1 DELAWARE HEALTH FUND ADVISORY COMMITTEE DEPARTMENT OF HEALTH AND SOCIAL SERVICES Glasgow High School Newark, Delaware November 30, 1999 7:00 p.m. -- -- -- -- TRANSCRIPT OF PUBLIC HEARING -- -- -- -- BEFORE: DELAWARE HEALTH FUND ADVISORY COMMITTEE GREGG C. SYLVESTER, M.D., Chairman ALSO PRESENT: STEPHANIE McCLELLAN, DEPARTMENT OF HEALTH AND SOCIAL SERVICES WILCOX & FETZER 1330 King Street- Wilmington Delaware 19801 (302) 655-0477 2 1 DR. SYLVESTER: I'm the chair of the Health 2 Fund Advisory Committee. You may have received a couple 3 pieces of paper as you walked in. If you have, let's 4 walk through them; if you haven't, I'll tell you a little 5 bit about them. 6 One of them has all the advisory committee 7 members' names on them, so we won't take the time to 8 actually go through and introduce each and every one of 9 us. But there's a sheet that has each one of us. Most 10 of us are here tonight, but some were not able to attend. 11 The second piece of information I want you 12 to have is that, although we're doing public hearings, we 13 certainly want to hear from you tonight, those that 14 haven't had a chance to speak and want to send it in 15 writing we will make it part of the public hearing. We 16 have had transcripts from every one of the hearings, this 17 is our fourth, and we will make them available over the 18 Web or you can write us at this address and we will send 19 you that. But if you want to make sure that your name or 20 your comments got put into the public hearing document, 21 we would make sure that that would happen. 22 There's two other pieces of information. 23 One are the purposes. We thought it would be important 24 for you to see what the law says how the money ought to 3 1 be spent or how we are going to make recommendations to 2 the general assembly and to the Governor and there are 3 eight purposes and we have supplied those for you. 4 Finally, we have a little bit of ground 5 rules to see if we can stay on track and make sure that 6 everyone gets an opportunity to speak tonight. Some of 7 those are written up here. I want to share with you, we 8 do have a Website for those that like to use their 9 computer. You can write us, call us, whatever you like. 10 We want to hear from you. That's the first white piece 11 of paper that you see. 12 The middle one is the guidelines, which is 13 that piece of paper that I held up. The idea is that we 14 are going to have those that called us up ahead of time, 15 we are going to call your names out first. Those that 16 came tonight and signed up, you will have the second 17 opportunity. And then the third opportunity will be for 18 those that are just spontaneous and want to get up at the 19 end and share your thoughts with us. We will make 20 sure -- this is our fourth hearing and we have made sure 21 that everyone has had an opportunity to share their ideas 22 and thoughts with us. 23 We do have a timekeeper, and I think Mary 24 is right here. Mary is going to hold two cards up. A 4 1 yellow card is going to say you have one minute left. We 2 are going to try to hold you to three minutes. When you 3 have one left she's going to hold up the yellow card to 4 say you'd better start wrapping up. At the three-minute 5 mark she's going to hold up a red card to say it's time 6 for you to sit down and let someone else have an 7 opportunity. We have not yanked anybody, but please try 8 to stay to three minutes. It does make it easier. 9 If you are with multiple organizations, if 10 you are here with -- we have heard some wonderful people, 11 but if you are from the Heart Association, we want to 12 hear you talk and then allow other people to talk, so we 13 would like one speaker from each association. And we've 14 been a little lenient on that and will continue, but that 15 would be nice if we make that happen. 16 It's been very exciting. We have had three 17 outstanding public hearings. We really value you coming 18 and spending the evening with us. 19 With no further adieu, let's get started. 20 Stephanie is going to call out your name. She will call 21 your name and the on deck circle to let you know who is 22 going to be up next. When you get done with your talk, 23 stay up there for a moment in case any members have 24 questions for you. 5 1 All right, Stephanie. 2 MS. McCLELLAN: Sarah DuBois, followed by 3 Lelia Perkins. 4 I'm Sarah DuBois representing the Delaware 5 KBG. I'm here today to help you decide where the money 6 from the recent tobacco settlement should go. We have 7 all worked very hard to get the money put into the health 8 fund. Where now it could end up paving a road in front 9 of a hospital or constructing a sign for the local 10 pharmacy, why not have the money help the initial 11 problem, tobacco, such as cessation programs, school 12 organizations, rallies and other youth-involved 13 organizations. Prevention and control programs cover a 14 wide variety of things. Sure, our primary focus is to 15 stop people from smoking, but we also touch on heart 16 diseases, lung diseases, various types of cancer and 17 other such problems. 18 I'm sure Phillip Morris and everyone else 19 in the tobacco industry would love for us to use the 20 money in the settlement on hospital construction, but 21 what do we honestly get out of that? If we attack the 22 whole tobacco issue, then people would be healthier and 23 we wouldn't need as many hospitals, anyway. 24 All I'm trying to say is the money from the 6 1 tobacco settlement should be used to fight tobacco, 2 because I don't know about all of you, but I'm sick of 3 being just another pawn of industry. And me, along with 4 those here with me, are willing to fight back. We have 5 the will, ambition, the support. All we need now is 6 money. 7 MS. PERKINS: My name is Leila Perkins and 8 I'm a member of the Governor's Advisory Council on 9 Services for Aging and Adults with Physical Disabilities. 10 On behalf of the council I would like to thank you for 11 already allocating $5 million of the tobacco settlement 12 to fund the Pill Bill that will benefit more than 6,700 13 people. 14 The purpose of our advisory council is to 15 promote and advocate for the benefits of the elderly and 16 adults with physical disabilities. We are asking that 17 you strongly consider their need. 18 American history has been marked by 19 revolutions. The American Revolution was the highlight 20 of the 18th century. The 19th century saw the Industrial 21 Revolution. The 20th century saw the information and 22 technology revolution. And the 21st century will be 23 marked by the dramatic aging of our population, a 24 demographic revolution. 7 1 It is projected that between the years 2000 2 and 2020 Delaware's population of those 60 and older will 3 increase by approximately 50 percent. While we can't 4 predict the number of people with disabilities, we know 5 this population is also increasing. Advances in 6 technology, medicine, are allowing more people to survive 7 serious accidents. For example, there was a 22 percent 8 decline in traumatic brain injury-related death rate in 9 the U.S. between 1979 and 1992. 10 We all want to live in our own homes and 11 have control of our lives and as long as possible. 12 Surveys show that it is much more cost effective to keep 13 a person in the community rather than a nursing home. 14 Home and community-based services are the answer. We 15 must think about redirecting our focus of services from 16 medical model to a social model. We must develop 17 policies that provide assistive devices or home 18 modifications. We must assist older persons, adults with 19 physical disabilities and their families to choose 20 creative alternatives to institutional care. A waiting 21 list already exists for these services. 22 Cost per unit of services are going up. 23 While Delaware's economy is good, the cost of living 24 continues to be a problem for many people who used to 8 1 volunteer their services. They can no longer afford to 2 work without compensation. 3 We are so fortunate to live in an age when 4 advances in medicine and technology allow the elderly and 5 persons with physical disabilities to live longer. These 6 persons can improve their own health if they begin to 7 take charge of their own lives. 8 We strongly recommend developing programs 9 related to prevention on how to manage chronic diseases. 10 Wellness and prevention activities need to be developed 11 and promoted in order for people to live a better quality 12 of life. The alternative is the high cost of caring for 13 this population. 14 We realize that no one can foresee what the 15 future return will be from the tobacco industry, but in 16 your long-range planning please don't forget this 17 population. We must not forget that we are a nation that 18 was built on dreams and we continue to dream of a 19 community enriched by old people. 20 Thank you for your attention. I would like 21 to distribute a copy of this to the members in the 22 audience if that's okay. Thank you. 23 MS. McCLELLAN: Next is Tom McFalls, 24 followed by Dr. Shane Palmer. 9 1 MR. McFALLS: Good evening. For my first 2 number I'd like to sing I left my heart in San Francisco. 3 I want to thank each of you for the time 4 and energy that you are putting into this effort. It's a 5 remarkable requirement and we as citizens of Delaware 6 genuinely appreciate it. 7 Despite my youthful appearance, Senator 8 Blevins can attest to the fact that I am over 65 years of 9 age. So we do want to thank you for your efforts. I'm 10 sure by the end of these hearings you will find that you 11 wish you could find another pot of gold, but I know you 12 only have one to deal with. 13 Tonight I'm representing the Wilmington 14 Senior Center, the Grahm Senior Center, Newark Senior 15 Center and Cheers Senior Center from Sussex County. In a 16 sense I think all seniors are looking for the opportunity 17 for a second chance. If you have seen any old movies you 18 will remember that if you looked at them closely in those 19 days most of the people in old movies smoked. And we are 20 still reeling from that model of role models and the type 21 of person that people try to aspire to. 22 But we're not just talking about smoking. 23 Were talking about giving seniors a second chance with 24 their lifestyle. Giving them a chance to have supervised 10 1 fitness equipment, exercise programs and nutrition 2 programs will turn their lives around. Just today I 3 talked with a man who is recovering from a heart 4 condition and he was so pleased with the progress that he 5 had made in his fitness program. He never envisioned 6 himself before getting involved in something like this. 7 He was encouraged to do this by his children. And he 8 told me that he was very inspired by the staff that were 9 providing the supervision that was required. 10 We're generations of seniors who need a 11 second chance. This effort was originally pioneered by 12 the St. Hedgewick Senior Center that is now the Claymoore 13 Senior Center. We're asking you to, as a part of your 14 consideration, to provide the funds that would allow 15 senior centers to have the proper fitness equipment, 16 proper supervision. It's not an expensive item. For 17 thirty to $50,000 centers can be outfitted with the right 18 equipment and for about $30,000 a year they can have the 19 type of cardiovascular supervision that they need. 20 So in closing we would like to say simply 21 we believe that the seniors today need a second chance. 22 We believe that you have the opportunity to provide it. 23 And we hope that this can result in a shared vision. 24 Thank you very much. 11 1 DR. PALMER: Dear, ladies and gentlemen, 2 thank you for the opportunity to speak today. My name is 3 Dr. Palmer. I've been a practicing physician in the 4 state for the last ten years. Presently I'm vice 5 president of the Delaware Chiropractic Society. 6 The issue I'd like to address tonight is 7 health education in the public school system. I have 8 contacted the CDC and the Campaign for Smoke Free Kids in 9 Washington and asked for their recommendation on 10 effective programs that could be administered in our 11 school system. 12 I've also contacted a number of new 13 physicians who have just received their licenses to 14 practice in the state. I asked for their willingness to 15 teach these programs recommended by the CDC, as well as 16 to teach preventative healthcare through the five facets 17 of health, those being proper nutrition, proper exercise, 18 proper rest, proper mental attitude, and proper posture 19 and communication within the body itself. This will be 20 followed with a strong influence of self worth, self 21 respect, despite race or economical situation and job. 22 But with the influence of the HMOs, these 23 new physicians do not have access or means to pay back 24 student loans, which can range from seventy to $100,000. 12 1 And the government expects these physicians to start 2 paying back about a thousand dollars a month within a 6- 3 to 8-month period after graduation. 4 I feel that these new physicians could fill 5 an important educational position for a fair salary and 6 credit towards their student loans. 7 Thank you and I look forward to creating a 8 beneficial program with this committee. 9 DR. RIZZO: Committee members, thank you 10 for allowing me to appear before you and talk about the 11 tobacco issue here in our state and the need for 12 concerted effort to help our smokers quit. 13 I'm Dr. Albert Rizzo. I've been a long 14 time volunteer for the American Lung Association of 15 Delaware and I've served in various positions, including 16 past president. 17 As a pulmonary specialist in New Castle 18 County I care for many Delawareans who are affected by 19 tobacco use. Many are primary users of tobacco and 20 suffer from the related illnesses of chronic bronchitis, 21 emphysema and lung cancer. 22 Many are non-tobacco users and are affected 23 by the environmental tobacco smoke, either of their 24 spouses', parents' or co-workers' habits. These 13 1 individuals often have asthma which is based on allergic 2 or hereditary factors. As important as smoking 3 prevention is, because it can and will prevent our young 4 people from become addicted to nicotine, there's a strong 5 need for effective smoking cessation programs. 6 Many Delawareans are already regular 7 smokers and are hooked on nicotine. Most of them want to 8 and have tried to quit multiple times. Helping these 9 people deal with their psychological and chemical 10 dependency will produce significant short term and long 11 term benefits. In the short term these individuals will 12 have less illness and a better sense of well-being. This 13 will translate into increased exercise, tolerance and 14 ultimately productivity. In the long term there should 15 be less of a decline in their pulmonary function. This 16 will mean less encounters with physicians, less 17 hospitalizations and also a decline in the development of 18 lung cancer and premature death. 19 Helping our smokers to quit will mean less 20 smoking adults generating secondhand smoke that affects 21 our children with asthma, less smoking mothers and less 22 smoking role models to observe. 23 In Delaware in addition to preventing our 24 youths from becoming smokers, we must ensure that 14 1 programs to help smoking teens and adults quit are 2 accessible, affordable and effective. Smoking cessation 3 is just one piece of a comprehensive sustained tobacco 4 prevention plan, but it's an important piece. The 5 American Lung Association of Delaware supports full 6 funding for a plan to achieving a tobacco-free Delaware. 7 This is an approach that we participated in developing, 8 along with many members of the Impact Delaware Tobacco 9 Prevention Coalition. 10 Thank you. 11 MS. McCLELLAN: Richard Johnson is next. 12 MR. JOHNSON: Thank you. I appreciate the 13 opportunity to present the view of AARP on how Delaware's 14 use of the tobacco settlement funds could be best spent. 15 AARP's current Delaware concern, and our 16 ongoing concern, will always be for the quality and 17 safety of care that people receive in nursing homes. In 18 addition, it is an AARP mission to support the ability of 19 older Americans to remain independent and in their homes 20 for as long as they are able physically and financially. 21 Our current and future efforts will work to, one, improve 22 the quality of care in Delaware's nursing homes and, two, 23 increase the home and community support for Delaware's 24 families and elders as they age in place in their own 15 1 homes. 2 Over the last two years Delaware has passed 3 important legislation to support better quality of care 4 in nursing homes. But that job is not done. Currently 5 there is legislation pending in committee, having passed 6 the Senate, to increase the required nursing home 7 staffing. Increased staffing will help ensure that 8 patients receive sufficient time and attention from 9 nurses to make sure that physical disabilities from which 10 they suffer are alleviated and not exacerbated. 11 Increased staffing will help ensure that 12 even in these extreme situations of poor health and 13 disability, nursing home residents retain the maximum did 14 he degree of dignity and respect to which all human 15 beings are entitled. 16 It is AARP's position that increased 17 staffing levels are the best cure to solving the quality 18 of care problem in nursing homes. There are too many 19 complaints and too many survey deficiencies to treat this 20 problem with half measures. Approximately 5,000 of our 21 elders, among the most vulnerable of all people, live in 22 Delaware nursing homes and daily, even as we speak, 23 endure the levels of care attributable to our action or 24 inaction on increased staffing. 16 1 It is our position that additional work 2 must be done to ensure that goal. And while we protect 3 those among us who are the most vulnerable, we must 4 simultaneously plan and work to prevent other seniors 5 from unnecessary or premature institutionalization due to 6 the current lack of adequate home and community-based 7 services. 8 Approximately 80 percent of the home-based 9 care currently provided to elders comes from our 10 families. Yet today often children move away or both 11 parents work and provide child care. Families often have 12 limited ability to take on additional burdens. Home care 13 is prohibitively expensive for many. If an adequate 14 system of home care is not available or affordable, then 15 the nursing home, usually financed by public taxes, 16 becomes the alternative. 17 Delaware is somewhat ahead of the national 18 curve, yet it, like the rest of America, must address the 19 needs for an adequate, affordable, high quality system of 20 home and community support. 21 I close by returning to the beginning. It 22 is our concern and AARP will work diligently to both 23 enlarge the necessary system of home support for seniors 24 so that they may remain independent and in their homes, 17 1 and to not forget the thousands of Delaware seniors in 2 nursing homes who need and deserve additional staffing to 3 ensure the highest possible quality. Thank you. 4 I have copies of this testament and I'd be 5 happy to provide it to anyone interested. 6 MS. McCLELLAN: Gregory Durette next. 7 MR. DURETTE: Good evening. Thank you very 8 much, distinguished panel. 9 I'm representing I guess a lot of different 10 people, IMPACT, National Assembly School-Based Health, 11 and my former employer as a wellness center coordinator 12 of Delcastle Technical High School. Currently I'm 13 unemployed, so if you have any positions... 14 I'd like to use this opportunity to thank 15 you. I'm joining the thousands of individuals and 16 organizations who care about the overall health of 17 Delaware residents, specifically, the health of children 18 and adolescents. I urge you to dedicate a significant 19 portion of Delaware health funds to support coordinated 20 school health programs. 21 As you know, maybe you don't, Massachusetts 22 just contributed $11.6 million to its school health 23 program from the tobacco settlement monies to improve 24 coordination, promotion, education and services that 18 1 enhance the health and welfare of students. 2 Schools and community organizations, 3 primary care and health care professionals must respond 4 by making preventive services a greater component of 5 their practice. The physical and emotional health of the 6 student is clearly a factor in the ability of the 7 students to achieve academic success. Supporting 8 programs address student needs and support health 9 services. 10 The data obtained through the Delaware 11 Youth Risk Behavior survey and the Delaware Student 12 survey indicates that the students often lack the skills 13 to manage and negotiate decisions that are in their own 14 best interests and tend to have difficulties resisting 15 pressures from peers and the media. And I think funds 16 for this initiative will definitely help that scenario. 17 Specifically regarding tobacco, please 18 consider the following recommendation. All adolescents 19 should receive health guidance annually to promote 20 avoidance of tobacco, alcohol and other abusable 21 substances. All adolescents should be asked annually 22 about their use of tobacco products, including smokeless, 23 especially since tobacco is -- should be classified as a 24 drug. Adolescents who report any use should be assessed 19 1 further to determine their pattern of use. A cessation 2 plan should be provided for adolescents who use tobacco 3 products. 4 And I think I can also speak in terms of 5 some of the organizations that may be represented here. 6 We have psychologists, we have students that are coming 7 out in the field, they can be utilized if we get the 8 funds to do that. 9 And I'm peaking here, but due to some of 10 the significant changes to federal policy, positions 11 should increasingly call for integration of services in 12 school-based health and school-linked sites. And school 13 leaders should be asked to assume the responsibility of 14 reexamining the ways in which education, health and human 15 services are delivered to American children and families. 16 And tomorrow the FDA is about to go on I 17 guess trial as to regulate tobacco products. And if the 18 FDA is granted authority to regulate tobacco the industry 19 claims it could ban the sale of tobacco outright. Let's 20 hope the FDA's knowledge of nicotine as a drug will help 21 advocates against tobacco use. 22 I'm sorry for taking additional time, but 23 thank you again for allowing me the opportunity to speak. 24 MS. McCLELLAN: Dr. Pollner, followed by 20 1 Nancy Wooten. 2 DR. POLLNER: My name is Philip Pollner. 3 I'm a family physician in the Newark, Delaware area. And 4 I hope that the committee will recommend that significant 5 amount of the funds be used to provide needed quality 6 medical care for the 115,000 uninsured citizens in 7 Delaware who don't even get a first chance. These folks 8 are nameless and faceless, invisible, but is a problem 9 that is ever increasing in our state by large numbers 10 each year. 11 It's interesting that in 1994 doctors 12 offices nationally provided care to about a third of the 13 uninsured people in the country, at a cost of something 14 like $11 billion in uncompensated care. But the 15 situation is much, much worse now. A recent study in the 16 Journal of the American Medical Association this past 17 March involving 10,000 physicians in private practice 18 throughout the country in some 60 random communities 19 throughout the nation noted that managed care affects the 20 physician's ability to provide care to medically indigent 21 people. That physicians who were involved in the 22 heaviest involvement with managed care in their practices 23 were less likely to provide any charity care. 24 So the private sector in Delaware for sure 21 1 is having a very difficult time trying to provide charity 2 care in their own offices. As a result, much of the care 3 provided to the uninsured is through the emergency room 4 at a great cost. And the more we're involved with 5 managed care, the less we can do anything about it and 6 the more the emergency room is going to be the primary 7 providers of primary care. 8 We all know that that is very expensive, 9 very ineffective, and apparently if it continues it's 10 going to be more expensive and more ineffective. 11 So it is my hope that we start looking at 12 this serious problem right now, using these funds in a 13 significant manner to provide needed medical services to 14 the 115,000 uninsured people in the state. And there's 15 an enormous number of other folks who have some 16 insurance, but not enough to get quality medical care and 17 they have great need, too. 18 I'll just close by saying that I'd be 19 willing to volunteer my time and my energy to provide 20 medical care for this large group of people, but I 21 certainly would need financial support and the hands of 22 many of my colleagues and other volunteers to work on 23 this project. Thank you very much. 24 DR. WOOTEN: I'm Dr. Nancy Wooten. Today 22 1 I'm representing Delaware Volunteers in Healthcare -- I 2 believe it says "for healthcare" -- an organization 3 comprised of individuals and organizations from the 4 community, including healthcare professionals, senior 5 citizens, students and organizations whose constituents 6 are most affected by difficulties accessing healthcare. 7 We are working together to implement a medical service 8 project which will provide medical care for uninsured and 9 underinsured Delawareans. 10 I'm here to address the issue that brought 11 us together working on such a project. It is to 12 Delaware's shame that we have felt compelled to act. In 13 this affluent state during this prosperous time we still 14 have over 115,000 residents who lack health insurance. 15 Countless others in the state are underinsured. So many 16 Delawareans endure obstacles to accessing quality medical 17 care. 18 In the midst of this economic boom, in 19 spite of programs in place such as CHIPS and the Diamond 20 State Health Plan, demand is up for charity care and 21 recourse to emergency rooms for medical care is on the 22 rise. 23 The issue of 115,000 uninsured Delawareans 24 is not only a social issue, a civil rights issue, but it 23 1 is also an economic issue. Each time an uninsured or 2 underinsured individual becomes ill and ends up in the 3 emergency room or hospital, all of us pay through cost 4 shifting. Delawareans pay through their subsidizing of 5 charity and emergency care. Uninsured and underinsured 6 Delawareans pay with their pain, suffering and illness 7 that might have been prevented or checked at a less acute 8 stage. 9 It is my hope that, Delaware Volunteers in 10 Healthcare's hope that this committee and ultimately the 11 state applies a generous proportion of these resources 12 thoughtfully and practicably to eradicate the existence 13 of uninsured Delawareans. Thank you. 14 MR. McCLUNEY: Good evening. To the panel, 15 elected officials, Dr. Sylvester, I want to thank you for 16 giving me the opportunity to come before the panel 17 tonight to address the reason why I believe, our 18 organization believes, that a better way to spend this 19 windfall is to dedicate it to long-term healthcare. 20 My name is Amos McCluney and I represent 21 Delaware Volunteer Coalition for Long-Term Healthcare 22 Reform, reforming the healthcare system for the new 23 millennium. 24 Whereas, the components of the healthcare 24 1 system are so interrelated that no part can function well 2 unless the system as a whole functions well; 3 Whereas, the cost of healthcare is rapidly 4 escalating and currently represents over 19 percent of 5 the state's budget and over 25 percent of each older 6 person's annual household income; 7 Whereas, 115,000 Delawareans are uninsured, 8 of which 25 percent are children; 9 Whereas, the current healthcare system does 10 not adequately promote and support preventative care; 11 Whereas, Medicare covers less than 50 12 percent of all healthcare expenses of people age 65 and 13 older, provides no outpatient drug coverage and covers 14 almost none of the cost of long-term care; and 15 Whereas, the healthcare system is an 16 important consideration in reducing the state budget; 17 Therefore, be it resolved by the 1999 18 Delaware Health Fund Committee to support a statewide 19 healthcare reform effort that will adhere to the 20 following principles: 21 The state should create by law a statewide 22 healthcare system that guarantees universal coverage, 23 quality service, comprehensive benefits, including: 24 long-term institutional, home and community base 25 1 services, efficient administration, broad-based 2 financing, a strong system-wide cost containment and 3 emphasis on health promotion and preventative services; 4 All citizens of Delaware regardless of age, 5 race, ethnicity, physical or mental disability, or income 6 should have health security, including availability of 7 and access to affordable quality, physical and mental 8 healthcare and long-term care, choice of provider and 9 health plans; 10 Cost containment is a critical component of 11 meaningful healthcare reform and must not be separated 12 from the reform process; 13 Medicare's commitment to its beneficiaries 14 must not be jeopardized by arbitrary cuts. The general 15 assembly should resist calls for cuts which would damage 16 the program, devastate the healthcare system and 17 adversely affect frontline healthcare workers. Any 18 savings that may come from changes in Medicare and 19 Medicaid as a result of healthcare reform should be 20 applied to strengthen the program and expand coverage, 21 including long-term care. The use of savings in Medicare 22 and Medicaid for tax cuts for the well-off citizens 23 should be prohibited; 24 Long-term care must include cost effective 26 1 alternatives such as home and community care, as well as 2 institutional services as essential components of 3 healthcare reform. 4 I see the red flag. Let me just say again, 5 thank you very much for giving me the opportunity and I 6 hope that you will look at this and I will be sending a 7 copy of this resolution to the committee. Thank you very 8 much. 9 MS. BEARS: Good evening. Is everybody 10 warm? I'm still freezing. 11 My name is Nancy Bears. I'm representing 12 the advisory board to the Alliance for Adolescent 13 Pregnancy Prevention. You have heard everything from 14 womb to tomb. I'm here to advocate for increased 15 resources to promote primary prevention of high risk 16 behaviors among our youth in Delaware. 17 Currently, there are almost 100,000 18 Delawareans between the ages of 10 and 19. 55 percent of 19 these young people are sexually active. 74 percent have 20 tried smoking cigarettes. 20 percent have considered 21 suicide. 22 Primary prevention efforts to reduce high 23 risk behaviors need to be comprehensive. There's no one 24 program or magic bullet that's going to help us in this 27 1 area. Prevention efforts should include three essential 2 components. All three of these areas need additional 3 resources if they are going to be effective in our state. 4 First, educational efforts need to be 5 consistent. Young people need the facts. For example, 6 responsible sexuality education should be available at 7 all grade levels. 8 Second, young people need access to 9 services. School-based wellness centers provide access 10 points for high school students. Middle school wellness 11 centers would improve access among younger students. 12 Access to comprehensive services, especially condoms, 13 need marked improvement. Access to mental health 14 services and treatment for all addictions, tobacco, drug 15 and alcohol, should be available upon demand. 16 Finally, this is my favorite point, 17 enhancing communication between young people and their 18 parents and the competent adults in their lives is very, 19 very powerful in reducing high risk behavior. 20 Communication training for parents could occur at the 21 workplace, through our schools or through the media. 22 Thank you for allowing me to testify and 23 have a happy holiday. 24 MR. FINA: One of my disabilities is 28 1 hearing loss. 2 My name is Nick Fina. I'm chair of the 3 State Rehabilitation Council for the State of Delaware, 4 and also a member of the Alliance for Mentally Ill. I'm 5 here representing the Alliance tonight. I'll be making 6 some different points from the ones you heard Dick 7 Patterson make. 8 I want to tell you about a friend of ours, 9 a family friend. He lives in New York. He came down 10 last week for Thanksgiving. His name is Sam. Actually, 11 it's not Sam, but that doesn't matter. Sam is a singer 12 and a songwriter. Not a famous one, but he's pretty 13 good. He specializes in songs for children and he sang 14 some of them for us. 15 He also told us a story that was pretty 16 hairy. I want to tell you about it. 17 When he was 22 years old -- he is 56 now. 18 When he was 22 years old Sam started having psychiatric 19 problems and he was admitted to a hospital. In the 20 hospital they gave him real heavy drugs, severe 21 neuroleptic changes, and they gave them chains to keep 22 him under control and occasionally they beat him. He had 23 no brothers or sisters, so none of them visited him. His 24 wife left him. His parents gave up and stopped coming to 29 1 see him. This went on for 10 years. 2 Finally, after ten years of hospitalization 3 a new doctor came on the scene and said this guy has 4 manic depression, give him lithium. Ten days later he 5 was ready to leave the hospital and start his life over 6 again. 7 This is a horror story and it wouldn't be 8 so surprising if it happened in Transylvania, but it 9 happened one generation ago in the most advanced 10 civilization in the world. In many ways we are coming 11 out of the dark ages when it comes to mental illness and 12 the heart of what happened to Sam is ignorance, and the 13 basis of ignorance I think is the basis for the most 14 severe problem that's facing people with mental illness 15 and that is the problem of stigma. 16 If you don't think stigma exists as a 17 problem for people with mental illness, listen to the 18 story of another friend. I have another friend with 19 manic case depressive illness and she doesn't file one 20 penny for insurance for her psychiatric care or for her 21 medications. She pays it all out of pocket because she 22 is afraid of what will happen if somebody finds out. 23 We have to fight stigma and I would like to 24 see the healthcare fund used in part for fighting stigma. 30 1 The other two problems that I think we need 2 to fight are housing and jobs. The national unemployment 3 rate for people with severe and persistent mental illness 4 is 70 to 90 percent, and most experts in the field think 5 it shouldn't be more than 30 to 50 percent. We need to 6 provide jobs as a basis for self esteem, it's the basis 7 for financial security. We need to work on that. DVR is 8 working on it right now and we need to expand that 9 program. 10 In the area of housing, many, many people 11 are not able to accommodate their need for housing and we 12 need to work on that, too. 13 I have a red flag, so I will stop. Thank 14 you. 15 MR. TOMLINSON: Thank you for this 16 opportunity to speak. These millions of dollars sound 17 like a lot of money, but when you look at the many 18 situations needing immediate and long-range attention, it 19 really isn't that much. 20 Number 1, we must find a way to discourage 21 our young people from employing bad habits, using tobacco 22 and drugs. 23 Number 2, over 100,000 Delawareans have no 24 healthcare at all and several thousands more have 31 1 inadequate coverage. 2 Number 3, Delaware lacks free clinics to 3 care for the sick and injured. 4 Number 4, the physically disabled are 5 subjected to an inadequate transportation system with 6 long waiting lines and is run inefficiently. 7 Number 5, nursing homes have reduced their 8 staff and services beyond the safety point. Many times I 9 personally have visited homes and see few staff people. 10 We tell people if you have a loved one in a nursing home, 11 visit them often. And also, visit them during irregular 12 hours. But we do have several good nursing homes in this 13 state, thank God. 14 The nursing profession has been severely 15 reduced and part of their work given to unqualified 16 personnel. We need more nurses. 17 You have received information from people, 18 professionals in their fields. They have told you the 19 terrible damages caused by tobacco use. Damaged hearts, 20 lungs and other vital organs show the result of the 21 terrible attack on the human body by this evil habit. 22 But sad to say, some things will be with us always, 23 smoking, drinking alcohol. 24 I don't encourage the idea that we should 32 1 not work to control and treat these symptoms, but I don't 2 think even more money will eliminate the problem. Every 3 time a large project is started, bureaucrats admittedly 4 want to form a committee to make a study. And I'm sure 5 there's excessive information available now with complete 6 details of the problem. We don't need another study to 7 tell us the damages caused by smoking tobacco. 8 They usually must appoint administrative 9 staff, location, office supplies, furniture. Must fund 10 travel to other states to obtain information on the best 11 use of -- the list goes on and on. Unfortunately, most 12 of the time very little, if any, of the money goes to 13 correcting or eliminating the problem. That's a 14 situation with HMOs today. Their administrative cost 15 runs from 15 to 23 percent. One CEO's salary of $82 16 million, plus other fringe benefits. 17 I don't have an answer to the best use of 18 the money, but I implore you to remember where it came 19 from, why tobacco companies were forced to pay it. And 20 many times these types of funds are used to activate some 21 personal project of an elected official, for example, 22 filling potholes. 23 If this was a private company who received 24 the funds they would I'm sure hold part of it and use the 33 1 interest to correct these programs or start new ones. I 2 think this would be a wise thing to do. 3 Delaware State Council of Senior Citizens 4 has our seniors' health and welfare as top priority. 5 Some can't afford to buy needed drugs. And drug money is 6 great, that's wonderful and nice. They need doctors, 7 nurses, treatment labs, people-friendly nursing homes, 8 assisted living availability and affordable, which leads 9 to living a life with dignity, which is really the number 10 one priority of seniors. 11 I give you this situation, but not the best 12 program to use. The fact that we are talking and you are 13 receiving this information is a big, big step in the 14 right direction. Thank you. 15 MS. McCLELLAN: Dr. John Goodill, followed 16 by Leonard Young. 17 DR. GOODILL: Good evening. My name is 18 John Goodill and I would like to echo the thanks of a 19 number of speakers to the committee for holding these 20 public comment sessions. I think they are very helpful 21 to all of us. 22 My comments tonight are on behalf of the 23 Medical Society of Delaware. And I'm a pulmonologist. 24 I've been in practice for the last 12 years in this 34 1 state. I'm very close to this tobacco issue. I spend 2 all my days basically taking care of people with chronic 3 bronchitis, emphysema and lung cancer. And I work very 4 hard to get people to quit smoking every day. 5 We're here tonight I guess because the 6 tobacco industry decided to settle for their past sins. 7 I was a little puzzled by the tobacco settlement. I 8 think there was a number of people that were puzzled why 9 the tobacco companies decided to hand over all that 10 money. I'm not exactly sure. I think they were hoping 11 that they were going to avoid future liability and 12 lawsuits and so here we are. 13 I heard recently that there's now been 14 found a volume clause in this settlement whereby if sales 15 of tobacco products drop and income from tobacco products 16 goes down, then the payoff drops also. So I guess we 17 really don't know exactly how much money we are going to 18 get at this stage. 19 I think the hidden benefit here is that 20 dropping tobacco sales mean less people are smoking and 21 from my view that is probably the winner situation, 22 anyway. 23 How should we spend this money, how should 24 we spend the tobacco settlement money in Delaware? Well, 35 1 the Medical Society polled its members on this question 2 at their recent annual meeting and on review of the 3 responses two simple themes emerged. And I think you 4 have heard that over and over again here tonight already. 5 First, spend it to provide healthcare to those 6 Delawareans who have none. And second is to use it to 7 educate, especially our youngsters on the evils of 8 tobacco and provide programs to help those who are 9 smoking quit. 10 It's not really a level playing field out 11 there. The tobacco industry still has a lot of money 12 left and they spend it. This(indicating) is from this 13 past weekend's Sunday News Journal. It's a full page ad 14 for $20 carton of Marlboros. It takes a lot of money to 15 just get to a level playing field with these guys and I 16 I'm sure we will end up spending that much money quite 17 quickly to match them. 18 I think the Medical Society hopes that the 19 committee will see that it is right and compelling for 20 those monies to be used to decrease the number of lives 21 that are ravaged and cut short by tobacco and to use it 22 to enhance the health and well-being of our citizens. 23 There's really few other credible choices for the use of 24 this money. Thanks. 36 1 MS. McCLELLAN: Leonard Young followed by 2 Robert Hall. 3 MR. YOUNG: Hello. Thanks to the Health 4 Fund Advisory Committee. 5 I threw away my ten-page speech up in 6 Wilmington and I'll give you the 52 pages typed, single 7 spaced, you know, by the 10th. But I tried to think what 8 could I say that would probably simplify your job. So 9 for those of you who know me, I do have a prejudice in 10 favor of kids, a bias, so I think we should give all the 11 money to kids. Forget all the rest of the stuff. 12 As I listen to all of the comments, about 13 three-quarters of them, two-thirds to three-quarters of 14 the comments really impacted the kids, whether you were 15 talking about smoking, you know, prevention, education. 16 You need to focus on kids. And when you talked about 17 high risk behaviors and high risk lifestyles, you needed 18 to focus on kids. 19 And, you know, we have seen, read about 20 lots of studies where young children are like sponges, 21 you know. You teach them anything, two years, three 22 years. If you have kids you have had that exposure. So 23 let's teach them when they are sponges. And if you teach 24 them well, they are going to keep that learning for life. 37 1 And we know that many kids are turned off 2 by the third grade in school. Let's teach them something 3 about health that they have got fixed in place by the 4 third grade. Now, that could be smoking addiction 5 prevention, high risk behaviors and lifestyle, conflict 6 resolutions, whatever, but we know that the pay back is 7 tremendous. 8 We go back to those old fashioned values 9 that politicians like to quote, you know, stitch in time 10 saves nine. That means that the pay back on the stitch 11 is 9 to 1. An ounce of prevention is worth a pound of 12 cure. That means the pay back on an ounce of prevention 13 is 16 to 1. 14 I did a little arithmetic. There's 100,656 15 kids in Delaware. If every one of those kids gets some 16 of the 35 million, that's $344 a kid. We know that 17 probably 80 percent of the issues, whether they are 18 dental issues, health issues, whatever, are clustered in 19 the lowest 20 percent economic group, so let's just say 20 the lowest 20 percent is where we focus. That would give 21 us $1,725 per kid in Delaware. Not a lot of money. 22 Let's say we invested that money in each 23 individual for the first ten years. That would be a 24 $17,000 investment over 10 years. I'm willing to bet 38 1 that at the end of 25 years we wouldn't need any more 2 prisons. We wouldn't have half the -- one-tenth of the 3 health things. We would probably create an entire 4 generation without any of the problems that we're talking 5 about. Thank you very much. 6 MR. HALL: Distinguished chairman, 7 honorable members of the general assembly and other 8 esteemed colleagues, thank you for this opportunity to 9 make this presentation to you this evening. 10 I represent the Delaware Ecumenical Council 11 on Children and Families, which is a state-wide 12 organization that had begun over a dozen years ago as a 13 collaboration between the Southern Governors Association 14 and the National Commission to Prevent Infant Mortality. 15 Today we function as a voluntary faith-based organization 16 that tries to involve individuals and congregations from 17 the faith community in support of public health and 18 welfare initiatives. We also serve as state level 19 affiliate for the National Coalition on Healthier Cities 20 and Communities. And I'm here to urge you to consider in 21 your planning of the programs and services to be 22 supported with the tobacco settlement money to include 23 the faith community in your planning. 24 Already there are many, many entities 39 1 around the state that come out of the faith community, 2 including our group, the Sussex County Religious Task 3 Force on Children and Families, two Interfaith Volunteer 4 Caregivers projects, and over 50 congregational health 5 ministries that are active supporting healthcare and 6 health services delivery from the State of Delaware. 7 The collaboration between the healthcare 8 delivery system and the faith community is part of a 9 national movement that has already produced good results 10 in many other communities. 11 The faith community can be involved in 12 quality value driven services with great efficiency. It 13 already has an extant infrastructure. There's relatively 14 low overhead costs. It exists at the neighborhood level, 15 has great moral authority, is in touch with the majority 16 of the citizens of this state on a regular, usually 17 weekly, basis. 18 For the last couple of years the council 19 has been actively engaged in needs assessment in the 20 northern half of the state, talking to citizens at the 21 neighborhood level about their assessment of the 22 healthcare system in Delaware. And based on that we have 23 the following suggestions to offer to you. 24 One, like many other speakers here, I think 40 1 we speak for the vast majority of Delawareans when we say 2 we support above all reduction of the incidents and 3 impact of tobacco use. We look for the faith community 4 to be actively involved with the key voluntary health 5 agencies working on that issue. 6 Second, we suggest to you to consider the 7 use of the faith communities as sites for wide range 8 health promotion and disease prevention that addresses 9 critical health status issues in Delaware. Probably no 10 other institution speaks with the moral authority of the 11 faith community. When your pastor tells you to quit 12 smoking, you probably quit smoking. 13 We also suggest that you look very 14 seriously at the congregational health ministries that 15 are being established. There was a speaker who spoke 16 about the parish nurse programs. These are amazing ways 17 to replace the neighborhood-based healthcare services 18 that we no longer have. Many of the people who responded 19 to our needs assessment spoke about the old public health 20 nurses with blue capes and white uniforms and how they 21 were missed. This is a way to replace them. 22 Finally, the faith communities can help you 23 to provide what used to be called general services 24 support for the families that are already affected by 41 1 chronic health problems across the life span, including 2 people who deal with disabilities of any kind, rare 3 disorders, and things that insurance programs are simply 4 not able to help with. 5 Thank you very much. 6 DR. FRELICK: This committee should be 7 commended for having these public forums, which, among 8 other things, really demonstrate that these tobacco funds 9 are really not large enough to cover all the problems 10 that Delaware has in terms of health. 11 The credentials for making the following 12 suggestions are based on over 50 years of working on 13 Health Problems in Delaware. 14 The 15 percent designated for the Pill Bill 15 and the proposed 20 percent for a long term trust fund 16 for health needs after the tobacco funds are gone makes 17 sense. I would suggest that the deposit for the trust 18 fund should be closer to 15 percent. 19 Since tobacco industry payments are 20 partially to pay for some of the costs of illness and 21 death caused by tobacco in Delaware, it's appropriate to 22 use 5 to 10 percent of those funds to reduce tobacco use 23 in Delaware. Such funds have already been shown to be 24 effective in California, Massachusetts and Florida. 42 1 With the remaining 75 percent of the funds 2 I suggest that an RFP should be requested from both 3 public and private sector, nonprofit and profit, to 4 respond to health priorities based on ways to prevent 5 injuries or diseases and to detect early evidence of 6 disease. The applications should be peer reviewed and 7 have potential to be a cost effective and feasible way to 8 reduce health risks for those at most risk. 9 Since managed care preventative programs 10 have been disappointing in part because it's been 11 difficult to show reduction in healthcare costs and hard 12 for adults to adopt healthy lifestyles, the first 13 prevention priority should be given to the captive 14 audience of students from kindergarten to 12th grade. 15 The Department of Education is now 16 upgrading the standards for health education with 17 cooperation of the Division of Public Health and is 18 seeking ways to improve schools' health services, 19 physical education, and teacher training programs for 20 health behavior education in the state institutions of 21 higher learning. 22 This priority to help children adopt 23 healthy lifestyles should supplement the Department of 24 Education's efforts to adapt and improve its health 43 1 programs to be appropriate for ages and needs of growing 2 children. Teaching elementary students the advantages of 3 healthy habits can be one of the best ways to influence 4 hard to reach parents since many adults seek help to quit 5 smoking because of pressure from children. 6 School prevention programming may require 7 coordinators to enhance collaboration of available health 8 resources, public and private, to make them available at 9 appropriate times in the health program to stimulate 10 healthy lifestyles in students. Likewise, senior high 11 school students need a course focused on the 12 responsibilities of parenthood since about 50 percent of 13 couples' first children are born within two years of 14 graduation from high school. 15 Next priority should be given for program 16 applications to promote cost effective health prevention 17 efforts across disease entities since many preventative 18 messages are similar for many chronic diseases and for 19 injury prevention. Similar plea can be made for 20 screening programs for which there's effective 21 intervention since screening more than one disease at a 22 time can be more cost effective than screening one 23 disease at a time. 24 Best wishes to the health fund committee as 44 1 it faces the best way to improve health in Delaware with 2 the resources of the tobacco settlement money. 3 MR. TNSMAN: Thank you for the opportunity 4 to speak to you this evening. I'm Mark Tnsman, director 5 of emergency and health services for American Red Cross 6 in Delaware; also a citizen of this county. 7 One of the issues that impacts the lives of 8 many Delawareans and people nationwide is sudden cardiac 9 arrest. I'll give you a couple facts. 10 Up to a quarter of a million people are 11 killed each year as a result of sudden cardiac arrest. 12 That's nearly a thousand lives a day. It's believed that 13 50,000 of these deaths could be prevented if there was 14 immediate intervention by trained rescuers with a device 15 called an automated external defibrillator. Technical 16 name for a tiny device that delivers immediate shock to 17 the heart and can restore a normal rhythm. 18 It's believed that currently the survival 19 rate for people who have suffered sudden cardiac arrest 20 is about 5 percent, while distribution and dissemination 21 of these devices and training could help increase that to 22 30 percent. It's simply an electrical malfunction in the 23 heart. Even the Red Cross advocates, with the Heart 24 Association, in performance of CPR, that's a way to 45 1 sustain one's life, but it's not a way to save the life 2 directly. This device has been proved to be about 75 3 percent effective in helping people who have sudden 4 cardiac arrest to survive long enough to receive advanced 5 cardiac care. 6 Americans go to work daily, they spend 7 about half their waking hours in the workplace and the 8 majority of heart attacks occur either on Monday, closely 9 followed by Friday, with the fewest occurring on 10 weekends. One of the ways we think the health fund could 11 impact is to support training, education and public 12 awareness to raise the knowledge of the public of the 13 cardiac chain of survival. AED is a link in the chain. 14 We also believe there's a fairly strong 15 link between tobacco use and cardiovascular disease, that 16 there's some sense to using monies from the tobacco fund 17 to fund this kind of education and the placement of these 18 devices with nontraditional rescuers. Get them into 19 businesses, public gathering places, malls, the Bob, 20 schools, where people who would know how to use them can 21 get to them. 22 The fact of the matter is if you don't have 23 this device available to you within the first few 24 minutes, the odds for survival go down dramatically. 46 1 Every minute the odds for survival decreases by 10 2 minutes, which means by 10 minutes later there's almost 3 no chance to survive. The best EMS response generally 4 arrives at someone's side 8 to 10, 15 minutes after the 5 event occurs. 6 Trained rescuers can make a difference. I 7 had the pleasure of meeting Mary Ann Luke, a woman in 8 Felton, Delaware. She was at Dover Downs one evening, 9 suffered a sudden cardiac arrest. Had had no symptoms, 10 experienced no pain. That evening luckily there was a 11 security guard at the race area who had had training 12 within the last month. The device was available. He was 13 able to deliver a shock that saved her life. 14 Support for the purchase, placement and 15 training of the public could make a significant impact in 16 the lives of Delawareans. I thought it was interesting 17 in the Journal today, recording the activity of this 18 committee in our hearing yesterday, the page following 19 this includes an article highlighting the necessity and 20 use of these devices to save life. 21 SENATOR BLEVINS: Could I ask a question? 22 The AEDs that have been proposed, I think a lot of people 23 would be interested to know a little bit more about the 24 device. These are devices that don't require training? 47 1 MR. TNSMAN: They do require training. 2 SENATOR BLEVINS: Would they be in public 3 places accessible to people that didn't have that 4 training? 5 DR. SYLVESTER: The question was do they 6 require training. The follow up to that is would they be 7 available in places where they would be available to 8 people who did not have training. 9 MR. TNSMAN: We are not advocating the fire 10 extinguisher model. We are advocating the placement of 11 them in facilities and the knowledge of where they are 12 placed by people who have been trained to use them. 13 We don't want to see people -- I will be 14 honest with you, this device, if you take it, you turn it 15 on, will tell you exactly what to do. I have shown 16 several people a video type of this device's use and with 17 a few minutes -- and we take about four and a half hours 18 to five hours to train someone in the proper use, but 19 within a few minutes an untrained individual could know 20 how to use it to save a life, although we are not 21 advocating. 22 A COMMITTEE MEMBER: You couldn't shock 23 someone who didn't need it? 24 MR. TNSMAN: The reason these are made 48 1 available for public distribution is years ago you needed 2 a trained paramedic or professional medical person to 3 analyze the rhythm of the heart and to decide if it was 4 appropriate. These devices have a small computer that 5 analyzes that and only allows the device to administer a 6 shock if it recognizes a condition that could be 7 corrected by the shock. It requires intervention of a 8 rescuer. There's not a danger to the rescuer. Somebody 9 has to say is everybody clear. None of these devices go 10 through without human intervention. 11 DR. SYLVESTER: Thanks. 12 MS. ALLEN: I'd like to thank the review 13 panel for allowing me to speak. My name is Marie Allen 14 and I'm representing the members of Heroin Hurts. Heroin 15 Hurts believes that a consequence of tobacco use has led 16 many Delawareans to the addiction of hard core illegal 17 drugs such as heroin. Tobacco is generally the first 18 drug used by young people, who then enter into a sequence 19 of drug use that can include tobacco, alcohol, marijuana 20 and heroin. Nicotine has thus been called a gateway 21 drug. 22 Heroin Hurts is requesting an adequate 23 portion of the settlement fund to be used to combat the 24 health-related consequences of tobacco use such as drug 49 1 and alcohol abuse. 2 Additionally, a portion of the settlement 3 needs to be spent on programs that are a direct 4 consequence of drug abuse, such as HIV, AIDS, and 5 hepatitis. According to researcher Dr. Marlene Matthou, 6 Ph.D., 60 to 90 percent of all drug users are also 7 nicotine addicts. Even though this pattern does not 8 necessarily imply that tobacco use can cause other drug 9 use, it does imply that other drug use rarely occurs 10 before the use of tobacco. 11 So it seems if we had done a better job of 12 preventing tobacco use by our adolescents and young 13 adults, we may have done a better job of preventing these 14 other health issues as well. 15 In the State of Delaware over nine people 16 every day, 365 days of the year, seek help for drug and 17 alcohol addition in state funded facilities. In the 18 State of Delaware during the fiscal year of 1999 the 19 number of admissions to state run programs for heroin 20 addiction surpassed the number of admissions for alcohol 21 and surpassed the combined number for cocaine and crack 22 cocaine. 23 It would almost seem criminal not to use a 24 portion of the settlement to help supplement Delaware's 50 1 grossly underbudgeted behavioral health programs, such as 2 inpatient and outpatient drug and alcohol treatment 3 programs. In 1988 Surgeon General Koop stated that the 4 pharmacological and behavioral processes that determined 5 tobacco addiction are very similar to those that 6 determine addiction to drugs such as heroin. 7 The members of Heroin Hurts would like this 8 panel to understand how difficult it is to stop using 9 drugs, especially heroin, without receiving the proper 10 medical and/or psychosocial modalities, as well as 11 spiritual counseling. Heroin Hurts implores the panel to 12 make the recommendation to the Governor and legislature 13 that an adequate portion of the settlement money be made 14 available to treat a major health problem in this state, 15 the disease of drug addiction that in 60 to 90 percent of 16 most cases started with nicotine. Thank you. 17 MR. WATERFIELD: My name is Allan 18 Waterfield. I live in Newark. I work at the University 19 of Delaware where I direct the graduate program in health 20 promotion. I've had the privilege to chair the 21 Governor's Council on Lifestyle and Fitness since 1991, 22 so it will not be surprising I'm here to talk about 23 health issues related to lifestyle. 24 The data indicates at least 80 percent of 51 1 the potential years of good health we might add to our 2 lives are directly related to lifestyle issues. Included 3 are issues of choice, which maybe at times I think I must 4 be a member of the lifestyle police. They are choices 5 such as seatbelt use, drinking and driving, what we do 6 with our bodies day by day. 7 The three issues I'd like to focus on are 8 use of tobacco, regular physical activity and good 9 nutrition. 10 If we were to classify coach potatoes as a 11 disease, we would be dealing with the one disease that 12 affects the most people in our nation. The recent 13 behavior risk factor data shows that Delaware is one of 14 the least physically active states in the nation. In 15 fact, second least active. If we combine that with the 16 epidemic of obesity and high use of tobacco products, we 17 have an unhealthy lifestyle epidemic in Delaware. 18 The drafts of both the Delaware and 19 National 2010 health plans feature interventions to 20 promote regular physical activity, good nutrition and 21 reducing tobacco products as key strategies for the next 22 decade. 23 It is our assessment that in Delaware we 24 have under funded the tobacco strategy and have almost 52 1 entirely missed the physical activity/good nutrition 2 strategy. On what seems like a weekly basis we have 3 research reports that place regular physical activity as 4 a way to reduce disease. These diseases include all the 5 big ones, cardiovascular disease, many of the cancers, 6 diabetes, asthma, as well as mental health, on and on. 7 I urge this committee to put the funding of 8 programs that will support the improvement of lifestyles 9 of the people of Delaware atop your priority list. Thank 10 you. 11 MR. AVRON: Good evening. I'm Avron 12 Abraham. I'm a faculty member of the University of 13 Delaware and also affiliated with the Delaware Coalition 14 to Promote Physical Activity, dovetailing. 15 I think it's really important that we 16 understand why this coalition was formed. If there was a 17 magic pill that we could take that affected everything, 18 when we were young, when we were old, when we were 19 pregnant to some people, whether we stayed active or not 20 was probably the magic pill. And I think that it's time 21 that we started feeling this and working with it as part 22 of a strategy within the State of Delaware. 23 It was to this end that we created the 24 Coalition to Promote Physical Activity in the State of 53 1 Delaware, which has really included about, at this point 2 about 25 organizations, including the American Lung 3 Association, American Heart Association, the YMCA, Boys 4 and Girls Club. All of these organizations have 5 acknowledged that physical inactivity is a major public 6 health issue in the state and that Delaware is -- these 7 organizations are committed to promoting a more active 8 lifestyle for all Delawareans. 9 This coalition is also affiliated with the 10 National Coalition for Promoting Physical Activity. 11 These coalitions were really an indirect result of the 12 1996 Surgeon General's report on physical activity and 13 health, which highlighted the fact that physical 14 inactivity is a major public health concern. This report 15 is also clearly presented with the scientific information 16 relating physical inactivity to other factors, to 17 increased obesity and cardiovascular disease, diabetes, 18 stress and anxiety. 19 We also know that some of these diseases 20 are related to smoking. And more recent really exciting 21 research shows the positive effects of exercise on both 22 the initiation and cessation of smoking. Really exciting 23 information that's just come out. 24 For these reasons and the fact that the 54 1 recent data shows Delawareans becoming less physically 2 active, with only a small portion of the population 3 meeting minimum standards for being active, we believe 4 that it is essential that we address this important 5 health issue at this time. 6 Again, I thank you for your efforts and I 7 know how hard it's going to be. 8 DR. SYLVESTER: How much physical activity 9 are you talking about? 10 MR. AVRON: The CDC, together with the 11 American College of Sports Medicine, came out with a 12 recommendation that 30 minutes of moderate physical 13 activity, five to six days a week, preferably every day, 14 would be a great place to start. 15 I think the question really is a 16 dose/response question and how much do you need to incur 17 the full benefits of exercise. I hesitate to use the 18 word "exercise" because of the connotations to some 19 people. I think if we instituted a program that dealt 20 specifically in getting people active, changing the couch 21 potato syndrome, making it harder to be inactive, I think 22 we will be approaching a method that will make a 23 difference. 24 So it's a difficult question. I think the 55 1 idea is that doing something is better than doing 2 nothing. Doing more is probably better than doing less. 3 MS. MATTY: Good evening. My name is Beth 4 Matty. I'm a school nurse representing the Delaware 5 School Nurse Association. School nurses are really 6 pleased to be able to offer our thoughts on how to use 7 the funds that Delaware will receive from the tobacco 8 settlement. Delaware should be commended that this money 9 is targeted for a dedicated health fund. 10 As school nurses we support programs that 11 will benefit children and adolescents. For those of you 12 who have not had contact with school nurses, we interact 13 with all of Delaware school children. We see their needs 14 every day. 15 We want the committee to remember that 16 education and prevention is necessary starting from 17 birth. For children to develop lifelong healthy 18 lifestyles education and prevention must be continued 19 throughout their life span, but especially in their 20 developing years. Children must internalize the messages 21 so that healthy behaviors become part of their attitudes, 22 beliefs and their actions. This is not just a one shot 23 deal. We must do this over and over and over again. 24 If children do not get the message at home, 56 1 it must come from the school and the community. But, 2 remember, programs alone won't do it. There must be 3 opportunities allotted for the personnel to get the 4 programs that work to our children. Health programs 5 should include health education, prevention and health 6 services. 7 Our children are our future. Help us to 8 start them out right. Please plan your budget to include 9 a portion in targeting programs that work with 10 appropriate personnel and services for children. Thank 11 you. 12 MR. BERG: Ladies and gentlemen, I'd like 13 to thank you for your time and consideration in allowing 14 me to testify about smoking in Delaware. 15 My name is Cliff Berg. I'm a volunteer 16 with the American Cancer Society, having served in a 17 variety of positions at the local, state and national 18 levels. 19 I know that other American Cancer Society 20 volunteers, as well as others here tonight, have 21 testified before you about the importance of youth 22 tobacco use prevention and tobacco cessation services. 23 However, I would like to take a moment to address the 24 importance of changing the social norm surrounding 57 1 tobacco. We must overcome years of tobacco industry 2 marketing that has glamorized tobacco use. Teens see 3 tobacco use as a way to show their rebelliousness and 4 independence. 5 The settlement with the tobacco industry 6 has established some restrictions on tobacco company 7 marketing and advertising. However, much more needs to 8 be done. For example, the agreement places no limits on 9 restrictions on tobacco advertisement in newspapers -- 10 and that was shown tonight -- magazines or over the 11 Internet. The settlement also does not restrict tobacco 12 advertising and promotion in stores that sell tobacco 13 products such as local convenience stores where most of 14 our young people purchase tobacco products. 15 For these reasons we must employ a strategy 16 to this media savvy generation with advertising that 17 makes not using tobacco at least as rebellious and cool 18 as using. 19 As you know, the American Cancer Society 20 believes that we must fund a statewide tobacco control 21 program like those seen in Massachusetts, Florida and 22 California. We must fund a plan such as the one the 23 Center for Disease Control recommends. By funding this 24 comprehensive multi-faceted program at the appropriate 58 1 levels, Delaware can become a nationwide leader in 2 tobacco control. And as the CDC recommends, its best 3 practice, it is very important to fund a strong media 4 campaign in order to garner the public's attention and 5 influence public opinion, especially opinion of our 6 youth. 7 Finally, I want to briefly say that the 8 time to use new and innovative ideas has never been 9 better. Encouraging thinking outside of the box on 10 programming ideas and encouraging new thought, as the 11 experience in Florida demonstrates, is critical to 12 involve our young people from the beginning. In creating 13 an effective media campaign working closely with teen 14 advisers to guide the media campaign will present the 15 best opportunity for success. 16 I want to reiterate that the opportunity 17 that we have before us may never come around again and we 18 must capitalize to protect the future of Delaware's most 19 valuable resource, the health of our young citizens. 20 Thank you. 21 MS. McMULLIN-POWELL: My name is Daniese 22 McMullin-Powell. I'm here tonight representing Adapt, 23 which is a grass roots civil rights group by and for 24 people with disabilities. I have no prepared speech, 59 1 just notes in margins of papers that I carry. 2 People with disabilities often need 3 long-term care. Currently programs do pay for long-term 4 care if it's based in nursing homes. But for personal 5 assistance in the home and community based, is usually 6 under funded or not funded at all. 7 Delaware uses approximately 14 percent of 8 its long-term care Medicaid dollars for home and 9 community-based services, and 86 percent towards nursing 10 homes, below the national average of 25 percent home and 11 community based and 75 percent nursing home. This is 12 called institutional bias and is recognized by the 13 federal government as such. 14 Federal legislation was recently 15 introduced, The Medicaid Community Attendant Services Act 16 in federal legislation was introduced the last time we 17 were having the meeting of the committee here and I 18 mentioned it. This legislation when passed will 19 facilitate moving people from nursing homes to the 20 community. And legislation has been drafted and will be 21 introduced in the Delaware legislation to facilitate 22 attendant services so that they will be able to live more 23 effectively in the community, so that people will have a 24 choice of where they can live. 60 1 There are approximately 100,000 people with 2 disabilities in Delaware. I've heard anywhere been 3 70,000 and 150,000. I'll settle at 100,000. Almost 4 4,000 people in nursing homes, many of them 5 unnecessarily. The Division of Services for Aging and 6 Adults with Physical Disabilities is able to provide 7 attendant services for only 30, that's not a mistake, 30 8 people, and Easter Seals for two. There are 9 approximately 75 people on a waiting list and an 10 additional 210 waiting for similar services. The cause 11 of the waiting list is lack of funding. 12 Too many of us have had to fight to get out 13 of nursing homes or state institutions. Too many lost 14 homes, family, dignity and worse, simply because we need 15 assistance with what bureaucrats like to call activities 16 of daily living or instrumental activities of daily 17 living. For us this isn't a matter of developing policy. 18 It's a struggle for our lives and the lives of our 19 friends and colleagues, and it really needs to be funded 20 to have attendant services, which is the number 1 issue 21 for people with disabilities, significant disabilities. 22 We need that in order to live in and contribute to the 23 community. 24 Thank you very much. 61 1 MR. BRIGGS: My name is Andy Briggs. I'm a 2 retired clinical chemist and I really enjoy the 3 opportunity to grind my axe or share my heart. 4 One of the things that is going on is the 5 lead values, that they have changed over the 50 years -- 6 we were very happy if they were under 50. Today if you 7 are over twenty you are mildly lead toxic. If you are 8 around forty, you are moderately lead toxic. 9 Now, where is lead coming from? Well, lead 10 gasoline is gone, but Delaware got its share of it. I 11 live on a creek and one day I had water and I could smell 12 gasoline and I have four children. 13 Well, anyway, to make a -- get to the 14 point, I believe with some of this money we could look at 15 this facet, this educational thing. We've got children 16 who have maybe borderline leads and we don't really know 17 it because we are working with new numbers. But we have 18 a very simple screening method. 19 So what I'm recommending is with maybe a 20 little of this money we could kill two birds with one 21 stone. We could see if there's an educational factor 22 here with low lead levels. And also, the treatment is so 23 cheap, it's for free. Your soda, Mountain Dew, has a 24 medicine for treating lead poisoning. If you look at the 62 1 label you see the words "Calcium EDTA." This is what 2 they use. They also use a supplement along with that. 3 But what I'm recommending is for a few 4 thousands let's get screening tests on the borderline 5 children that have, apparently have trouble and shouldn't 6 be having trouble. Maybe their mothers and fathers are 7 both Ph.D.s and they are surprised their child is a 8 little slow. 9 Thank you for allowing me to share this 10 thought. 11 MR. MITAL: Hello, ladies and gentlemen, my 12 name is Praveen Mital. I'm president of Students for 13 Healthcare Equality at the University of Delaware. I 14 come here tonight to explain our organization's goals and 15 concerns and I hope that you will make them your concerns 16 and goals and will help to try to do something about it. 17 Our organization, Students for Healthcare 18 Equality, believe healthcare should be a human right. 19 What do I mean by a human right? Well, for example, 20 let's say a person gets his wallet stolen or whatever. 21 That person has a right to go to the police, call the 22 police and ask for help. If a person's house burns down 23 or is burning, he or she has a right to call the fire 24 department and have the fire company put that fire out. 63 1 The community has an obligation to help those people to 2 protect its community, to put out the fire. 3 But when a person is sick, has lung cancer, 4 whatever, goes into the doctor's office, he does not have 5 the right to just go into the doctor's office and expect 6 medical attention. The community does not have the 7 obligation to provide medical care for these people. 8 We as students and members of the community 9 believe that the community has the obligation, has the 10 responsibility, to provide healthcare for everyone, at 11 least basic healthcare. Healthcare is not a private 12 commodity that is reserved for only those who can afford 13 it. It's a public good, a nonexclusionary service that 14 every human being deserves. 15 Until we as a society, our government, 16 realizes that, we will continue to waste money into these 17 different programs. They are going to help a certain 18 number of people, a certain number of children here and 19 adults here, but we need to implement a program that's 20 going to help everyone. We are going to continue to 21 waste money. 22 The United States, as an industrial nation, 23 has a very poor healthcare system. While we have these 24 industrial nations such as Japan and Canada and England 64 1 that spend only 9 percent of their GDP on healthcare and 2 cover everyone, we are spending twice as much and we can 3 hardly cover anyone. 4 So we can continue to put money into 5 Medicaid and Medicare and children's programs, whatever 6 else you want to think of, but you are going to fight the 7 symptoms. Let's start fighting the cause. Let's get a 8 program that gets everyone healthcare. You know, we have 9 the motivation, you know, and now we're starting to get 10 the resources to do this. 11 We were the first state to ratify the 12 Constitution. Now let's become the first state to 13 provide comprehensive healthcare for everyone, regardless 14 of age and sex and race, and especially regardless of 15 wealth. Why? Because healthcare is not a piece of 16 jewelry which only a few can afford. It's a treasure 17 that every human being deserves. 18 I and our organization and other students 19 at the University of Delaware urge you to devote a large 20 portion of the fund to help everyone obtain adequate 21 healthcare for everyone. 22 I thank you for your time. If you have 23 questions, please see me. Thank you. 24 MS. DUNKELBERGER: Hi, I am a recovering 65 1 heroin addict. I would like to address the issue of -- 2 it is something that Dr. Guberman created because he is a 3 former heroin addict and he found something to help us. 4 It may not be a miracle drug, but it allowed me to come 5 out of a cloud that I lived in for three years. 6 When I eventually hit rock bottom I looked 7 for state funding and everything I could possibly do to 8 get my life better. And unfortunately, in order to get 9 into a 10-day detox there are guidelines. Well, when you 10 are sick there is no guidelines, you just need help. 11 Thank God, I had a strong family. The cost was about 12 $400 and it lasted for two months. 13 It is not FDA approved, but from what I 14 understand if you are a habitual offender of heroin use 15 and you are in prison, they do issue this pellet to 16 prisoners when they are released on the street. I don't 17 understand why they do that. Why somebody like me, who 18 has no money and just really just wants to live a normal 19 life, the state will not fund that for me, but they will 20 fund it for a prisoner. 21 Dr. Guberman, they shut him down and now 22 you have a bunch of heroin addicts walking around not 23 knowing what to do next, because unfortunately they don't 24 have a lot of follow up on that program and I can see 66 1 that's a big issue. 2 It does start out I think from mental 3 health. I grew up and went to a lot of psychiatrists and 4 they never pinpointed until now that I am bipolar and 5 that has a lot to do with it. 6 I don't know, really didn't prepare myself 7 too well for this because I'm working two jobs, but I 8 want you to give some money to the people that do need. 9 I mean, I don't know if people realize, but Newark, 10 Delaware is number 1 in heroin use and we are such 11 conservative state. That's hard for me to believe. 12 Maybe the adults are -- but the youth, I 13 mean, if parents give a little bit more time to their 14 children and pay attention to them, maybe they won't turn 15 to other things. 16 Thank you. 17 DR. SYLVESTER: Thank you. We visited 18 Dr. Guberman's club in New Jersey before it was closed. 19 DR. ARM: Hello and thank you for allowing 20 me to speak. 21 I'm Robert Arm. I'm representing the 22 Delaware State Dental Society for Dr. Lewis, who was 23 unable to attend. 24 Tobacco causes many health problems, 67 1 especially cancer and cardiovascular problems. Many 2 costs of these diseases are covered in part, but one 3 health problem is not, particularly for adults. This 4 problem is made worse by tobacco, made worse by many 5 diseases caused by tobacco, and many other chronic 6 diseases and by many medications used for these diseases. 7 It is also -- the lack of it may make the efforts to cure 8 these diseases worse and is not covered. That's 9 dentistry. 10 The dentist plays a role in diagnosis and 11 treatment of many of these patients with these diseases: 12 To prevent infection in heart patients; and to prevent 13 jaw infection, gangrene, in patients receiving radiation 14 for cancer; to prevent infection and ulceration in 15 patients with chemotherapy from cancer that may have been 16 caused by tobacco, in fact, dental care has been reported 17 in a study of the University of Maryland to reduce 18 admissions by 25 percent; to help prevent aspiration in 19 pulmonary patients and the elderly; to help maintain 20 nutritional status in all the ages, the young and the 21 elderly. 22 The problem we have is that dentistry is 23 now not covered by Medicaid in those above twenty-one, 24 and for those below twenty-one there is limited access to 68 1 care because of lack of practitioners and lack of 2 funding. 3 We're asking you to help provide funding to 4 help the dental society, the state public health section 5 of dentistry and dental educational programs to provide 6 earlier diagnoses to help in prevention and reduce 7 complications in patients with chronic diseases, the 8 young and the aged. Right now these are not covered. 9 And by providing this coverage it could help reduce some 10 of the costs. 11 I thank you for the time. 12 MS. McCLELLAN: Milton Draper. 13 MR. DRAPER: I did not intend to speak 14 tonight. I assume I signed on the wrong page. 15 DR. SYLVESTER: That's all that signed up 16 either before the meeting or during or right before the 17 meeting. Is there anybody else tonight that has not had 18 an opportunity to speak at one of the four public 19 hearings and would like the opportunity now to say a few 20 words to all of us? Good. 21 Any members want to say parting words? I 22 want to thank you all for coming out tonight and sharing 23 your thoughts with us. It was very appreciated. 24 (The hearing concluded at 8:45 p.m.) 69 1 State of Delaware ) ) 2 County of New Castle ) 3 4 5 C E R T I F I C A T E 6 I, Vincent Bailey, Registered Professional 7 Reporter, do hereby certify that the foregoing record, 8 pages 2 to 69 inclusive, is a true and accurate 9 transcript of my stenographic notes taken on November 30, 10 1999, in the above-captioned matter. 11 IN WITNESS WHEREOF, I have hereunto set my hand 12 and seal this 7th day of December, 1999, at 13 Wilmington. 14 15 16 17 18 Vincent Bailey 19 20 21 22 23 24