those 8 three priority issues are access to affordable primary 9 care, opportunities and activities for youth that 10 minimize their opportunity to otherwise engage in 11 health risk behaviors typical of adolescents, and 12 lastly communication and education about the 13 availability and proper utilization of existing health 14 and social service resources. 15 Our partnership is geared by a board of 16 directors and has a committee that addresses each of 17 these priority areas, meets monthly, and we have since 18 1996. The participation in the partnership is broad 19 and diverse. It's made up of representatives from 20 public health and clergy, from education, from the 21 communities at large, and those of us who have 22 participated in the partnership since '96 have 23 witnessed in many aspects of our personal and 24 professional lives these priority issues reiterated 31 1 and reidentified time and time again. 2 Sussex County additionally has federal 3 designations that further validate these communities' 4 contentions. I won't get into the federal 5 definitions, but I can if you'd like. For instance, 6 the entire county of Sussex County is medically 7 underserved and the northeastern-most portion of 8 Sussex has a health professional shortage here. These 9 are federal indices that are driven by economics, 10 provider-to-population ratio and mortality health 11 status. Those types things. 12 In 1998 the University of Delaware 13 completed a report for the Division of Public Health 14 that had some interesting findings regarding primary 15 care physicians' capacity in the state. Some of those 16 things pertinent to Sussex County were that only 17 25 percent of Sussex County's physicians participate 18 in managed care plans, and that's at a time in which 19 all of Delaware State Medicaid programs had 20 transitioned to a managed care program and many 21 employers have transitioned. 22 In that same '98 report there was 23 finding that only 5 percent of practicing physicians 24 in Sussex are of Hispanic origin and 1 percent of 32 1 African-American origin, and this is despite the fact 2 that both of those populations in Sussex are the 3 fastest growing populations in the state. 10 percent 4 of Sussex right now is Latino population, and that 5 represents a nearly 300 percent growth rate since 6 1990. 7 Our partnership initiatives focus on 8 pooling of resources and the reduction of duplication 9 of efforts to accomplish initiatives aimed at these 10 priority areas. Often times the resources that 11 members bring to bear in these partnerships are the 12 resources of commitment and the resources of time. 13 And while we are very pleased with those 14 contributions, we are here tonight imploring you to 15 please make funding available to complete the 16 initiatives that we have identified and planned and 17 would like to spearhead, and we're asking that the 18 things that you consider be community-based, 19 community-driven enhancements to the existing health 20 care delivery system and consumers' use of it. 21 MR. LIEBERMAN: Could you expand on that 22 second one? You said access to care and the third was 23 utilization and communication regarding existing 24 resources. What was the second one? 33 1 MS. WHEELER: Opportunities and 2 activities for youth to minimize the availability of 3 time that they may have to otherwise engage -- 4 MR. LIEBERMAN: Get into things gainful 5 rather than hanging out. You don't want too much 6 hanging out. That's commendable. 7 Thank you. 8 MS. McCLELLAN: Reverend Batten. 9 REV. BATTEN: Good evening, 10 Dr. Sylvester and to the committee. Thank you for 11 having us here tonight. I'm here to represent the 12 American Red Cross in Delaware. 13 I just listened to one of our 14 counterparts talk about cardiovascular problems and 15 conditions. Sudden cardiovascular arrests is one of 16 the leading causes of death in the nation. Not only 17 just in Delaware but all across the United States. It 18 looks like that 250,000 lives are lost each year 19 because of cardiovascular arrests. Nearly 1,000 a 20 day. It is estimated that as many as 50,000 deaths 21 could be prevented each year due to widespread 22 deployment of automatic external defibrillators in 23 public places such as airports, shopping malls, golf 24 courses, and large office buildings. 34 1 The American Red Cross in Delaware 2 believes the committee should consider supporting this 3 effort to put more defibrillators in use. I believe, 4 if I'm correct with numbers, that there's about 212 in 5 use in Delaware. That's not very many for the entire 6 state of Delaware. So we want to make the public 7 aware of the cardiovascular chain of survival 8 especially to train members of the communities in the 9 use of these AEDs to provide wider access in large and 10 public gathering places. 11 Since tobacco has been linked to 12 cardiovascular disease and its effects, it seems 13 logical to ask that funds will go in this area since 14 tobacco seems to be some of the problem or the major 15 cause of these cardiovascular experiences. 16 And so I'm here to tell you that the 17 American Red Cross began offering first aid and safety 18 programs in 1909. In the year of 1996, nearly 19 12 million people enrolled in health and safety 20 courses. Each year the American Red Cross trains 21 approximately 6 million people in lifesaving first aid 22 and CPR which has a result of thousands of lives being 23 saved. And certainly they would be likely to add to 24 their course curriculums, offering a course in AED 35 1 skills training and then that course will run about 2 six-and-a-half hours, and certainly we're requesting 3 that you support the purchase, the placement, and 4 training in the use of AEDs that could greatly enhance 5 the survival rate for sudden cardiac arrest across the 6 state. 7 Thank you for your time. 8 CHAIRMAN SYLVESTER: If we have 212, how 9 many would you recommend that we have? 10 REV. BATTEN: I would recommend at least 11 212 more. We certainly could use them in training and 12 helping to bring down a greater survival rate. 13 MS. McCLELLAN: Kay Wilz. 14 MS. WILZ: Dear Dr. Sylvester and 15 Delaware Health Fund Advisory Committee, my name is 16 Kay Wilz, and first and foremost, I'm a mother of a 17 teenage smoker. Since 1993 I have been employed by 18 the State of Maryland as a cardiovascular disease 19 prevention coordinator. During that time I have 20 received many national, state, and local awards and 21 citations for my work in tobacco prevention and 22 cessation. Over there is all the things off my wall 23 that I brought to show. But it's with great pride 24 that I work for the State of Maryland, a state that is 36 1 a forerunner in regards to tobacco issues. 2 Tonight I wish to relate to you the 3 issues as I see them as a tobacco-educated citizen of 4 Delaware. Public opinion and apathy towards the 5 smoking problem is appalling. Example, I was in a 6 local store that displayed this sign: "You must be 18 7 years old or older to buy cigarettes here and prove 8 it. Those under 18 may go to the nearest cigarette 9 vending machine." I called the store manager and he 10 said he could do nothing about it. I called my local 11 elected officials numerous times to get the signs 12 changed. 13 Tobacco vendors must be educated. Laws 14 should be made and enforced towards businesses who 15 sell tobacco products to minors. Comprehensive 16 tobacco prevention and control programs need to be 17 implemented. Partnership grants and community 18 programs are a valuable tool in educating the public 19 on tobacco use and hazards of secondhand smoke. 20 I am proud to say that through many mini 21 grants I have distributed in Caroline County, a grass 22 roots organization was formed called Church Held 23 Education Resource Union Believers, CHERUB. 24 Twenty-two area churches banned together to educate 37 1 their congregations and communities. 2 There must be an effort between all 3 organizations to unite and prevent tobacco use by our 4 youth. Tobacco is a gateway drug not only to harder 5 drugs but also to cardiovascular disease. An 6 effective tobacco youth and adult cessation program 7 must be funded. I would like funds to be allocated 8 for more after-school programs with the hiring of 9 positive role models for our youths. Educate peers to 10 talk to peers about smoking. Don't create tobacco 11 education programs which are just based on just say no 12 but programs in which reasons why adolescents want to 13 smoke is explored. 14 Next, allocate some of your monies 15 toward rehabilitation centers where people who have 16 become addicted to tobacco and drugs can be given the 17 quality time to recover. And, Senator McBride, you 18 might wonder why I traveled over 45 minutes to a 19 different state. It's because I have been told 20 secretly, nonsecretly that the legislation of this 21 state is pro tobacco; that you have over five to six 22 tobacco lobbyists; that the tobacco legislation would 23 rather give in to the tobacco companies than to 24 prevent illness among the citizens of Delaware. 38 1 Thank you. 2 SENATOR McBRIDE: Thank you. I was 3 wondering. I wasn't sure I could ask that question 4 today. 5 MS. McCLELLAN: Sy Londoner. 6 SENATOR McBRIDE: Excuse me. Where did 7 you get that? Is that from a store in Delaware? 8 MS. WILZ: Yes. Right here in 9 Georgetown. 10 CHAIRMAN SYLVESTER: Because our 11 Legislature did pass a law that youth cannot buy not 12 only in stores but also from vending machines. 13 MS. WILZ: You can pass laws. Unless 14 you get law enforcement to enforce them -- 15 SENATOR McBRIDE: I would agree with you 16 that we could do more and we should do more. 17 MS. WILZ: I didn't mean to pick on you. 18 MR. LIEBERMAN: He's used to it. 19 SENATOR McBRIDE: That's why I drove 20 from New Castle County. 21 MR. LIEBERMAN: If he wants to get 22 picked on, he can go home. 23 MR. LONDONER: Good evening. Thank you 24 for this opportunity to acquaint you with our need for 39 1 your help. I am Sy Londoner, president of Peach Tree 2 Acres. 3 For those of you who are unacquainted 4 with us, and I know some of you are, let me tell you 5 about Peach Tree Acres. It is a joint venture 6 sponsored by Beebe Medical Center and the Brain Injury 7 Association of Delaware. It started about five years 8 ago when one of the members of the Brain Injury 9 Association donated five acres of land in Harbeson to 10 be used for a long-term assisted living residence for 11 severely impacted survivors of brain or spinal cord 12 injury. Harbeson is just a few miles from here. If 13 anyone any of you would care to go and talk to our 14 people and see the place, we would be very happy to 15 have you. 16 Peach Tree Acres was formed as a 17 corporation to raise the funds and then construct the 18 needed facility on the donated land. We are providing 19 facilities in two stages, with the first consisting of 20 a three-bedroom house for three survivors residing 21 there which started out very successfully on May 1st 22 of 1998. Has been in very good and happy operation 23 since. The three residents who were there initially 24 in 1998 are still there. And Roger here will tell you 40 1 that it is home now. 2 Operation of this home is mostly funded 3 through an annual contract between the Department of 4 Health and Beebe Medical Center, amounting to 5 approximately $200,000 per year. This house is also a 6 first licensee under the assisted living regulations. 7 The second stage will provide a 8 residence for 20 survivors. The capital cost of this 9 project is about $2 million. It is now essentially 10 fully funded, with construction start scheduled for 11 early spring following approval of the plans by HUD 12 and startup in January 2001. 13 Funds raised include over $700,000 for 14 the State's Community Redevelopment Fund, $180,000 15 from HUD 811 program of housing for adults with 16 disabilities, and over $500,000 from individuals and 17 foundations within Delaware. The very first donation 18 was a personal check from Governor Carper. But these 19 funds have already been utilized to provide that first 20 house. 21 It is estimated that the operating cost 22 for the 20-resident facility will be approximately a 23 million dollars a year. $400,000 of this is 24 available, with $200,000 from the existing continuing 41 1 appropriation for operation of Peach Tree, $70,000 2 from HUD as part of their grant, and approximately 3 $130,000 from the residents. This leaves a shortfall 4 of approximately $600,000 per year. It is these funds 5 that we are requesting that you consider for funding 6 from the tobacco settlement. The facility will be 7 ready for operation in about one year. Your 8 assistance is vital. 9 Thank you. Any questions? 10 MS. McCLELLAN: Kay Edman. 11 MS. EDMAN: Hi, Dr. Sylvester. My name 12 is Kay Edman, and I'm a director with Beebe Medical 13 Center which serves the residents of Sussex County. 14 I talked with our CEO today when I told 15 him that I was going to be here and talk with you, 16 asking what is it that Beebe would like out of this 17 $775,000, and he said, "You know what, I don't want 18 any money for our treatment of people in our 19 institution because we have third-party reimbursement 20 for that and we ought to be able to make that work for 21 us if we do our job right." 22 I agree with that perspective on cost 23 containment, but Beebe is a community hospital in the 24 truest sense of the word. One of the reasons that I 42 1 went to work for them is because I admire that. I 2 think in this age of multisystem big business medical 3 care, it's really nice to find a health care center 4 that is of and by and for its community. 5 So the Beebe CEO said, "But we do need 6 some programs in the community that are not funded by 7 third-party payers or Medicare or Medicaid." And we 8 have a deep commitment to those. One of them is the 9 one that Mr. Londoner just spoke about is our 10 commitment to the care of the brain injury and spinal 11 cord injury people. There essentially is no 12 third-party reimbursement for the long-term care of 13 those people in this area or anywhere else. 14 Those of us that work in the medical 15 field are very proud of ourselves. In the last 16 15 years we have developed the science to save the 17 lives of thousands of people that suffer these massive 18 head injuries and spinal cord injuries. The problem 19 is that once we have performed our miracles, we then 20 have some responsibility for what are we going to do 21 to insure that they have the decent quality of life 22 for the rest of their life. 23 So now we have people who have survived 24 these terrible injuries. My friend Roger is one. And 43 1 they have older, aging parents that can no longer live 2 at home. Some can live on their own with the help of 3 wonderful community-based programs. Others do not 4 have the ability to do that. So they are very poorly 5 placed in nursing homes, which is a horrible placement 6 for people that essentially are of a fairly young 7 age. 8 Therefore, Beebe has this deep 9 commitment to becoming a center of excellence for 10 caring for the traumatically brain injured, and we 11 want to serve Delawareans who now are not being served 12 and have to go out-of-state. We ask your support for 13 operations of Peach Tree Acres. We ask your support 14 for our plans to have an educational center to train 15 people to care for the brain injured at our school of 16 nursing, and in general we ask your support of spinal 17 cord and brain-injured Delawareans. 18 Thank you very much. 19 MS. McCLELLAN: Eve Tolley. 20 MS. TOLLEY: Hi. I'm not much of a 21 public speaker, but here goes. 22 MR. LIEBERMAN: Don't worry about that. 23 MS. TOLLEY: My name is Eve Tolley. I 24 wear a lot of hats. Currently I'm the president of 44 1 the Brain Injury Association of Delaware. I'm the 2 vice president of Peach Tree Acres and First State 3 Headquarters. 4 I have to say I'm here for a lot of 5 money for a lot of different things. I would like to 6 tell you briefly that the Brain Injury Association is 7 a 19-year-old group of people that started out in 8 1980, Merrill Spivack in Washington, and we started 9 out in Delaware in 1984, and Sy Londoner, he spoke to 10 you, he was one of the original founders here. One 11 was Lois Dawson, Mary Ellen Sweeney, and a few other 12 people. I came along in 1990. 13 I have a son who's 43 with a head 14 trauma. One thing that I think that we need most, we 15 need funding for the brain injury association for 16 prevention. We need to make some impact on the kids. 17 We finally got the bicycle helmet law passed. We're 18 looking towards perhaps getting a law passed for the 19 seat belts, a mandatory seat belt law. There is some 20 15 or so states that have them mandatory. We find 21 that people who wear their seat belts, they normally 22 will zip their kids in as well. But if they don't, 23 kids are torpedoes. We can't do anything but 24 prevent. That's the only thing we can do. We can 45 1 prevent. After it happens, we have a problem. 2 I would hope to see that the Peach Tree 3 Acres here, my friend Roger over there which I have to 4 tell you is in a nonsmoking residential home, he may 5 not love me for it, but he used to be the worst smoker 6 and had a terrible chest. But he's finally gotten 7 past that. So that was through education as well. 8 And this is one of the things we need money for. 9 We need money to educate people about 10 bicycles. You have no idea. I have had maybe within 11 the last month-and-a-half a half a dozen people with 12 calls about bicycles who were killed or terribly 13 injured. 14 I wanted to digress for a minute here 15 about the senior citizens and the prescription drugs. 16 I have a lady who gets $488 a month. She takes 17 insulin. It's $100 a month. She couldn't afford to 18 get the eye medication which was around $80 a month. 19 She had three different prescriptions. I'm helping 20 her, I think, through Ely Lilly to get some of this. 21 But just so you should know, just taking care of her 22 retarded brother, $488 a month, you need to take care 23 of these medical bills. 24 Thank you. 46 1 CHAIRMAN SYLVESTER: You brought up 2 something. Did you want to share that with us? 3 MS. TOLLEY: I'd love to. But I didn't 4 want know if it was appropriate or not. 5 This is a perspective of Peach Tree 6 Acres that's to be built. You have no idea how hard 7 we have worked on this. This has been really 8 something. This is the copy of how it will look 9 interior. You notice, we have a couple libraries in 10 there. We have sitting rooms. We have 10 11 apartments. We have 10 rooms for those who couldn't 12 handle an apartment who really needed additional 13 help. As Sy said, now we have to keep it rolling and 14 keep it going. 15 I want you to know, as president of the 16 Brain Injury Association, there's not one other state 17 in this union that has done this. We have been one of 18 the few states that have come up with any kind of a 19 program like this and now Elda Kane has been a big 20 help right here. And you know that, don't you? 21 CHAIRMAN SYLVESTER: Thank you. 22 MS. TOLLEY: Thank you very much. 23 SENATOR McBRIDE: I wanted to tell you 24 that your friend, $480 a month, she makes -- 47 1 MS. TOLLEY: $488 a month Social 2 Security. 3 SENATOR McBRIDE: That's her only 4 income? 5 MS. TOLLEY: Yes. 6 SENATOR McBRIDE: She would qualify for 7 the Pill Bill that we passed, and you could talk to 8 Eleanor. She will make sure that you get -- 9 MS. TOLLEY: I'll talk to Eleanor. 10 SENATOR McBRIDE: She had raised the 11 issue about the 480 some dollars total income per 12 month and that particular individual would qualify for 13 the new legislation that was recently signed in law by 14 the Governor, pharmaceutical assistance for the aged 15 and the physically disabled persons. 16 MS. TOLLEY: She's 61. Does that still 17 qualify? 18 SENATOR McBRIDE: 65. But there might 19 be other programs. I'm not sure. You should talk to 20 somebody in health. 21 CHAIRMAN SYLVESTER: Call Eleanor. 22 SENATOR McBRIDE: Everybody has been 23 calling Eleanor for about 30 years. 24 MS. TOLLEY: Thank you, all. 48 1 MS. McCLELLAN: Joe Liefbrower. 2 MR. LIEFBROWER: Good evening. I wish 3 you all luck. I don't think you have enough money. 4 MR. LIEBERMAN: We have a lot of friends 5 we didn't have before. 6 MR. LIEFBROWER: My name is 7 Joe Liefbrower. I'm chairperson of Delmarva Health 8 Initiative, and I'd like to suggest four issues for 9 your consideration. 10 The first is access to dental health. 11 We have a dental crisis in our state and it's getting 12 worse each year. In 1997 we had a public hearing 13 which identified the issue. In 1998 the Legislature 14 put fluoride into law, and in 1999 we're still working 15 at it, but not a lot of Delawareans are getting dental 16 access. And this is across the entire state. From 17 the inner city of Wilmington to the rural areas of 18 Kent County and in fact the whole of Sussex County. 19 It's all underserved. 20 Simply put, there are not enough 21 dentists. We have 44,000 Medicaid children in the 22 state and last year Public Health was able to see and 23 assist a little over 10,000. Private dentists served 24 1,500 of those 44,000. That left quite a deficit. So 49 1 11,500 of the 44,000 received dental assistance. That 2 doesn't address the estimated 15, 20,000 uninsured 3 children of the state. Nor does it address probably a 4 much larger issue with the adult population in this 5 state that's underserved by dental issues. 6 The issues have two elements. Public 7 awareness of the health needs, of the dental health 8 needs, and the access to dentists. There simply 9 aren't enough of them in the state. 10 The second issue I bring to your 11 attention is that of mental health. There's a growing 12 problem in our communities. It's seen in our 13 schools. It's seen by law enforcement. Most recently 14 I had the experience from a medical community at a 15 retreat in a downstate hospital, Nanticoke Memorial. 16 The ER doctors testified -- or not testified I guess 17 but attributed 30 to 50 percent of their patients on a 18 daily basis are a result of mental health issues. 19 Drug, alcohol, or abuse. Just think of that. 20 Nanticoke had 13,000 visits in the ER last year. 21 BayHealth I believe was 20,000. In total Sussex 22 County has probably 40 some thousand visits to the ER 23 each year. I attribute that to mental health issues. 24 You can see it's the tip of the iceberg. 50 1 The third issue I have is sewer and 2 water. Our drinking water is poor quality for many 3 Delawareans in this state. Our sewers and waste 4 streams contribute to the pollution. Funds invested 5 in any of these areas would benefit all Delawareans 6 for the purpose of I think Bill No. 8. Senate Bill 7 No. 8. 8 The fourth issue I have is one of 9 equity. I believe any funds spent should be spent 10 equally by population across the three counties. No 11 one county should receive a windfall. 12 Any questions? Thank you very much. 13 CHAIRMAN SYLVESTER: I would only point 14 out that the State got a tremendous amount of money, 15 not like what we're talking about here, for 16 low-interest loans to communities for drinking water 17 improvements called the Drinking Water Revolving 18 Fund. Any community can tap into that through Public 19 Health and DNREC. If there is a problem in Sussex or 20 anywhere in the state, those monies are available. 21 MR. LIEFBROWER: For drinking water. 22 And the other issue would be sewage. I guess the 23 fluoridization issue, it's been mandated as a law and 24 communities still aren't mandated. 51 1 CHAIRMAN SYLVESTER: Maybe look at 2 drinking water or the fluoride through this. If we 3 have a pot of money for drinking water, we should use 4 that pot of money before we dip into this one. 5 MR. LIEFBROWER: Thank you. 6 MS. McCLELLAN: Joe Connor. 7 MR. CONNOR: Good evening. My name is 8 Joe Connor. I'm chair of the Governor's Advisory 9 Council on Drug Abuse, Alcohol and Mental Health. 10 I appreciate the opportunity to go a 11 little later in the evening because I haven't heard a 12 bad use put forward this evening for the funds. I 13 haven't heard any group come here and make selfish 14 requests for these funds. I'm very proud to be 15 associated with a group of people that are sitting up 16 here or took the time to come here tonight when you 17 could be Christmas shopping or doing just about 18 anything else and you're here talking about an issue 19 as important as this. 20 But I'm here to make a case for a 21 specific group of people, and a couple of things were 22 pointed out, and the specific group of people that I 23 represent are folks with addictive diseases and mental 24 health disorders. And I found out tonight that I'm 52 1 part of a demographic revolution, and I need to tell 2 you, thank God, in my business, I'm in real estate, 3 that a good bit of it's going to be bought right here 4 in Sussex County and a lot of nice money is going to 5 be spent on it. 6 Those folks that are coming here from 7 either other parts of Delaware or wherever do deserve 8 to reap the rewards that are out there for health 9 benefits and health improvements and maintaining their 10 health after having perhaps been affected by tobacco 11 in the past. And I think that the case that was made 12 by the physical disabilities folks is the case that I 13 would make for the constituency that I represent. 14 Also tonight the case was made that 15 tobacco is a gateway-drawing drug. I don't think 16 there's any dispute in that. The case has been made 17 that prevention is important, and I think that the 18 young man that spoke tonight pointed up that education 19 works, and I don't have a teenager anymore. He's 20. 20 But having to tell kids over and over is not a 21 surprise to those of us who are parents. 22 My issue would be in that area, that I 23 think we're making real progress. I'm just an 24 optimist by nature, and I think we're making real 53 1 progress, that kids are making better choices and 2 better decisions. And I believe that prevention at 3 that age can be partnered with prevention of other 4 choices, that kids could be making better choices, and 5 I just simply believe that you all do have a tough job 6 to do, but I think you will make good decisions, and I 7 hope you will make good decisions. 8 As a former coach at Delaware Tech here 9 and having been involved in soccer all my life, the 10 last thing I want is a red card. 11 MS. McCLELLAN: Is an Amy Thomas here? 12 (No response.) 13 MS. McCLELLAN: Don Post. 14 MR. POST: Yes. My name is Don Post. 15 I'm district manager with the American Diabetes 16 Association. I wanted to thank you to give me this 17 opportunity to speak on behalf of the American 18 Diabetes Association. 19 I really didn't plan any preparation 20 here on a speech, but just bear with me. I just 21 wanted to talk about how serious diabetes has become 22 in this state. It's a mutilating, deadly disease. It 23 is something that we have taken very lightly for years 24 and now we're paying the price from the consequences 54 1 of diabetes. 2 Diabetes, when we talk about trying to 3 educate children, believe me, there's a lot of people 4 out there with Type 2 diabetes, the elderly, that need 5 education on the managed care of the disease they 6 have. I have a father who died of Type 2 diabetes. 7 He was what some people don't like. There's many 8 certified diabetes educators don't like the word 9 "noncompliant," but I think it's the best way to say 10 it. He was a noncompliant diabetic which leads to all 11 the major complications. 12 You talk about all these other 13 mutilating diseases, but let me tell you, diabetes 14 will take your eyes. It will take your kidneys. It 15 will take your legs possibly. It will take your 16 heart. It's one of the leading causes of stroke, one 17 of the leading causes of amputations, one of the 18 leading causes of kidney failure, and one of the 19 leading causes of adult blindness. 20 Believe me, we need this money also to 21 give some of it towards education of people with 22 diabetes. We also need some of the money to go toward 23 those who cannot afford managed care for diabetes. 24 Diabetes is a very, very costly disease and there's a 55 1 lot of people out there that are choosing between 2 eating or managing their diabetes. Test strips are 3 costly. Whether we want to criticize that it's 4 outrageous that they charge so much, the 5 pharmaceutical companies, it doesn't matter. 6 The problem is you have to have it to 7 live. It is proven fact that those people who manage 8 their diabetes greatly reduce all the complications 9 that come forth. It is also the sixth leading cause 10 of death in Delaware, higher than the national 11 average. The national average is seventh. But it's 12 the sixth leading cause of death in Delaware. It is 13 the second leading cause of death by children by 14 disease in the United States. My child is a Type 1 15 diabetic. 16 I also just want to briefly read you 17 some of these CDC statistics that say it all for 18 Delaware. This is from the 1996 report. There were 19 29,000 cases of diagnosed diabetics in Delaware. I 20 feel it's higher, but let's go with this. This is 21 definitely an accurate figure, but it should be 22 increased more than that because there are a lot more 23 cases than that. There are 227,000 cases of people 24 that are high risk for diabetes, such as 56 1 African-American women, Spanish-Americans, and 2 Native-Americans. There were 52 new cases of 3 blindness. There was 235 new cases of amputations. 4 There was 80 new diabetics that had to go on 5 dialysis. Also direct and indirect costs, it was 6 $381.4 million for the State of Delaware. 7 Thank you for giving me this 8 opportunity. 9 MS. McCLELLAN: Noreen Broadhurst. 10 MS. BROADHURST: Good evening. My name 11 is Noreen. I'm with Beebe Medical Center, and 12 actually I have just a couple issues to speak to 13 tonight. 14 After hearing all the comments made by 15 everyone else, so much has been said that there's no 16 need to reiterate because there are many, many 17 programs out there that can promote good health in our 18 state. Delaware is a very fortunate state in many 19 ways, and I believe Sussex County, although it's 20 growing very rapidly, is still behind in many ways, 21 and I would like to say on behalf of Beebe Medical 22 Center that we think, as Joe Liefbrower said, that we 23 deserve a proportionate share of monies to spend here 24 in Sussex County to address the health needs we have. 57 1 There are many uninsured folks in this 2 area. Access to care is an issue. It's not only lack 3 of health care insurance but it's transportation, and 4 we need to develop ways and means to get people to the 5 physicians to seek care early rather than seeing them 6 at our emergency department, which when we see them 7 there, the care is a lot more costly, not only 8 financially but also physically, to people that we 9 see. 10 I think we need to implement programs 11 that are grass roots from the community level. The 12 community partnerships, talked about the Southern 13 Delaware Health Partnerships. There's also an issue 14 or a similar group in Nanticoke, the Western Sussex 15 County Coalition for Health Care Partnerships, as well 16 as one on the eastern side. All of these are examples 17 of grass roots organizations that we're trying to 18 promote community health. We're looking at the people 19 taking charge of their own health. We need to have 20 finances, other resources available for them in order 21 to do that. 22 I think it's a process of education and 23 also one of support because a lot of times the 24 communities that we're dealing with that don't have 58 1 the access to health care often don't have the other 2 resources in order to learn how to take care of 3 themselves as well as they should. I think those are 4 programs that we should promote, and thank you for 5 your time. 6 MS. McCLELLAN: Dr. Hal Bowen. 7 DR. BOWEN: Good evening, and thank you 8 for this opportunity. I'm Dr. Hal Bowen. I'm a 9 doctor of chiropractic in Midway Shopping Center, 10 Rehoboth Beach, and I'm here on behalf of the Delaware 11 Chiropractic Society which I'm past president. I also 12 currently serve as Governor Carper's appointee to the 13 Delaware Board of Chiropractic. I thank you for this 14 opportunity. 15 I have really I think three issues. 16 I'll try to focus on that and be as brief as possible 17 and leave any remaining time, if that's possible, for 18 questions from the committee. 19 We have three issues that I think may 20 bear on some of the concerns that this settlement 21 money is supposed to relate to. The first I would 22 consider is part of the general theme of prevention. 23 Part of the problem that sometimes is seen with young 24 folks who begin to use tobacco is that they often have 59 1 a self-esteem problem. One of the things that we feel 2 in chiropractic we may be able to help address is the 3 concern of scoliosis or spinal curvatures. We feel we 4 could be very effective in helping to screen at early 5 grades and perhaps later on to help identify those 6 with potential curvatures and perhaps participate in 7 X-ray if that seems indicated. 8 Second issue that I would bring forward 9 is one of secondhand smoke. As I'm sure those on the 10 panel who are familiar with the medical concerns, 11 children who are in homes with cigarette smoke suffer 12 a significantly higher number of upper respiratory 13 infections and ear infections in their younger years. 14 Chiropractic is often helpful in addressing these 15 particular concerns. And we would be willing as a 16 group or as individuals to participate in any way 17 along that line as well on the secondhand smoke 18 issue. 19 Third and finally is chiropractic is a 20 drugless and surgery-free method of health care which 21 we feel may help to shape the thinking if introduced 22 in an early age of some of the folks who may be 23 interested in smoking, and we feel that we may have 24 doctors who would be willing to participate at some 60 1 level in the school system to help educate young folks 2 to become more health-oriented and better life-styles 3 and things of that nature. 4 If any of you have any questions, I 5 thank you for your time, I'd be happy to answer them. 6 CHAIRMAN SYLVESTER: Thank you. 7 MS. McCLELLAN: David Rickards. 8 MR. RICKARDS: Hello. My name is 9 David Rickards, and I'm the owner of Burt's Home 10 Gardens. I am spokesperson for the Inland Bays Indian 11 River Tributary Action Team. Although it's not 12 related to tobacco, I hope the health merits of this 13 project will warrant you to listen to me. 14 I want to make an appeal for funds to 15 reduce the health dangers of brown tide and pfiesteria 16 in inland bays. By using a microalgae named spirolena 17 in 200 selected sites, several which run into the 18 Nanticoke, Pocomoc, St. Martin's and Indian River, and 19 Miller Creek, we can eliminate a large portion of 20 nitrogen and phosphorus into our inland bays, 21 according to 22 Everett P. Lincoln of the University of Florida. 23 This project should become financially 24 self-supportive within five years and cost only 61 1 $750,000 to start up, run for the five years, and 2 advertise the product. 3 Thank you for the privilege of talking, 4 and I'll follow up by sending in more detailed 5 description of the project by the 10th. 6 DR. REINHARDT: What is spirolena? 7 MR. RICKARDS: It's a microalgae that 8 can consume nutrients such as phosphorus and nitrogen, 9 and this Dr. Lincoln from the University of Florida 10 has been utilizing it now in a study for over 11 25 years. They have been basically using it for the 12 pig factories down there. The drainage lagoons that 13 they use, they utilize spirolena to eliminate the 14 nitrogen and phosphorus from that prior to letting it 15 go into the tributaries there. And according to him 16 it would work just as well in Sussex County. 17 MS. McCLELLAN: Greg Mazzola? 18 (No response.) 19 MS. McCLELLAN: Mazzola. 20 MR. MAZZOTTA: Might that be Mazzotta? 21 MS. McCLELLAN: It might be. 22 MR. MAZZOTTA: It's an old-line Sussex 23 County family name. 24 Thank you. I'll be glad to take a few 62 1 minutes. I just wanted to speak as an advocate for 2 two concerns. One is the Food Bank of Delaware which 3 has recently broken ground in Milford for a 4 distribution center, and it seems like some old 5 concerns fall off the radar screen, and the Food Bank 6 of Delaware has been around for quite sometime. It is 7 doing wonderful work. And it strikes me as we 8 identify all of these concerns that some things are 9 more easily serviced than others and there's really no 10 reason for a Delawarean to go hungry when there's an 11 abundance of food, and some of the concerns are really 12 challenges are delivery systems and distribution. So 13 hopefully in the next couple weeks you will hear more 14 about those types of solutions. 15 So if there is a match with regard to 16 health care, I think some of the research is rather 17 striking as to you're going to have somebody fed 18 before they can really take advantage of health 19 concerns. 20 And the second thing is the Blood Bank 21 of Delaware or of Delmarva Peninsula is another 22 concern. They will be debuting in the next few months 23 a comprehensive training program to be delivered in 24 the schools throughout the Delmarva Peninsula to help 63 1 educate kids as to healthy blood and that there's no 2 risk involved in giving blood, and it's kind of the 3 opposite in England. It's not viewed as a health 4 risk. 5 So those are the two concerns I wanted 6 to speak on. Thank you very much. 7 MS. McCLELLAN: John Reeb. 8 MR. REEB: My name is John Reeb. I'm a 9 citizen from Georgetown, Delaware. I'd like to thank 10 you, the committee, for having this meeting tonight. 11 I have listened for about an 12 hour-and-a-half now to all of the bureaucrats. I'm a 13 concerned citizen. I'm on the other side of the 14 fence. I'm a smoker. I think the funds that's being 15 received by the State of Delaware should be put in two 16 areas. One, prevention. The other one for 17 smoke-related illnesses only. Since I pay my taxes 18 with my cigarettes, I feel that it should go just for 19 smokers. Nobody else. That's my own personal 20 opinion. 21 And of all bureaucrats I heard up here, 22 not one of them mentioned anything about tobacco 23 itself and the manufacturers. You want to make a 24 product safer, then why are all these things in 64 1 cigarettes banned by the EPA and nobody does nothing 2 about it? I have a pack of cigarettes here. You can 3 take any product in your house and look on it and you 4 will have the ingredients. There's not one ingredient 5 on this pack of cigarettes that has warning labels 6 which the government has traded off with the cigarette 7 manufacturers years and years ago. They traded off 8 the ingredients on the cigarettes for the warning 9 labels. 10 If you want to make a safe product, just 11 go to all-natural tobacco cigarettes and you will have 12 a safe product, and it's something to look into. 13 Let's look in the other direction rather than blaming 14 all the diseases. I have heard a lot of numbers up 15 here tonight and a lot of it's not complete. Put it 16 that way. I have heard there's more people killed in 17 the state of Delaware by other means other than the 18 cigarettes. If a man died of a heart attack and he 19 had one cigarette, you can contribute that to 20 smoking. So let's not play games with the numbers. 21 I want to see this money used. You sued 22 for recovering costs for paying for people's health 23 and related with cigarettes, and let's use it for 24 that. Use it for enforcing the 18-year-old law. You 65 1 got to be 18 years old to buy cigarettes. 2 It's a legal product. That's another 3 thing. Let's make it a legal product. Let's make it 4 a safe, legal product. Like cars. There's a lot of 5 people killed by cars, but I don't hear nobody jumping 6 on the bandwagon about that. It's a bad product 7 because a lot of people don't use it. If I said to 8 everybody in this audience, well, I will take your car 9 away because it's dangerous, how many you think would 10 jump up here and beat me to death? A lot. 11 I'm just saying there's only 25 percent 12 of people in the state of Delaware smoke. I'm just 13 saying let's be realistic about it. And let's try 14 attacking it from another direction. 15 MS. McCLELLAN: Joann White? 16 (No response.) 17 MS. McCLELLAN: Jack Short? 18 (No response.) 19 MS. McCLELLAN: Earl Godwin? 20 (No response.) 21 MS. McCLELLAN: Margot Kea? 22 MS. KEA: I'd like to relinquish my time 23 and write a letter instead. 24 MS. McCLELLAN: Ann Wilson? 66 1 MS. WILSON: Thank you for coming. I'm 2 Ann Wilson. I am a United Methodist ordained person 3 working on missionary ministry facilitation. 4 This is our new effort, just a couple of 5 years old, to try to consolidate some of our small 6 congregations into more forceful groups, and we are 7 trying to minister in our communities, and everywhere 8 we turn, particularly in Sussex County, we run into 9 health issues. And we know that you're trying to do 10 the good things for all of us and we're trying to do 11 the good things back, but we need to be sure that 12 Sussex County that is underserved and has so many 13 transportation problems and just seems to be sometimes 14 out of the loop gets some consideration. 15 And as these groups form and hopefully 16 apply for startup grants and try to work with the 17 faith and health connection that is becoming so 18 apparent, we can be some of the arms and legs for some 19 of the programs you have heard about tonight. 20 We appreciate your attention to this 21 place and these people. Thank you. 22 CHAIRMAN SYLVESTER: I would say that 23 the Carter Center in Atlanta focused on the fact that 24 health departments typically go at health problems and 67 1 faith communities go at health problems, but they 2 sometimes go in different directions and they work 3 very closely together to actually get the two to start 4 working together. We have actually had conferences in 5 the state about getting our faith communities and 6 Division of Public Health to work closer together. I 7 guess Reverend Gary Gunderson who leads that mission 8 down at the Carter Center -- 9 MS. WILSON: That inspired me. 10 Reverend Hall who works for the Ecumenical Council for 11 Children and Families is helping us organize down 12 here. We seem to be sort of at loose ends. But with 13 some churches getting together into community groups 14 and with his help, we are hoping for the little bit of 15 assistance that will get us off the ground so that we 16 can be a link and unite together with the health 17 communities. We're hoping to start some parish nurse 18 programs and working and help hospitals in the area 19 and we hope we have the help of the State. 20 CHAIRMAN SYLVESTER: I would only see, 21 and I see one woman, but Barbara Bastianni, and she 22 would be a wonderful link with the faith communities. 23 She would be the public health side. As well as I do 24 know she's with the faith side, too, because she left 68 1 a meeting at church. 2 MS. WILSON: I think December 13th. 3 SENATOR McBRIDE: Before you leave, I'm 4 wrestling with how to ask the question not only of you 5 but several other speakers, but I'm going to ask. 6 Several speakers have talked about geography and 7 Sussex County. Maybe if you could just like talk a 8 little more about it. 9 MS. WILSON: Sussex County is the 10 biggest county east of the Mississippi. You know 11 that. You know that we have the most Methodists per 12 capita. But not enough. 13 CHAIRMAN SYLVESTER: I had forgotten 14 that. 15 MS. WILSON: But those are just little 16 plugs. 17 SENATOR McBRIDE: But the issue has to 18 do with the fair share. I heard that sometimes. From 19 my view, in Dover, as a legislator for a number of 20 years, I haven't necessarily seen that. I'm not 21 saying it isn't correct, but I see no -- I can assure 22 you I see no organized efforts in Dover to help one 23 area over another necessarily, but perhaps for a lot 24 of reasons, and that's what I was hoping maybe you 69 1 would share, I was thinking perhaps the ruralness 2 perhaps. When you used the word "transportation," 3 that meant something to me because I know we do 4 wrestle with that on delivery of services and so 5 forth. As you get out more in a spread-out community, 6 it's more of a problem. 7 MS. WILSON: A lot of our volunteers, 8 new organizations are trying to provide transportation 9 for people to the medical services that they need, 10 which is a good idea, but we need enough organizations 11 to network together to know how to do that more 12 efficiently. It's those kind of things. We're just 13 not very well organized and we hope we're going to be 14 able to help that. 15 SENATOR McBRIDE: Lastly, I would just 16 say -- 17 MS. WILSON: I don't think we're very 18 good at advocating for ourselves. 19 SENATOR McBRIDE: I do know that I have 20 read where the senior population is moving south in 21 Delaware. In the future, if you will, I know that 22 that's going to be a bigger struggle, hurdle for us to 23 insure that we do work with that movement. 24 MS. WILSON: Our area is Kent and Sussex 70 1 Counties. I happen to live in Sussex. We are 2 starting these missionaries. Thirteen are on the 3 books so far. And I think nine of those are in Sussex 4 County. But the idea is to get several of these small 5 congregations together as one resource, and they are 6 then doing needs assessments, and housing is certainly 7 coming in. Most of them are health-related. Concern 8 for teenagers. Concern for the poor children, the 9 children in poverty. The Hispanic programs. We just 10 have to pick and choose and start somewhere. That's 11 what we're doing. Some support will help us a lot as 12 we work in the health area. 13 Thank you. 14 MS. McCLELLAN: Deirdre McCutcheon. 15 MS. McCUTCHEON: Thank you, 16 Dr. Sylvester and distinguished members of the 17 committee. My name is Deirdre McCutcheon. I am the 18 president of the Delaware Dental Hygienists 19 Association. I would like to speak in favor of 20 dedicating a portion of the Delaware Health Fund to 21 support comprehensive, sustained, and research-based 22 tobacco prevention and cessation programs. Registered 23 dental hygienists working closely with dentists in 24 private practices and in a variety of other health 71 1 care settings are thoroughly educated to provide 2 tobacco prevention and cessation programs to our youth 3 and adults in Delaware. Our early interventions can 4 help to reduce tobacco-related deaths, including mouth 5 and throat cancers and treat gum diseases caused by 6 tobacco habits. 7 I urge the committee to recommend monies 8 to support these preventive programs and to be 9 confident in the knowledge that registered dental 10 hygienists of Delaware are ready and willing to play 11 an active role in improving the health of our 12 citizens. 13 Thank you. 14 MS. McCLELLAN: Joyce Fitch. 15 CHAIRMAN SYLVESTER: We have one more 16 signed up. We will take other people that have not 17 signed up. We did have an opportunity to do that in 18 Dover. So those that did not sign up -- 19 MR. MILLS: Can I ask the committee a 20 question? You had indicated there might be some 21 supplementation of drug benefits for seniors. We're 22 not going to pay retail for those drugs, are we? 23 CHAIRMAN SYLVESTER: I don't believe 24 so. It's going to be bought off the State contract. 72 1 MR. MILLS: Negotiated. 2 CHAIRMAN SYLVESTER: Right. 3 SENATOR McBRIDE: If I might, that was 4 part of the discussion during the legislation. That 5 was of interest to a number of people. 6 MR. MILLS: Good discussion. 7 SENATOR McBRIDE: We wanted to get as 8 much of the product out there to as many people as we 9 could. 10 CHAIRMAN SYLVESTER: Any other 11 questions? Yes, sir. 12 MR. BELL: My name is Rick Bell, 13 B-e-l-l. 14 Can anyone describe for me the programs 15 that were mentioned in Massachusetts and Florida and 16 California? 17 CHAIRMAN SYLVESTER: I have them down to 18 send them to the Health Care Commission as one of the 19 research topics. Dr. Silverman, can you elaborate on 20 any of the Florida, California, or Massachusetts 21 programs that have been spoken about tonight? 22 DR. SILVERMAN: A little bit. These are 23 programs that have a number of elements of 24 tobacco-controlled programs which CDC then looked at 73 1 from California, Florida, Massachusetts and 2 summarized, and I would say that they had various 3 components such as community-based interventions, 4 cessation programs. I can't remember the whole thing 5 offhand. What's called counter-marketing to negate 6 the effects of tobacco advertising. And the point is 7 that they were comprehensive and they were 8 well-funded. And they occurred in both states, at 9 least in California and Massachusetts, at the same 10 time that increases in the cost of cigarettes occurred 11 through excise taxes. So the combination of the 12 disincentive to prevent kids from smoking and the 13 education on bad tobacco and how to avoid it seemed to 14 have a fairly significant effect on tobacco use. 15 What makes them special is that they 16 were well-studied by CDC and these various program 17 elements were described and it was really the first 18 efforts to look at what makes a comprehensive tobacco 19 prevention program and to show that when you have a 20 comprehensive, sustained program, it can result in a 21 reduction of tobacco. 22 Off the top of my head that's about as 23 particular as I can be. 24 MS. WILZ: My name is Kay Wilz. I can 74 1 make copies. This is coming from CDC on best 2 practices for tobacco control, outlining California 3 and Massachusetts. So I'd be more than willing to 4 make you copies. 5 CHAIRMAN SYLVESTER: Thank you. I 6 appreciate that. 7 MR. HOYT: I believe you're going to get 8 a copy of that from the Impact Coalition. 9 CHAIRMAN SYLVESTER: Several of us went 10 to national meetings and brought some of that back. 11 SENATOR McBRIDE: Let me also for the 12 audience just suggest, for those of you that have 13 access to the Internet, the National Conference of 14 State Legislators, which is one of the national groups 15 that our legislature is a member of and works with, 16 has substantial information on that topic. I have 17 attended several national meetings on that, and it is 18 available, quite interesting, and would fill in some 19 blanks for you perhaps. 20 If you have difficulty getting that, you 21 could either contact myself or your own legislator if 22 you live in Delaware and I'm sure they would be happy 23 to get you information dealing with that issue. 24 MS. FITCH: My name is Joyce Fitch, and 75 1 I'm here as a private citizen, but I do work with 2 child care providers. 3 A couple weeks ago a child care provider 4 in Bridgeville called me and she just turned on WBOC 5 about this tobacco money we were getting and she said, 6 "You know, I think it would be a good idea if they 7 took that money and set up a fund to insure people who 8 have trouble paying for insurance as it is now. All 9 the self-employed, all the low-end people that work 10 for small businesses that don't offer health 11 insurance." She's a child care provider and she works 12 nights at Wal-Mart so she can get her health insurance 13 through there because she cannot afford to pay for 14 health insurance. 15 Now, she said that she believes that 16 people should pay for health insurance, but many 17 people just can't pay at the rates that they now go 18 through. Three, $400 a month is just out of the range 19 for a lot of people. It's a subject I have been very 20 passionate about for many years. I know so many 21 people who don't have health insurance and who put off 22 going to a doctor for a long time and then they're in 23 real trouble. 24 There's a lot of people in this state. 76 1 And one of the nicest things that happened in this 2 state about a year ago is the Healthy Child Care Plan 3 where all children can get affordable health insurance 4 for up to 5 to $25 a month. That's wonderful. But 5 what about the parents that have to take care of those 6 children? 7 I really think that we need to do 8 something about affordable health care. Thank you. 9 CHAIRMAN SYLVESTER: Sir? 10 MR. DARLINGTON: May I come down? 11 CHAIRMAN SYLVESTER: Please. 12 MR. DARLINGTON: To the distinguished 13 panel, my name is Jack Darlington. This lady has the 14 right idea when she says a lot of people cannot afford 15 the insurance. Recently a very close friend of mine 16 had a severe heart attack. He died on my kitchen 17 floor. Six weeks ago. If it wasn't for Beebe 18 Hospital, he wouldn't be here today. Believe me. 19 They sent him up to the other hospital and they put 20 two stints in his heart and a balloon. 21 Well, now this gentleman smoked a lot 22 and he's here with me today. It's Eddie. So he come 23 out of the hospital and he said, "Jack, give me a 24 cigarette." Well, I smoke. So far there's no reason 77 1 I should stop, but I know it's going to hit me sooner 2 or later. Since it happened so close to home, I 3 figured, well, maybe I better. So I'm not my 4 brother's keeper, but Eddie is trying to stop 5 smoking. 6 Here's the problem. We went up to Happy 7 Harry's. Now, the doctor give him a prescription for 8 some patches. Okay? Uh-uh. $150 for 30 patches. He 9 don't have the money. Now what do you do? Please 10 tell me. I don't know. So I figured, oh, Beebe has a 11 way out of it. Let's go down to Beebe. They have a 12 program set up where people that don't have money can 13 usually get patches to start off with. Beebe has 14 16-milligram. The doctor ordered 7-milligram. Now, 15 he's starting low and apparently his heart is not 16 going to take a 16-milligram. So I know some people 17 at Beebe because I have been in contact with them. 18 Thank you. 19 So my question to you is what is the 20 guidelines here to make sure that Sussex County gets 21 some allotment monies for these tobacco products? 22 Does Beebe give enough help to say, okay, we can help 23 you to help some of the people that don't have money? 24 That has to come into it, too. We're all human 78 1 beings. And she's right. There's a lot of people 2 that can't afford $665 a month for health insurance 3 that's 800 some dollars if you're married with the 4 family plan. That's expensive. I don't care who you 5 are, it's still expensive unless you got a golden 6 job. Maybe at tenure. That might do it. 7 So I just wanted to ask. Thank you. At 8 least you could put it in a way that maybe you can get 9 it into something to help other people. 10 CHAIRMAN SYLVESTER: Thank you. You 11 know, I'd like to make a comment about that. I'm sure 12 maybe the Senator will. Remember, we're an advisory 13 committee to the General Assembly and the Governor, 14 and you have representatives in Sussex and in Kent and 15 in New Castle. 16 My recommendation would be to talk to 17 your elected officials because they're the ones we're 18 going to make recommendations to, Senator McBride and 19 his colleagues and to the Governor, and they're going 20 to make those decisions whether we make good 21 recommendations or bad. 22 If you like the recommendations we made 23 and it says give a third of it or a proportion down to 24 Sussex and you like that, tell your legislators you 79 1 think it's a good idea. If we write things and say 2 all we're going to do is the City of Wilmington, my 3 goodness, I hope you go to your legislators and say 4 don't listen to that group. 5 MR. DARLINGTON: Senator Bunting. 6 CHAIRMAN SYLVESTER: I would advocate 7 that you have a conversation because he and his 8 colleagues, Senator McBride, they're going to be the 9 ones that are going to have to either agree with ours 10 or choose to change it, and that's how all of our 11 money gets spent in this state is through the General 12 Assembly. 13 MR. DARLINGTON: How is it allotted? 14 Like is Dover because it's big or Christiana? You 15 going to give it to the hospital? Are they going to 16 get all the allocation or is it going to be each 17 person in a way to have that kind of monies? 18 CHAIRMAN SYLVESTER: That's what the 19 public hearings have been about is to listen to you 20 about where you think the best -- 21 MR. DARLINGTON: I think it's in 22 tobacco. 23 CHAIRMAN SYLVESTER: We will get 24 together and we will recommend to the General Assembly