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House | March 23, 2013 | Chamber | Session

Full MP3 Audio File

The House will come to order. Members, please take your seats. Visitors, please retire from the chamber. Members and visitors in the gallery, please silence all cellular phones and personal electronic devices. Sergeant at Arms, please lock the door. The prayer will be offered by Representative Bill Brawley. Members and visitors in the gallery, please stand and please remain standing for the Pledge of Allegiance. [SPEAKER CHANGES]. This is the day that the Lord has made. Let us rejoice and be glad in it. For those of you that will, join me in prayer. Father we are grateful there is no snow today, and for the approach of spring that will banish the cold of winter for a while. We are grateful for the seasons that will teach us life, like the weather, is both warm and cold, stormy and calm. We pray for wisdom to do your will today, that as we work for those we serve we reduce the storms of life and help the good days last just a little longer. We each call on you in our own way. I call on you in the name of Jesus. Amen. [SPEAKER CHANGES]. I pledge Allegiance to the flag of the United States of America and to the Republic for which it stands, one nation under God, indivisible, with Liberty and Justice for all. [SPEAKER CHANGES]. Representative Moore is recognized. [SPEAKER CHANGES]. Mr. Speaker, the journal for Monday, March 25th, 2013, has examined and found to be correct. I move to approval as written. [SPEAKER CHANGES]. Representative Moore moves that the journal for March 25th be approved as written. All in favor say aye. All opposed say no. The ayes have it. The journal is approved as written. Petitions, memorials or papers addressed to the General Assembly of the House? Chaptered Bills will be noted. Ladies and gentleman of the House, the Chair would like to, the House will come to order. The Chair would like to extend a welcome to the nurse of the day. The nurse of the day is Lisa Elliot, from Sanford. Lisa, thank you for serving this House today. Reports of standing committees and permanent subcommittees. Representatives Howard, Brawley, Lewis, and Setzer are recognized. Send forth Committee Report, the clerk will read. [SPEAKER CHANGES]. Representatives Howard, Brawley, Lewis, and Setzer, Finance Committee. House Bill 191, Grifton De-annexation, favorable. [SPEAKER CHANGES]. Calendared. [SPEAKER CHANGES]. House Bill 193, Expand uses of Mecklenburg Court, Charlotte Local Taxes. Favorable as Committee Substitute, unfavorable as to the original bill. [SPEAKER CHANGES]. Committee Substitute calendared, original bill unfavorable. Calendared. [SPEAKER CHANGES]. House Bill 229, Holden Beach, Canal Dredging District Fee. Favorable as to Committee Substitute, unfavorable as to the original bill. [SPEAKER CHANGES]. Committee Substitute bill calendared, original bill unfavorable, calendared. [SPEAKER CHANGES]. House Bill 179, Joint Agencies Sales and Excise Tax Exemptions, favorable as to the Committee Sub, unfavorable as to the original bill and ?? to Government. [SPEAKER CHANGES]. The Committee Substitute for House Bill 179 will be re-referred to the Committee on Government, the original bill unfavorable calendared. Representative Moore is recognized to send forth Committee Report. The clerk will read. [SPEAKER CHANGES]. Representative Tim Moore, Chair for the Rules, Calendar, and Operations of the House. House Resolution 47, Honor Conway's 100th Anniversary. Favorable for adoption. [SPEAKER CHANGES]. Calendared. Ladies and gentleman of the House, upon motions, Representative Shepard and Cleveland, from Onslow County, the Chair is happy to extend the courtesies of the gallery to the Onslow Learning Center and teacher, Mrs. Jackie Jackson. Please stand and let us welcome you. Introduction of Bills and Resolutions. The clerk will read. [SPEAKER CHANGES]. Representatives Ramsey and Moffitt, House Bill 418, Asheville, Buncombe County Parks and Recreation Authority. [SPEAKER CHANGES]. Government. [SPEAKER CHANGES]. Representative Adams, House Resolution

Section 419, honor women's history month. [SPEAKER CHANGES] Rules calendar, operations of the House. [SPEAKER CHANGES] Representatives Foushee and Insko, House Bill 420, school calendar flexibility of Orange County. [SPEAKER CHANGES] Commerce and job development and favorable education. [SPEAKER CHANGES] Mr. Speaker? [SPEAKER CHANGES] Representative Moore, please state your purpose. [SPEAKER CHANGES] For a motion pertaining to the bills that were just introduced and a rereferral request. [SPEAKER CHANGES] The gentleman is recognized for a motion. [SPEAKER CHANGES] Mr. Speaker, you just read in House Resolution 419, which is honor women's history month. We ask that the referral to Rules Committee be stricken and be allowed to be calendared under 32A for tomorrow. [SPEAKER CHANGES] Without objection? So ordered. If the pages would please come to the front of the chamber and the pages at the ?? step down for a moment. We'd like to properly introduce you. Pages, the Clerk will be reading your name in just a moment. As the Clerk reads your name if you could please step forward, wave to the group so we can properly identify you. Clerk will read. [SPEAKER CHANGES] Brad Adams, Fairfax County, Virginia. Deanna Alston, Franklin County. Lauren Applewhite, Pitt. Justin ??, Wayne. Brandon Croom, Pender. Sasha Duncan, Wake. Joshua Garner, Randolph. Jamal Hall, Durham. Brooklyn Harris, Forsyth. Miles Heath, Wake. John Hodges, Wake. Taylor ??, Cumberland. Mark McMahon, Burke. Baird Naisang, Buncombe. Taylor Perry, Chatham. Leah Perry, Chatham. Preston Shaker, New Hanover. Michael Spencer, Durham. Randy Stitt, Mecklenburg. Donald Trickett, III, Swain. Laylee ??, Lee. [SPEAKER CHANGES] Pages, on behalf of all the members, I want to welcome you to your service this week. I hope that you have an opportunity to learn a little bit about what we do and along the way maybe make some friends and have experiences that you'll bring back to your brothers and sisters and friends and encourage them to do the same thing. Thanks in advance for all the work you'll do. You may now return to your stations, and members let's please properly welcome them. [CLAPPING] Ladies and gentlemen of the House, House Bill 418 was read in earlier and referred to government; there will be an added referral to House Bill 418 to government, if favorable, Finance. Representative Moore is recognized to send forth a committee report. The Clerk will read. [SPEAKER CHANGES] Representative T. Moore, Rules, Calendar, and Operations of the House, House Resolution 206, honors sponsors of Pittman-Robertson Act. Favorable for adoption. [SPEAKER CHANGES] Calendar. Ladies and gentlemen of the House, upon motion of all the members and the Chair, we are happy to extend the courtesies of the gallery to members of the Association of Police Chiefs. Police chiefs across the state, thank you so much for what you do for our state and thank you for your service. [CLAPPING] [AUDIO ENDS]

Speaker: house bill 250 the clerk, Speaker Changes:too many substitute for house bill 250 a bill had time o act and perform enrollment put priority and procedures for certain students applying charges schools general assembly north Carolinian acts, Speaker Changes: Representative ?? please state your purpose, Speaker Changes: To debate the bill the gentlemen is recognized to debate the bill, Speaker Changes:what we addresses last week this bill address trying to ?? procedures it is by parting bills it's supported by north Carolina lines public charter schools and also by north Carolina public charter schools association with that i like to amend the bill and appreciate your support, Speaker Changes: Representative ?? please, Speaker Changes: to start the amendment, Speaker Changes: Representative ?? is recognized to start the amendment the clear will read Speaker Changes: Representative ?? moves to amend the bill on page 1 lines 30 to 33 by rewriting those lines to read, Speaker Changes: the gentlemen is recognized to debate the amended, Speaker Changes: thank you ladies and gentlemen and the members of the house there is a private school which is converted into a charter school and the parents that has raised money to bring up the bill public school standards serving the board but unless your children make changes and start to ?? once is converted so i just owe for the amend for your support, Speaker Changes: further discussion further debate on the amendment, Speaker Changes: representative ?? please state your purpose, Speaker Changes: to debate the amendment, Speaker Changes: the gentlemen is recognize to debate the amendment, Speaker Changes: had a discussion to debate the amendment Representative ?? i think it is a good amendment i recommend yes to vote, Speaker Changes: further discussion further if not the question before the house as the passage of the ?? for the houses committee substitute for house bill 250 all in favor vote aye all oppose vote no the clerk will open the vote all members wishing to record please do so this time the clerk will record the machine will quote the vote 113 having voted in the affirmative and 1 in the negative the amendment passes and back on the bill, Speaker Changes: further discussion further debate,if not the question before the house as the house passes house committee substitute for house bill 252 as amended on it's third reading all in favor will vote aye all oppose vote no the clerk will open the vote all memes wishing to record please do so this time the clerk record the machine and will quote the vote, Speaker Changes: ladies and gentlemen of the house the vote was cleared from the display the vote total we can re vote if there is an objection in the vote total ?? out of it 114 have voted in the affirmative and none in the negative the house committee substitute for house bill 250 amended pass it's third reading will be engrossed and send to the senate, Speaker Changes: house bill 17 the clerk will read , Speaker Changes: committee substitute for house bill 17 is the time to enact to provide company and ?? of information regarding conceals hand guns and pistol permits General assembly of north Carolinian acts , Speaker Changes: Representative ?? please state your purpose, Speaker Changes: to speak on the bill, Speaker Changes: the gentlemen is recognized to debate the bill, Speaker Changes: thank you Mr speaker this ?? straight forward bill that simply will protect the confidentiality of concealed hand guns permit holders and those who purchases pistols and protect their permanent information just quick and brief explanation well over 30 states have some sort of laws to place and protect privacy,

The conceal carry folks to protect their privacy,to protect folks who have, go and apply for permits to make sure their information is not able to be scattered across the web and out there for public consumption. What it will allow is for law enforcement to continue to receive this, these documents. And to obviously, you use them as necessary. And basically this just prevents any potential exposure of law abiding who want to have a conceal carry permit. It allows them to be protected and for them to have privacy. So there’s no potential for their information to be spread across the web where potential criminals can use that to either target those individuals or those who may not have a permit. So this is simply an effort to protect their privacy. But also take a potential tool away from any criminal who may choose to target these individuals. And I would ask for your support. I do believe there will be one technical amendment offered by Representative Jackson which I support. Thank you, Mr. Speaker. [SPEAKER CHANGES] Representative Jackson, please state your purpose. [SPEAKER CHANGES] Send forth an amendment. [SPEAKER CHANGES] Gentleman is recognized to send forth an amendment. The clerk will read it. [SPEAKER CHANGES] Representative Jackson moves to amend the Bill on Page One, Line 26 by rewriting the line to read, “officers and Clerks of Court on a statewide system.” [SPEAKER CHANGES] The gentleman is recognized to debate the amendment. [SPEAKER CHANGES] Thank you, Mr. Speaker. This is a technical amendment, ladies and gentlemen. The Clerks of Court currently have access to this information. It was I believe an oversight that they were deleted. Clerks of Court hear incompetencies proceedings, judges at the Clerks Office through the Clerks Office they hear domestic violence case, protective orders, and voluntary commitments. This will just allow them to still have access to this statewide information. I ask for your support. [SPEAKER CHANGES] Further discussion, further debate on the amendment? If not. The question before the House is passage of the amendment set forth by Representative Jackson to the House Committee substitute for the House Bill 17. All in favor vote aye. All opposed vote no. The clerk will open the vote. The clerk will log machine record the vote, 116 having voted affirmative and none in the negative. The amendment passes, we’re now back on the bill. Further discussion, further debate ?? Representative Michaux, please state your purpose. [SPEAKER CHANGES] Speak on the bill. [SPEAKER CHANGES] Gentleman is recognized to debate the bill. [SPEAKER CHANGES] Mr. Speaker, and ladies and gentlemen of the House, this may sound a little out of line. But let me just pose a question to you. I’m gonna vote against the bill for other reasons. But they tell me that the right to bear arms and ownership is a constitutional amendment. But you want to keep the names of those people off the rolls. I would submit to you that the right to vote is a constitutional right. But those voter rolls are open. So you can see anybody who voted or how they voted, if you want to take restitution or if you want to take retribution against those folks who voted. You can go through the rolls and find out and do all sorts of crazy things there too. I just thought I’d put that little bit of information in your mind. [SPEAKER CHANGES] Representative Pittman, please state your purpose. [SPEAKER CHANGES] Speak on the bill. [SPEAKER CHANGES] Gentleman is recognized to debate the bill as amended. [SPEAKER CHANGES] Thank you, Mr. Speaker. Everybody knows that I was going to offer an amendment to this bill. I believe that’s going to be my concern and that’s going to be handled elsewhere. And so that’s why we’re not running it today. But I just want to say that I am in favor of this bill. But believe or not, I really consider this a bit of a compromise. Because as I’ve repeatedly said elsewhere far as I’m concerned as long as you have no intention of harming an innocent person, it’s nobody’s business especially the government, what guns you have and how many. And I just don’t see any point of anybody having this information. But at the very least the privacy of gun ownership be protected. So I’m in favor of this bill. Thank you. [SPEAKER CHANGES] Representative Shepard, please state your purpose. [SPEAKER CHANGES] Yes sir, Mr. Speaker, I have a question for Representative Michaux and if this is out of order, you tell me. I was just curious about the statement. [SPEAKER CHANGES] Representative Michaux, does the gentleman yield? Representative Michaux,does the gentleman yield? [SPEAKER CHANGES] Yes. [SPEAKER CHANGES] The gentleman yields. [SPEAKER CHANGES] I heard what you said but at the same time, you can, you know if somebody is registered to vote, but you don’t know how they voted do you? There’s no way to find out how they voted right? [SPEAKER CHANGES] That’s true but I don’t know how many, I don't know

What kind of gun you registered either. [SPEAKER CHANGE] That was my clarification, because we can't find out how someone . . . [SPEAKER CHANGE] Gentlemen, do you wish to be recognized to debate the bill? [SPEAKER CHANGE] Yes, Sir. [SPEAKER CHANGE] The gentleman is recognized to debate the bill. Further discussion, further debate? If not, the question before the house is the passage of the House committee substitute, the House Bill 17 is amended on its second reading, all in favor vote aye. All opposed vote no. Clerk will open the vote. All members wishing to record, please do so at this time. Representative Graham. Clerk will lock the machine and record the vote. 98 having voted affirmative and 19 in the negative. The House Committee Substitute for House Bill 17 is amended to pass its second reading and without objection will be read a third time. [SPEAKER CHANGE] General assembly of North Carolina in action. [SPEAKER CHANGE] Further discussion, further debate? If not, the question before the house is to pass it to the house committee substitute the House Bill 17 is amended on its third reading. All in favor say aye. [SPEAKER CHANGE] Aye. [SPEAKER CHANGE] All opposed say no. [SPEAKER CHANGE] No. [SPEAKER CHANGE] The aye's appear to have it. The aye's do have it. The House Committee Substitute for House Bill 17 is amended, it's passed its third reading, it will be engrossed and sent to the Senate. House Bill 181, the clerk will read. [SPEAKER CHANGE] Committee substitute number 2 for House Bill 181. The bill is being titled, an act to confirm that North Carolina law requires positions of supervision of all nurses providing anesthesia services. General assembly of North Carolina enacts. [SPEAKER CHANGE] Ladies and gentlemen of the house, upon motion of Representative Larry Bell, John Bell, and Jimmy Dixon from Wayne County. I think the chair is happy to extend the courtesies to the gallery, to the President CEO Dean Lee, of 3HC home health and hospice care. Please, stand and let us welcome him. [Applause] Representative Dollar, please state your purpose. [SPEAKER CHANGE] To debate the bill. [SPEAKER CHANGE] The gentleman is recognized to debate the bill. [SPEAKER CHANGE] Thank you, Mr. Speaker. Members of the House, I will try to cover this and not take too much time. What does House Bill 181 do? House Bill 181 does one thing and that is that is codifies current state law, with regard to physician supervision of certified registered nurse ?? and the procedures that they undertake in their practice. If you want to ask why, why would we need to codify what is currently case law and that is because for the last 20 years this matter has unfortunately been very unsettled. I will go through that in just a few moments. But, be not mistaken in the state of North Carolina today, physician supervision of medical procedures by CRNA's is the law and is the practice in North Carolina. I want to make sure that I add, right up front, that certified registered nurse and ?? or CRNAs are advanced practice nurses who do work in collaboration with other healthcare providers pursuant to the nurse practice act and they do an outstanding job. They are a critical component of the care team in our operating rooms. I also think that one of the most important things that you need to know about this legislation is that this bill will change absolutely nothing in our operating rooms with its passage. Nothing will change in terms of the operations being done in hospitals, clinics, or dentist office. Just a very brief history, back in 1993, 1994 there was a consent order entered into by the Board of Nursing and the Board of Medicine, that resulted in a change to the law and to the administrative code. I'll just read the relevant portion of the law regarding CRNA practice, it says collaborating with other healthcare providers in determining the appropriate healthcare for a patient, but subject to the provisions of 90-18.2, not prescribing a medical treatment regimen or making a medical diagnosis, except under supervision of a licensed physician. The corresponding administrative code.

Says likewise. Pursuant to a request by Senator James Forrester, I think many of you knew him. The Attorney General issued an opinion in December 31st of 1998, that opinion reads in part while the list of permitted activities is broad, this is relating to CRNAs. Those activities are limited by a requirement that a CRNA “may not prescribe a medical treatment regimens or make a medical diagnosis accept under supervision of a licensed physician.” With the appropriate citation. Management of a patients anesthesia requires the prescription of medical treatment regiments and the making of a medical diagnosis. The CRNA rules therefore do not eliminate the requirement that anesthesia care patient be under the supervision of a physician. Moving down the road in 2005, the North Carolina Court of Appeals issued a unanimous decision. It was authored by Justice Wanda Bryant and concurred by Judge Hunter and by Judge Barbara Jackson. Affirming a lower court ruling that physician supervision is the law of North Carolina. I’ll read just one paragraph from the decision at this time. Physician supervision of nurse anesthetist, providing anesthesia care, when that care includes prescribing medical treatment regimens and making medical diagnosis, is a fundamental patient safety standard required by North Carolina law. At your desk you will find a letter outlining some of this that is given to you by the attorney on behalf of the North Carolina Board of Medicine. I would just like the read the first two sentences. Pursuant to your request, this was a response to request that I gave the Medical Board. Pursuant to your request, the legal staff of the North Carolina Medical Board reviewed the proposed statutory changes contained in House Bill 181. The legislation merely codifies and clarifies existing North Carolina law requiring physician supervision of nurse anesthetist providing anesthesia services. I would also like to note for you that if you look at the federal regulations for Medicare and Medicaid, these regulations require all hospitals to provide physician supervision for nurse anesthetist providing anesthesia services. That is Federal requirement that all hospitals have and has been confirmed by the Hospital Association. All hospitals in North Carolina obviously follow that requirement. This Bill is a bi-partisan Bill. It has passed with strong support in both the Health Committee and the Regulatory Reform Committee. Just to conclude, it does not change any practice in the operating room. Physician supervision is the law in practice in our state and the advantage of passing this legislation is this Bill will settle. Will take out of court jeopardy and out of the administrative wrangling that we’ve seen for 20 years and codify what is the current case law and current practice. Mr. Speaker and Members I’ll be happy to answer any questions that you would have and I would appreciate your support for the Bill. [Speaker]: Representative Cunningham, please state your purpose. [Representative Cunningham]: Mr. Speaker, couple of question for Representative Dollar. [Speaker]: Representative Dollar. Does the gentleman yield? [Representative Dollar]: I yield. [Speaker]: The gentleman yields. [Representative Cunningham]: Representative Dollar, are you aware that any type of practice in a nursing profession requires supervision of a medical doctor or some type of physician that has been required of every profession in the State of North Carolina? [Representative Dollar]: I am aware that if you look under the Medical Practice Act, you will see 20 specific exceptions to the provision of medical services. In the nursing provision, nursed can conduct medical procedures pursuant to the Subcommittee of The Board of Medicine and the Board of Nursing being in agreement. Specific to CRNAs, there is a requirement for physician supervision both in the nursing

00:00 to practice act as well as in the administrative code. follow up Mr speaker. does the gentleman yield. I yield. the gentleman yields. according to the North Carolina hospital association letter that we put on our desk the fourth paragraph states by the senior vice president in the case that there's no practical change that will result from HP181 but you're just saying that it would [??] are we thinking possibly that if the physician has to be on the site even though the CRNA is providing the service that we'll be an additional building for the physician's charge for being on site or are we looking at just the physician being able to be reachable by telephone but not physically being there but still able to collect some billing fees. okay I understand your question I think what's not being understood here and I apologize the physician is going to be there no one goes under anesthesia just for the sake of going under anesthesia you go under anesthesia for the purposes of a procedure whether that's an operational hospital whether it's out patient procedure so the physician is there the physician is on site this is immediately prior to during and post stop of an actual procedure so the physician could not be somewhere else because then there would not be a procedure being done and no need for anesthesia. follow up Mr speaker. does the gentleman yield. I yield. the gentleman yields. representative Dollar in the real world of practical medicine when an anesthesiologist puts you to sleep he does not remain in the room with you the CRNA most likely remains in the room with you the physician that performs the surgery leaves to surgery room and leaves you in the care of the recovery where the CRNA is available. representative [??] if the lady will yield this if the lady wished to direct a question or debate the bill. I'm fixed to asking my question Mr speaker so are you aware that the doctor is not always at the bed side when the surgery is done and may only return if he is called. well I think that's a bit of a misunderstanding of what the procedure is if you happen to be for example in a hospital where you have an anesthesiologist a physician is an anesthesiologist that anesthesiologist is going to be working somewhere between one and four operating rooms in a major hospital the CRNA is critical to the process because they do carry forward all of the procedures that are lifted for them to carry out in the administrative code again this doesn't change however in the case of the prescription of the exact anesthesia to be given that's a schedule to medication and that can only be done by either an anesthesiologist or by a physician or in certain cases by a dentist in certain scenarios so the and if something happens with that patient which thankfully is rare but when those occurrences happen whether it's the anesthesiologist or the physician or if it's just the physician if you're an out patient in a clinic somewhere they are in charge of that patient and the care of their patient. Mr speaker I'd like to debate the bill. the lady's recognized to debate the bill. thank you there are three counties in the state of North Carolina that do not have hospitals [??] hospitals are absent in those counties in most of these cases CRNA go in and provide services for pregnant women [??] anesthesiologist there's not an anesthesiologist that's present in that county because there's not a hospital in that count but they still need the services because they're birthing babies and sometimes even at home they're birthing babies with mid wives so therefore if there's not a supervisor of the CRNA's in these particular counties what are their possibilities for getting the service in those three counties well an anesthesiologist or a medical professional or someone would have to draft to that county this would eliminate some of those services because anesthesiologist most likely are not where a surgical clinic is or where a hospital is not so you still would have issue with it. 05:00

Concern is this. If we are going to have the additional bill and if a doctor drive 55 to 65 miles to sign off because he’s not going to be there 24/7. He’s, he’s gonna work his hours and then he’s gonna move on. So what you gonna supposed to do for those individuals. Are they just not gonna have the CRNA service? Rural counties in California have moved away and did an exemption so that rur, rural counties would not foul up under this stipulation of supervision. They’ve always been supervised. Always. It has never been a healthcare professional where you were licensed in the state of North Carolina that you were not supervised by a medical director or someone with a Doctor’s degree. It has never happened. So I don’t see what the significant change is in it. The only thing that I can see in it is this gonna be a possible way for another billing cycle that Medicare and Medicaid is not going to be able to pay. Thank you. [SPEAKER CHANGES] Representative Hollo please state your purpose. [SPEAKER CHANGES] To debate the bill. [SPEAKER CHANGES] The gentleman is recognized to debate the bill. [SPEAKER CHANGES] Thank you Mr. Speaker. First of all I fully support the CNRAs and the service they provide to the patients into the healthcare community. I would not support a bill that would impede their ability to work in their profession. This bill makes no changes in their delivery of anesthesia. It only clarifies the law. This bill was heard extensively for one and a half hours in the HHS Policy Committee and passed overwhelmingly. It was then heard in Regulatory Reform Committee where it also passed overwhelmingly. I would appreciate your yes vote on this bill. Thank you. [SPEAKER CHANGES] Representative Fulghum please state your purpose. [SPEAKER CHANGES] Debate the bill. [SPEAKER CHANGES] The gentleman is recognized to debate the bill. [SPEAKER CHANGES] Thank you Mr. Speaker. As some of you know I spent several thousand hours in an operating room in the last 35 years. And this is kind of how it works. You go and engage a physician to diagnose your problem. They may be the surgeon or the physician they refer you to a surgeon. And you have contract verbally sometimes. Sometimes even written with a surgeon to say I’m sick. I need your care. What do you recommend? They recommend and you agree. And then you go to the hospital. And you enter into a formal situation. The hospital they have you sign a what they call a consent. And the consent says and this pretty typical around the country, not just unique in North Carolina, hereby authorize the surgeon’s name to perform the following procedures or treatments upon myself the patient. Per that permit references I authorize administration to myself the patient of anesthetics to be determined to be necessary in the hospital by the physician, responsible for administrating or for supervising the administration of anesthetics. Now folks you go to an outpatient surgery center. You have a colonoscopy or you go get an ENT procedure done or any other kind of various environments. Now whether there’s an anesthesiologist around really doesn’t matter. The decision to operate is between the surgeon and the patient. And when the surgery starts, and how long it lasts, and when it stops, the decision is up to the surgeon. The surgeon needs anesthesia. No one wants to do it without that. In many cases the CNRA is the one who’s part of the team. But make no mistake about this, this is not a democratic operation. This is a captain of the ship situation. The surgeon is directing the care supervising the care of everybody in the operating room. And the most important person in the operating room is the patient. The critical nature of everyone’s job is apparent. And I will tell you that in my case I had a reputation for tolerating chatter for about 15 seconds. And then you’re out of the operating room. Everybody’s got to be focused on the task. I respect and I can’t tell you how much I do the efforts and the training of CNRA people I worked with over the years. They never however peeked over the drape separating me and them and said cut here. Or I think you better stop the surgery unless the patient was in trouble in bleeding or something of that kind. I mean I wanted to know things like that. And pretty much I kinda knew that already. So I’m in full support of this bill. They’re right. I can’t figure out what all the fuss is really about. It doesn’t change anything. I hope

doesn't change anything because I like it the way it is. Thank you. [SPEAKER CHANGES] Representative Lambeth, please state your purpose. [SPEAKER CHANGES] Thank you Mr. Speaker. I have also spent a fair amount of time [SPEAKER CHANGES] The gentleman is recognized to debate the bill. [SPEAKER CHANGES] I've also spent a fair amount of my time in hospitals and healthcare facilities, and I would point out that this bill does not say anesthesiologists supervision, it say physician supervision. I also point out the the North Carolina hospital association, which represents large urban centers as well as small rural hospitals, supports this bill. They say that physician supervision of CRNAs is the appropriate public policy. I agree with that. They say physician supervision is the current law and practice in hospitals. I agree with that. They also state that codifying the public policy and current law and practice assures that any change to that public policy occurs at the legislative branch, not at the courts or state agencies. I can tell you that I've talked to a lot of CRNAs over the last few weeks, and they are concerned about this bill. They are concerned about what's not said in this bill. And what I've tried to reassure them, each time I've talked to a CRNA, is that if things are not as they seem in this bill, we will address those concerns. But this bill seems to be good public policy and I also support this bill and encourage you to support it. [SPEAKER CHANGES] Representative Adams, please state your purpose. [SPEAKER CHANGES] To ask Representative Dollar a question. [SPEAKER CHANGES] Representative Dollar, does the gentleman yield? [SPEAKER CHANGES] I yield. [SPEAKER CHANGES] The gentleman yields. [SPEAKER CHANGES] Thank you. Representative Dollar, there was a concern raised about rural counties, that Representative Cunningham alluded to, can you speak to that? How does this bill take care of those rural counties, or does it? [SPEAKER CHANGES] Thank you, Representative Adams. It does not affect rural counties, because physicians supervise CRNAs. So CRNAs will continue to be able to practice in rural areas under physician supervision, which is the current practice. So it in no way impacts access to anesthesia services within rural counties. [SPEAKER CHANGES] Thank you. Just to speak briefly, Mr. Speaker. [SPEAKER CHANGES] The lady is recognized to debate the bill. [SPEAKER CHANGES] Thank you Mr. Speaker. Like most of you here, I've been in a lot of discussion around this bill. I have a very close niece who is a nurse. I have other members of my family who are in the medical profession, and some who are doctors. And I think about having had a couple of surgeries myself, and going under as we say, and coming out always wanting to make sure that I have the very best, I have a lot of respect for what nurses do, and nurse anesthetists as well. But for me, this bill is really about patient safety. I've looked at all of the information, I am convinced that it does codify existing law. And if you think about it, for the past couple of weeks, we have had at least two bills that I can recall, where there's been some question back and forth about interpretation and what we had to do was to clarify and codify. And I believe that's what it does, and I'm going to support the bill. I encourage you to do as well. [SPEAKER CHANGES] Representative Jones, please state your purpose. [SPEAKER CHANGES] To debate the bill. [SPEAKER CHANGES] The gentleman is recognized to debate the bill. [SPEAKER CHANGES] Thank you, Mr. Speaker, and I'll be brief, I don't want to say a lot. Most of the members that know me know that I'm a dentist, you may not know that I've had the privilege of being married for almost 22 years to a registered nurse. I just want to echo what Dr. Fulghum had to say, and basically, from my perspective, just to say that healthcare is definitely a team sport, and we're very blessed to have healthcare professionals of many honorable professions. And I will say that as a legislator, some of the bills that I have seen that have probably bothered me the most I guess in my three years here, are issues where different healthcare professionals are at odds with one another. And you see where there have been court cases over and over again, and I would just say that I think Representative Fulghum said it best, that in the operating room there has to be a situation where someone says the buck stops here. And that lies with the surgeon. And here at the General Assembly we pass laws and the buck stops here, and I think we have an obligation to bring clarity to this to try to keep these issues out of the courts, because it is in the best interest of those citizens which are the patients, as he said are the most important people

in the operating room. So for that reason and more I would just say that it's important that we bring clarity to the fact that we say that there's not being any change made, we've received a lot of emails from a lot of people that are apparently differently interpreting what it means to have supervision in the room and I think that we need to clarify that. So for that reason I do commend the bill. Thank you. [SPEAKER CHANGES] Further discussion, further debate. If not, the question before the House is the passage of the House committee substitute number 2 for House bill 181 on its second reading. All in favor vote "aye", all opposed vote "no", the clerk will open the vote. All members wishing to record please do so at this time. The clerk will lock the machine and record the vote. 92 having voted in the affirmative and 23 in the negative, the House committee substitute number 2 to House bill 181 has passed its second reading and without objection [SPEAKER CHANGES] Objection. [SPEAKER CHANGES] Objection having been raised, the bill remains on the calendar. House bill 1- Oh. ?? the clerk moves. Rep. Insko, the chair understands the lady would like to change her vote on House bill 17 from "aye" to "no", is that correct? [SPEAKER CHANGES] Yes, thank you Mr. Speaker. [SPEAKER CHANGES] So recorded. Ladies and gentlemen, upon motion of Rep. Richardson from Franklin county and Rep. Collins from Nash county, the Chair is happy to extend the courtesies of the gallery to the bows of Rocky Mount, alumni chapter of Kappa Alpha Psi fraternity. ??, military leadership scholarship program, here today to observe high school legislative day, please stand and let us welcome you. Now, House bill 199, the clerk will read. [SPEAKER CHANGES] House bill 199, a bill to entitle an act to increase the amount in controversy for civil actions in district court, General Assembly of North Carolina enacts. [SPEAKER CHANGES] Rep. Glazier, please state your purpose. [SPEAKER CHANGES] To explain and debate the bill Mr. Speaker. [SPEAKER CHANGES] The House will come to order. The gentleman is recognized to debate the bill. [SPEAKER CHANGES] Thank you very much Mr. Speaker. Members, this is a bill by Rep. Grady, Rep. Stam, Rep. Stevens and myself, which unanimously cleared Judiciary B, was recommended by the district court judges and is supported by superior court judges by the North Carolina Academy advocates for justice and no opposition from the North Carolina Bar either, and it simply increases the jurisdictional amount for civil actions in district court from 10,000 to 25,000 which hasn't been increased in some time, to allow those cases to be heard more quickly and expeditiously in district court, as opposed to superior court. I know of no opposition to the bill, and recommend it to you. Thank you. [SPEAKER CHANGES] Rep. Hastings, please state your purpose. [SPEAKER CHANGES] Mr. Speaker, it might not be in order. I was to gonna ask to have the record reflect a different vote on a bill, so I'll [SPEAKER CHANGES] The gentleman has the floor. [SPEAKER CHANGES] I would request that the record reflect that I vote "aye" on House bill 181. I apologize Mr. Speaker. [SPEAKER CHANGES] The gentleman will be recorded as voted "Aye". Further discussion, further debate. If not, the question before the House is the passage of House bill 199 on its second reading. All those in favor will vote "Aye", all those opposed will vote "no", the clerk will open the vote. All members wishing to record please do so at this time. Rep. Brandon. The clerk will lock the machine and record the vote. 114 having voted in the affirmative and none in the negative, House bill 199 has passed its second reading and without objection, will be read a third time. [SPEAKER CHANGES] General Assembly of North Carolina enacts. [SPEAKER CHANGES] Further discussion, further debate. If not, the question before the House is the passage of House bill 199 on its third reading. All in favor say "Aye". [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] All opposed, say "no". The "aye"s have it. House bill 199 has passed its third reading and will be sent to the Senate. Ladies and gentlemen, upon motions from Representatives Larry Bell and William Brisson from Samson county, the Chair is happy to extend the courtesies of the gallery to the Clinton-Sampson chamber leadership. Please stand and let us welcome you.

House Bill 243. The Clerk will read. [SPEAKER CHANGES] Committee substitute for House Bill 243, a bill to be entitled ‘An Act Authorizing an Owner of a Self-Storage Facility who has a Lien upon Personal Property to Deliver Notice of the Public Sale of the Property by Regular or electronic Mail, to Publish Notice in any Commercially Reasonable Manner, and to Conduct the Sale through an Online, Publically Accessible Auction Website, and to Increase the Late Fees for Self-Storage Facility Rental Contracts’. General Assembly of North Carolina enacts. [SPEAKER CHANGES] Representative Stevens, please state your purpose. [SPEAKER CHANGES] To speak on the bill. [SPEAKER CHANGES] The lady is recognized to debate the bill. [SPEAKER CHANGES] Members of the House, this is a bill that came to me at the request of people who operate self-storage facilities. If someone is more than 60 days late in paying the rent on their storage buildings, they then have to go through a procedure to notify the person. They’ve asked that they be able to use email and first class regular mail to try to get in touch with these. Email brings them more into the 21st century and they can get those other contracts. In addition, it tries to provide a better way to make sure we’ve got people to bid on this by establishing a regular… that at least three bidders need to show up – three independent bidders need to show up in order for the sale to be deemed commercially reasonable. It does increase the fees for not paying to whichever is greater, $20 or 20%, and that’s consistent with the rest of the county. One other thing in here has to do with vehicles that are left on the premises. It offers them by this statute to be able to move them by returning them to any lien holder. If the bank is holding a lien or whatever, it allows them to be able to tow that vehicle and allow the lien holder to deal with it in their process. And Mr. Speaker, I do have an amendment. [SPEAKER CHANGES] The lady is recognized to send forth an amendment. The Clerk will read. [SPEAKER CHANGES] Representative Stevens moves to amend the bill on page 3, line 13, by rewriting the line to read… [SPEAKER CHANGES] The lady is recognized to debate the amendment. [SPEAKER CHANGES] Thank you, Mr. Speaker, and this… We needed an effective date and there was not one on here, so weeded time to promulgate this, and it’s October 1st 2013, and then it will only apply to contracts that are in or after that effective date. So I’d ask for your support on this amendment and also for the underlying bill. Thank you. [SPEAKER CHANGES] The Chair observes two lights that were on, I think prior to the amendment. The Chair will recognize those members at the appropriate time. Further discussion, further debate on the amendment? Representative Presnell, please state your purpose. [SPEAKER CHANGES] I would like to be excused from the vote. We own storage buildings. [SPEAKER CHANGES] The lady will be. Further discussion, further debate on the amendment. If not, the question before the House is the passage of the amendment sent forth by Representative Stevens to the House Committee substitute for House Bill 243. All in favor vote aye. All opposed vote no. The Clerk will open the vote. All members wishing to record, please do so at this time. The Clerk will lock the machine and record the vote. 114 having voted in the affirmative and none in the negative, the amendment passes. We’re now back on the bill. Representative Collins, please state your purpose. [SPEAKER CHANGES] A question for the bill sponsor. [SPEAKER CHANGES] Representative Stevens, does the lady yield? [SPEAKER CHANGES] I yield. [SPEAKER CHANGES] The lady yields. [SPEAKER CHANGES] Representative Stevens, my question has to do with not the main part of the bill but the manner of advertisement. On page 2, end of line 29, it says you either have to advertise it in a newspaper or the second thing is any commercially reasonable manner, and it looks like to me according to ways to finding this that you don’t know whether you’ve advertised it properly until the sale actually happens. Is that correct? [SPEAKER CHANGES] Mr. Speaker, I may respond? Representative Collins, it is commercially reasonable if you can get at least three independent bidders there. At the current statute the way it reads, there is no standard. As long as you put it in a paper, if nobody shows up or one person shows up then that’s deemed to be commercially reasonable. So this is an effort to try and get more bidders in. [SPEAKER CHANGES] A follow-up on that please. [SPEAKER CHANGES] Does the lady yield? [SPEAKER CHANGES] I do. [SPEAKER CHANGES] The lady yields. [SPEAKER CHANGES] Does that mean then that that manner of advertisement deals with both part one as well as part two? It deals with whether you’ve advertised it in a newspaper or in some other manner; is that correct? [SPEAKER CHANGES] Correct. [SPEAKER CHANGES] One more question please. [SPEAKER CHANGES] Lady yield? Lady yields. [SPEAKER CHANGES] If I send a letter to my family members and three or four of my best friends, is that considered commercially a reasonable manner as long as I get three bidders there? [SPEAKER CHANGES] As long as they are independent bidders. I don’t think they can be the family members of

?? team, the selling is at the end of the times are in person on the PlayStation purpose as the resistance questionnaires and state is awaiting times more, was his idea and 1/2-season dollars and times he said that have prior to Friday the inner cities will never would not be mapped and send them back in time of issue of the seven show, three popup show and probably more chances and creator of Disney announced as an innovator to one well when U.S. Wants and I'm sure this corrected the same period of rest, as we might be: the installment is widely known what was then-acting just seems so wide open in the timing of the than on the street lunge of Chinese and Russian and have some sort of 1998 and 13 other supporters of the captain of the factory ?? in Hawaii, thank you, questions the white U.S. ?? of the disease in section three : 12 buildings for a swim in section three , the fetus including the time has run into a sea of dollars and 20% and Perot is 15% more ?? 2115, 15% of one and one of the nation's ideas that are at times been seen since the bombing of the area's other strains on it in 1948 house. Is that I'll allow all of us and there are just getting consumers and the time is money store has one big thing for his 1915 , and update the day he asked the contractual for Keenan said the presence and here is the contacted last year, tiled in the NAZI businesses offer to compliance mayor, Marion, in the Peters owl and other defendant trial, has been some reason was the 15th one on the active money sources and undeveloped, no time to scenes sees a staff of¢ volatility of storage Hillary Monday, it makes sense on the space of one ?? was the biggest enemies on so -my reasons would have the time has responded: Isabelle, ages nine and 1035 case of a section of 60 time referencing interest and $15.00 fighting on small fingers personnel following PlayStation purpose after that, fine said it has made no time so I started out well-liked the idea of recognition of us again that was later shot a five night movie was a resident with the audience you time and Scott was. Fumbled twice for conservative republican they contacted all his time you have very serious concerns about this all out of the sword swallowers for a 100 points in each row one another couple of years, now 26 for ?? every year and a strand of the provision that when it's also a different company their contracts are saying now the part of a year off the storage one times in nine months by somehow have not addressed no time in as an operating in five cities are about to receive requested one of them back to win all-time a $60.00 of housing and $105 a couple auto stores one and chai Ling, and I went down the street, they don't realize what others because no one stores would finish and ??..............

Speaker: And I'm looking you might have do something about it back to find out we don't have to give the notice that you cit the lot of because it's in our contract now quite candidly and they not sent sort of file receive request they would have found me they would still continue think that i was in the wrong place and they would sold ?? ends certified requested because there is no proof they even try with email to all those ?? I'm getting emails on house bill 17 by the time i red we would have wrong sense sold we are worried about betting we are worried about there should want to displace it if we can replace it I'm gotta vote against, Speaker Changes: Passage of house committee substitute house bill 243 not the question before the house as the passage of house committee substitute to house bill 243 to vote aye the clerk record machine will record the vote 70 having voted in the affirmative 44 in the negative the house committee substitute for house bill 243 has amended and passed in it's second reading and will remain on the calender ladies and gentlemen without objection rule 12 d is suspended is there a objection ,so ordered Representative ?? recognizes ?? the clerk will read, Speaker Changes: Representative ?? chair for the insurance committee house bill 170 department of insurance public heath service act favor the committee on substitute ?? to the original bill and reaffirm surely to judiciary sub committee, Speaker Changes: The serial on judiciary sub committee A is trick en committee substitute bill calender for senate bill 36 B original bill unfavorable calender ladies and gentlemen the house the prior referral of house bill 410 serial referral judiciary sub committee a is trick en the serial referral will judiciary sub committee B, Speaker Changes: Mr.Speaker, Speaker Changes: Representative Moore please state your purpose, Speaker Changes: Motion pertaining today's calender, Speaker Changes: The gentlemen is recognized for the motion ?? will be removed for today's calender and the calender for Thursday of this week, Speaker Changes: Without objection,so ordered ladies and gentlemen of the house the chair is happy to extend the courtesy of gallery to students teachers parents ?? students from Lincoln elementary ?? please stand up let us welcome in notices and announcements Speaker Changes: Representative ?? please state your purpose Speaker Changes: To point a personal privilege, Speaker Changes: The gentlemen is to appoint a personal privilege ladies and gentle men the house come to order, Speaker Changes: As many of you had already know the last Wednesday was a interesting day for me and as about interesting day for Representative ?? almost took her to the floor of north lobby but i want to thank the members of the body the security ?? in this bill in the house keeping staff and everybody else who came to my aid i don't have a ?? but you can help yourself and i could not help myself and it was touching and it was greatly appreciated i know i had the times said like dis functional family here and lord know we are,

Lord knows every family is, and when the chips are down the family comes together. and I appreciate every effort that was extended on my behalf because I now know two things, I know what it feels like to look like a big salmon laying in the north lobby flopping around and I know what it is to be embarrassed to absolute tears because the crowd gathered but the crowd was there to help and I do appreciate your kindness and your concern. thank you ladies and gentlemen of the house and members of this institution. [SPEAKER CHANGES] representative Millis, state your purpose [SPEAKER CHANGES] the point of personal privilege [SPEAKER CHANGES] the governor is recognized for a point of privilege ???? [SPEAKER CHANGES] I wanted to congratulate representative Jon Hardister, my seatmate for the passage of this first bill. he's become a legend, not only did he get a chance to speak three times for the second reading but he also made it through to here for this legislation, so it means a lot to me, you're my seatmate, and my bodyguard so I just wanted to give congratulations to representative Jon Hardister [SPEAKER CHANGES] representative Moore, please state your [SPEAKER CHANGES] motion pertaining to todays calender [SPEAKER CHANGES] the gentleman has recognized for a motion [SPEAKER CHANGES] speaker, I'm going to move that senate bills 20, 33, and 44 be removed from todays calender and calender for tomorrow [SPEAKER CHANGES] representative moore, does the gentleman also intend to have senate bill 97 in that motion [SPEAKER CHANGES] and 97 too, yes [SPEAKER CHANGES] without objection, so ordered representative Hurley please state your purpose [SPEAKER CHANGES] one announcement [SPEAKER CHANGES] the lady is recognized [SPEAKER CHANGES] thank you mr speaker the members of the justice of public safety appropriations committee meeting, please bring the governors budget with you at the 8:30 meeting in the morning [SPEAKER CHANGES] representative richardson, please state your purpose [SPEAKER CHANGES] personal privilege please [SPEAKER CHANGES] the hosue will come to order, the lady is recognized for a point of personal privilege [SPEAKER CHANGES] I would like to proudly stand today as a member of the lewisberg college board of trusties and announce that our womens basketball team won the national junior college athletic association conference this week, thank you [SPEAKER CHANGES] it's great to see some of our carolina teams winning. the clerk will read [SPEAKER CHANGES] the house committee on elections will meet tomorrow at 1 PM in room 643LOP [SPEAKER CHANGES] further notices and announcements, representative Morris recognized, and ladies and gentlemen if the gentleman will yield for a moment, ladies and gentlemen just for your planning purposes the chair anticipates that the session will be at 1 PM thursday, we don't believe that it's likely that we'll be able to move that early. earlier than that session the only possibility would be a no vote session but if there is a session time it will be at 1 PM. representative Morris recognized for 2 motions [SPEAKER CHANGES] mr speaker, I move that, no 2 PM is the question. I move that the house do now adjourn subject to the re-referral of bills and resolution to reconvene on wednesday march 27th, 2013 at 2 o'clock PM [SPEAKER CHANGES] representative Moore moves seconded by representative Hardister and subject to the re-referral of bills and resolutions so the house to now adjourn to reconvene on wednesday march 27th at 2 PM, all in favor say AYE [SPEAKER CHANGES] AYE [SPEAKER CHANGES] all opposed say no. the AYE's have it the house stands adjuorned