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House | April 15, 2015 | Chamber | Health

Full MP3 Audio File

If you would try to take your seats, we have a long agenda and we have about 50 minutes to get all four items in. I do want to welcome you to our Health committee this morning. Our sergeant at arms for our committee is Young Bay, Bill Morris, and Jim Muran always appreciate the work they do. We do have a couple of pages with us I believe, a Rachel Chesam[sp?] from Guilford as John Faircloth. She's right here in front she's doing her work already and Eli Hornbag[sp?] from Rutherford. Mark Hugh. We welcome you to our committee as well, thank you for what you're doing. As I mentioned we do have four bill because they all have PCSs we have about 50 minutes to try to get our work done this morning and I would note that any bill that does come out of this committee will likely be added to the supplemental agenda this afternoon for the floor, so be prepared bill sponsors for this afternoon if your bill comes out at this committee and is endorsed by the committee. Okay we will start with House Bill 355 enhance protection for group home residents. Representative Reeves, stand and since each one of this do have a PCS I do need a motion to accept the PCS. Representative Chatham makes that motion. Okay. You're up. Make it quick. I'm sorry I see the passes that you've had. Good morning everybody. We have a HCHP 355 I think all of you have in front of you and as we said the only difference was the PCS from the original bill that was added a training component. This bill was brought about in response to abuse that had been seen in group homes and I'm sure a lot of you are familiar with that being on this committee and understand how problematic that can be and what we've done is we've separated the current Class 1 misdemeanor offences of an employer or volunteer at a facility knowingly causing pain and injury to a client or [xx] take personal property from a client and what we've done is stated that, if he keeps borrowing, taking personal property from a client, it's going to be a Class 1 misdemeanor and it also makes an employee volunteering at a facility who knowingly causes pain or injury to a client, a Class A1 misdemeanor. And so what it's done is, its expanded the mandatory report requirement to include volunteers as well as employees at a facility who witnessed or have knowledge of the violations that are listed above or any accidental injury to a client, they can't be threatened or harassed as an account of making this report and we thought that was pretty important to have that in the bill section of the Bill is also created to protect the residents and create a class A1 misinformation[sp?] of employees and of volunteers of facility who witnessed a client coming a victim of a violation of art Seven A on Article 26 of Chapter 14 of the general statute charged with rape sex offences, [xx] against public immorality and filed the report of violation within the 24 hours of witness in it to the President of Social Services in the County. Then transferred the client to the District Attorney in that District. and this directs to the current department social services, and the district attorney to investigate over by the investigation in each report, and so that I hope he's a good brief summary of the Bill. That a very good summary, Thank you for that presentation. Far much, appropriate time. Okay Representative Dollar? Thank you Mr. Chairman. My question is have you worked with the industry on this bill, and if you have what are those whether those discussion being, and worth to all stand in discussion with the industry, and Mr. Chairman, the we would also be, interested in hearing any perspective that the industry may wish to the great unfortunate may wish to share, before we vote. Okay thank you representative Tom. Let's see if there's representative here from the group homes that would like to speak. See no one Representative Connie for question at the time

unless someone's here to speak You still want me to answer him. Yeah go and answer his question. Representative Doll the ministry has been contact and we would like to get free representative stamp we'll tell you about the contacts that has made consultant on this, and there's nobody that we know has any issue with this bill at all I haven't directly talked with him but we've also heard no negative comments since it was filed quit a while ago. These are misdemeanors not felonies but for those of you who make initial [xx] judiciary to the criminal committee and I will know for you that a class A-1 misdemeanor is not a felony but you can actually get more time on a A-1 misdemeanor than you can on a class [xx] felony but without the statement of rebellion and I actually who I work most with is in the Lieutenant government office and I think they have had context. Thank you. Representative Connie you had a question? Representative Stam must have read my mind that's what I just wanted that clarification. Thank you. Other questions if not we get Representative Goodman you want to make your motion? I move for favorable report of the the P. C. S in favor of the original were the referral to judiciary too.   You've heard the motion all those in favor say aye, aye any opposed thank you bill sponsors. Thank you Mr Chair. House Bill 437 pre permitted exemptions home renal products, representative Thompson is here. We also need a motion to accept the PCS on this bill as well do we have a motion? Somehow. Representative Crony move to accept PCS, representative Thompson. Thank you Mr chairman, thank you for allowing this bill to be heard today, members of committee, this is a fairly complicated bill so if you indulge me I'll try to explain it quickly. House bill 437 concerns something called peritoneal dialysis. It's a type of dialysis for patients who're undergoing something called in stage renal disease therapy. These patients are able to self administer the dialysis treatment their supplies were delivered right to their door. The ability to self administer it allow helps them to live a more stable lifestyle so I just wanted to give you a background of what we're trying to address here today. This bill seeks to streamline the end of the supply chain for the delivery of this supplies to the patients door. I won't take the time to go into details of the supply chain process I'll just say that they are several four, five and it could be argued six checks along the supply chain to make sure the order is accurate and the patient is getting what they need. Most recent of checks was added in May of 2013. So before I get to what I am asking to change, what I am asking from this committee I want to tell you what does not change with this bill with regard to the supply chain of peritoneal dialysis.  This manufacturers maintain strict control of all product from the time they are manufactured, sent to the replenishment center For storage, delivered to the distribution centers until they're delivered to the patients home. inspection and supervision of the U. S Food and Drug Administration. Once manufactured at the facility, dialysis solutions are not mixed or compounded prior to delivery to the home patient again still F. D. A Regulatory Authority will stay the same under this bill. As you can see online I think 17 the dialysis are drugs that are lawfully healed by agent of the manufactured that's properly licensed by the North Carolina Department of in Consumer Services as a manufacture or as a wholesaler or as both as required by the General Statute. This will not change so we'll still going to have the F. T. I authority, will still going to have department of health oversight, and a lot of internal control. So those things are not going to change, but with this permit exemption I do want to be as candid as I can and tell you what, will change. At the end of the process the supply chain process after the patient has already received their dialysis, an independent contract pharmacist is required to do a monthly retrospective meeting after the fact inspection of what took place. This bill does seek to exempt patients in dialysis from the pharmacy permits mandate so it would no longer require that after the fact inspection that's what we're trying to accomplish as a result of this bill the retrospect act inspection as I said will no longer be required. This will not unduly affect the

patient or create a lack of oversight for the following reasons as I said earlier internal checks, FTA checks, Department of Ad checks and third most importantly, and this is really what sold it for me, as a retrospective inspection meaning an after the fact inspection, it's not going to help the patient because it's done after the fact the patients already got the supplies that they need and the inspection that we're trying to exempt happens after the fact, so that to me is the three reasons why I agree to sign on to this bill and be a sponsor. There's also a 24/7 the pharmacy line available, so those things are going to be there, a lot work has gone on in this legislation to bring all the stakeholders to the table to reduce unnecessary regulation, but at the same time, make sure these patients are receiving supplies and care that they need in a timely manner. The Department of Agriculture had some issues, I worked with them to get their issues address so they know no opposition there, and know of no other opposition to this Bill. Five States have already enacted this, Pennsylvania, Texas, California, Ohio and one other that makes up about 30% of the United States population, just passed the Georgia legislature, the House and the Senate, waiting to be signed by the Governor and it passed unanimous in Georgia as well. So that's where we're at and that what I'm asking for and that will be the main components of the bill. OK thank you there's a few question I will start with Representative Avila. Thank you Mr. Chair, I would like to make a motion for favorable report, but I do have a question. When they put an after the fact inspection in place somebody had to have any reason do we have any idea of what they felt the positive results if that would be or what they're looking for, do you have idea at all? My guess would be just to, I guess do you have someone out there, may be able to answer the questions as well? Yes.  Okay we may give them an opportunity  as well. There she come will you come over and identify your self please.  Hello my name is Christine Kim, I'm from Baxter. The main reason why there was a retrospective review was because in Deerfield Illinois, it wasn't a pharmacy regulated site, but most recently in May of 2013 we receive liscenship from the Illinois Board of Pharmacy that put in this review of the prescription and the order in [xx]. So it is occurring today in [xx] and thats why we're just asking for the elimination of the redundancy of work. Thank you very much Representative Vince-core[sp?] Thank you Mr. Chairman. I assume that these regulations are put in place for patient safety so I would think that the after, the retrospective checking had to do with ensuring compliance of the chain. So I am curious about what problem exists that you're trying to solve with this bill. Is there some problem with the current system? Representative Dorson. Thank you Mr. Chairman, thank you for the question representing Vince-core. The issue is in May of 2013 This was implemented at the location in Deerfield, so that check that was being done here is currently being done here is being done at the Deerfield facility so it's no longer needed now in North Carolina because it's a duplicative ckeck Thank you representative Dolson. Representative Lucas had a question. Thank you Mr. Chair my question was answered [xx]  Okay representative Brand did you have a question?  Thank you Mr. Chair. Just clear about some things for me please. Alright, how often did that inspection occur or would it occur did you say once a month? That's my understanding, once a month. Tell me what is inspected and do they inspect at renal, I mean at dialysis centers or is it's just a home. I'm a little [xx] say, thank you. Thank you Mr. Chairman, thank you for the question that's part of the issue the inspection is not at the home or the dialysis center, it's actually at the

warehouse center where they are just literally checking the computer against the numbers. Thank you Represent Dopson[sp?]. Other questions? If not we do have Represent Dollar. You may have just answered my question but just to be clear we are talking a but eliminating one inspection arragement and you're saying that inspection arrangement is already covered, and the inspection that you're removing is one that happens at a warehouse doesn't happen at a facility it doesn't happen in home because I think you were saying maybe I didn't understand what you were saying earlier when you were talking about inspections after the delivery, but you are saying the delivery at a warehouse before the final distribution lets say out to a home because most well a lot of pair levels have obviously done a lot of that and what is the what would be the still existing product check that would be there that covers what you are not checking at the warehouse. Representative Dotson. Thank you again Representative Dollar for the question the warehouse the inspection that we're trying to exempt, actually takes place at the warehouse, it doesn't take place at the rental facility nor the home, it takes place at the warehouse and the check that happens is basically just to computer check that's why the check at the Beer filled facility is applicable to what's been taking place at the warehouse because it's just a computer check, there's no physical check of products or anything of that nature. Other questions if not Representative [xx] had a motion. Thank you Mr. Chairman I move for favorable report. to the PCS and as for the whether's it's the correct way wording it. If that will work. Unfavorable to the original. Unfavorable to the original OK all those in favor say aye aye any opposed, Representative Dopson congratulations that has passed and it is likely to be on the floor this afternoon, so be prepared. Thank you Mr. Chairman, thank you members of the committee. We're actually going to skip and take house bill 580 bans smoking in foster care to allow Representative Brawley to finish up another meeting so we'll call in Representative Cohen to come forward. Well so we have a P. C. S for this bill as well do I have a motion to accept the P. C. S? Have a motion by Representative Lucas over here to accept P. C. S. OK right here. Thank you Mr. Chairman and members, good morning? And I'm glad to have the bill co-sponsor Representative Adcock this is her first bill so please be kind to her this is going to be the simplest fill in and the quickest it is very simple as your bill summary says it's simply directs The Department of Social Services Commission to adopt rules on restricting foster parents smoking in the presence of an infant. An infant is defined as one or younger we've seen this bill before if you've been here a while with me. I do this every year and hope that the senate will take the message so I ask you for your support. Thank you for being brief on that. Representative Guadel, you had a question, then we'll come to Representative Dolla. Just for a motion at the appropriate tme. Okay representative Dolla. Thank you Mr. Chairman. Well I believe that the Bill sponsors have the absolute best intentions in mind, I really have serious problems with this bill and let me there's no questions that is with an infant or with any other child in child stage growth you prefer them not being around smoke just like you would prefer them not to be around other environmental hazards and the like however we're talking about foster children here We're talking about a much broader system and a much broader set of issues. I have spoken with people who do placements with foster parents who actually have to operate the rules on a daily bases all across the state and they have very serious concerns about this bill you are in some areas of the state we could be an essence for including some potential foster care parents because the

assumption would be if they are smoking that they might potentially smoke in the presence of a one year old you got someone who smokes in that family in that home how are you going to police whether they are smoking in front of the infant or not smoking in front of the infant you just know way you are going to know way to do that about the only way you know to do that is to say Okay we are not going to have many family that smokes. What if you have extended family members who are in there so that depends the foster parents may not smoke but there may be someone else, some other adult in the house hold that smokes. We have situations all the time but we are simply not flesh with foster parent, I mean it may be true, I'm not certain about some of the urban areas that I know the person Carolina as a whole, we have a problem getting foster parents and I think that the way it is done now particularly with the agencies we're working with most closely in trying to ensure quality with respect of foster care parents, they are looking at a wide range of conditions within the house hold and I know for a fact that they do look t tobacco use now, it is one of the things that they look at, but they're looking at in a wide range of things. And I think that you have to bring the totality together. I don't think the provision in lines 11, 12 and 13 fit with the, under the duties and powers of the commission. When you look at the other seven duties and powers of the commission, they apply to [xx] facilities and some other very, very broad things. To put this in there, I think is, frankly doesn't fit. I think that as a policy matter, well, I think that as a practice, we can continue to encourage what frankly already goes on, and that is to make a full assessment of those potential foster parent. I think this will also raise questions in terms of, OK what will we do [xx]? You've got a placement currently we're going to pull some child out now? The other questions that I have with this are, one of the big things that we've been trying to do and that this general assembly has encourages is saying, OK and by our best agency are saying, look, we want to try to place, if you can find a distant relative, if you can find somebody that connects that child with their family, their heritage, their lineage, then we really trying to do that, and that takes a lot of work well that person somebody in that family might smoke well do you let's weigh this things. You've got to weigh that entirety. And so it seems to me that we put this in policy, while the intent is no argument and there's no argument in terms of the health issue believe me no argument and nobody in this room is going to argue with that but I think when you look at the totality and the impact this is just not a matter that we ought to put in policy this is a matter that we ought to continue to work on on with the foster parent foster care agencies is they analyze those potential parents and Mr. Chairman actually I have some more questions and thoughts on this but concerns with it, but I'll leave it at there for the moment. Thank you representative Dollar go ahead. Thank you Respond if you'd like. Thank you Mr. Chairman and representative Dollar I appreciate your remarks, and this bill started off years ago I guess four sessions ago with a complete ban and looking at children of all ages in foster care. Because this was a request of children en foster care. I've worked very hard with this group and this was the number one thing that children ask to a currently in foster care worked with both chambers with the advocates and we narrowed the language down, very, very pretty strictly to infants, and it was particularly infants and that came recommended by many in the medical community because of the correlation with sudden infant death syndrome, especially children who might be more predispositioned to asthma and other respiratory issues that's why I say ages 1, it had originally been 18 months, it was lowered. I think all the questions you raised should debate it and that's why this bill would go to a commission. We are not answering all those questions so I

would like to see them answered and they might have a very lenient perspective? I don't know, I'm not on that commission. I do think we do have laws that protect our inmates we don't allow prison guards to smoke as we don't want our inmates to breath in that smoke, and I think we should protect babies as well. So I do understand if want me to delay the bill knowing that your referencing has talked with me which is disappointing with the agencies or groups, they know I file this bill every year and so I wish that they would have come forward because I do try to work very hard to listen to everybody and have stakeholders, but I'm happy to slow the bill down if you want or if want it to go down in flames pun intended. Let's, we have a couple other more questions Representative Dollar here to follow-up. Well I would like slowed down and I reached out to folks that I know who actually do the placements, and that's where the rubber meets the road, and the bill does say it adds in line 11, 12, 13 it says it directs the commission adopt rules establishing a policy to prohibit a foster parent from smoking in the presence of an infant and so that, I don't think that you would give a duty of power to a commission that you didn't expect them to obviously to exercise. So frankly I would appreciate it if it was displaced and maybe some discussion being had with some of the agencies who actually placed these children in foster care because they're the ones that are actually trying to look at the entirety of the circumstances  Representative Corney you had a question, that may have been Representative Brown okay, thank you. I got you, okay. Representative Brown, Thank you Mr chair, I just had a quick question, what is your definition of, in the presence of? Does that mean in the same room or in the same house? What does that mean? I'll have to let, Mr Chairman if I could let staff answer that because they're the ones who helped make that change. Okay, got it. Anyone want to tackle that? In the presence of, if you'll identify yourself.  Christine Harris,  in the presence of is not defined in the bill, Iit would be defined by rule. It would be defined by rule OK thank you let's see Representative Cohen. We can displace We will displace this and give you an opportunity to work with some of the groups as Representative Dollar has suggested and since we will be here I think for a few more weeks if you have the opportunity to bring it back at some point then we'll bring it back. And to those groups I'm available like I'm to everyone so I hope you will reach out. Thank you very much thank you for that discussion. OK I see that Representative Brawley is here and will call him up on house bill 543 and the also have a PCS on this so I do have a motion to accept the PCS. Representative Ford makes that motion, Representative Brawley, Representative Jones.  Thank you Mr. Chairman and thank you members of the committee. This bill basically has three main objectives, the first is to address some changes in the physicians health plan, this is not health insurance but rather so it's a group that tries to asses and treat physicians with potential problems before an actual problem develops. There was some controversy, the state auditor's office run an audit of this group they reviewed 200 or 110 files from PHP and all the files that they asked for from the medical board were made available. They found that there were no problems or improper outcomes but did make 10 recommendations to strengthen the program. All the administrative changes have been implemented, but there are some that require legislative changes they are included in this bill today. Second major objective of this bill is some process changes it's to make a more open and democratic process for medical board appointments, and also implement term limits it'll limit members to two terms in their life time, not just two consecutive terms. It 'll also bring about the use of some new acknowledging communications with licences and will re-do some reporting requirements therefore

reports are outdated are no longer needed. The third major factor in the bill, awesome changes in fees, it's been nine years since fees were last changed at this point I would like to ask staff to go through the more detailed explanation if that the desire of the committee. That might be helpful. Thank you Representative Brolly, if staff would do that, that would be helpful I think. Yes sir, I'm [xx] from the committee staff. I don't know how much to tell you, I mean to go into some of this are technical amendments there're substances amendments next in, you'll see in your bill summary for House Bill 543 that I've outlined by section what the changes are so the section one is a change in the term of the medical board member to complete three year terms in a lifetime section two just adds qualifications for the position of physician assistant or nurse practitioner, section three a technical change just to capitalize. Section four adds new language to the law pertaining to recommending board members. It allows the board to provide confidential and non public licensing investigative information to the review panel to specify that all applications, records, papers, files reports e. T. C. Received by the review panel as a result of soliciting, receiving and reviewing applications and making recommendations will not be considered public records. It also provides that the review panel is a public[sp?] body within the meaning of article 33 in chapter c and in chapter 143. However it specifies that the review panel will meet in close sessions to review application, interview applicant review and discuss information and to discuss debate and vet on recommendations from the governor. The review panel is however required to publish on its internet site names and private addresses of all applicants and 10 days of application deadline and publish the names and private addresses of the nominees recommended in the governor within 10 days and not less than 30 days [xx]. Section five amends the board's requirement to collect and publish data by removing our requirements to report fax numbers again that's kind of technical. It does continue to keep current active email addresses available again same thing with section six with regarding facts numbers. Section seven it means a lot to specify the board may not deny an application for a licence based solely on the applicant's failure to become board certified. Section eight is the fee increase that Representative Rolly mentioned. There's also a slight fee increase in section nine section 10 amends the law on disciplinary authority of the board to provide the licence, that if the license is retained cancel then both the board may serve to board the licence and licence's council. section 11 amends a law and disciplinary action pertaining to the written notice indicating charges made against the lincescy to add a requirement that once the charges have been issued, the parties may engage in discovery. Additionaly, the board must provide the respondent or respondent council with all excretory evidence and except for the following and you can see the exceptions on page two of the summary under section 11. Section 12, amends a reporting requirements for disciplinary action. Section 13, renames article 1D to the health program for medical professionals. Section 14, amends the first section in that article to provide that the Medical Board which we will refer to in shorthand as, the board. The Medical Society which we will refer to as, society and the Academy of Physicians Assistants or the academy, and the Physicians Health Program or the program, to identify for review and evaluate licencees of the board who have been referred to the program with regard to their ability to function in their professional capacity in coordinating regiments for treatment and rehabilitation there's some need to be included in the agreement there's some guidelines you'll see those under section four it's the first numerated section through six the program is described as an independent organization for medical professionals that provides screening, referral, monitoring, education, sports services. This program has been in existence for a long time we just didn't have a specific description of exactly what it did so we've included that. The board society academy may provide funds for the program. The program is required to report to the board on detailed information regarding the licencee their are

some other written information that's required section 15 repeals a requirement that the board provides a license see or applicant access to all information in it's possession that the board intends to offer into evidence in presenting its case, the effective date is 1st October of 2015. I'm happy to answer any questions. Thank you Ms. Matilda. Representative James you'd like to make some comments? Thank you Mr. Chairman just a couple of brief comments, I do want to say that this bill just to be clear is very much supported by the North Carolina medical board. As far as I know, there're no known opposition organized against it any group I can't really find anything that are deemed to be controversial about it. I would say the fee increase that was mentioned, I would just say from a perspective of a health care provider, it's a very modest one, it was mentioned that they had not done this in nine years and I would just say as a member of North Carolina Dental Society, that the fee is actually still less than what we pay in the Dental Society. So I think it's a very modest fee. Mr. Chair, I do have an amendment just a grammatical ammendment if I could send forth at this time. Proceed Representative James. Thank you sir. Everyone should have the amendment in front of them. If you go to lines 10 and 11 the number four there on page four, the current language there says the procedure by which license may obtain review of recommendations for assessment or treatment by the program is actually more grammatically correct adequately to say a procedure by which licences may obtain reviews of recommendation by the program regarding assesment or treatment, so simply a grammatical change to better reflect on what your supposed to say and Mr chair I would move the passage on the amendment. Okay, any questions on the ammendment, pretty straight forward. No questions. Do I have a motion to accept the amendment? You did that's right. Those in favor say, I Okay representative James thank you for that are there questions yes representative Henolton Johns. I'd be curious to know how the North Carolina hospitals association and the North Carolina medicals society feel about these changes. Thank you for that question representative Henoton as far as I know they're supporting not against no one is contact neither of the bill sponsors in acquisition so it's my understanding that there's no opposition by any group to this bill. Other questions? Yes sir. Way way back in the back right there. I'd say the removal of the information applicant is rejected by objective by the Medical or what's their legal procedure to appeal that decision? Thank you representative Blick[sp?], your overall representative Browly[sp?] you want to answer that? Mr chairman Tom Hansfield[sp?] Chief Legal Officer of the medical board is here,  I'd ask Hansfield[sp?] Chief Legal Officer the chair recognize him to answer that question. OK you come forward, state your name. Tom Hansfield[sp?] Chief Legal Officer from the medical board, thank you Mr. Chairman, that's a good question there are two levels of review, if an application is denied, the applicant can ask for a hearing before the full board, which consists of eight physicians and nurse practitioner in three public numbers, if the applicant is still unsatisfied with that result, that the applicant can then go to a superior court, and after the court appeals in [xx],   So we confirm   If they go to the court of appeals but they are not allowed to have any of the take out a provision but then we add in more specific language that provides for the discovery process just like in every other administrative proceedings in North Carolina under the APA. So all the information that the board has used to deny that application will be provided to the applicant in anticipation that hearing before the board that I mentioned so again they would use that, as that would be the evidence considered by the board and some of it presented by the applicant but again that would be presented at the superior court level and above. Representative Brawely.

Mr. Mansfield[sp?] if I could ask a question, as I understand the way the law works, the board would not publish it but it will be released to the applicant, so it's the applicants, what we're not saying is we're not going to put it in the public without applicant being involved in that process, so there could be a situation where the information that the board has, the applicant doesn't necessarily want to see on the front page of the [xx] observer this would prevent that from happening they would get the information on discovery so they would have full access for the port proceedings, of course once it becomes part that civil court proceeding at that point it will be in the public. So this is not going to prevent the applicant from having access for the information this is with all due respect the Jim moral prevented him from having access to it till it really needs to be in the public. Mr Misfile would you like to comment on that? I completely agree that's exactly right. Representative Pendleton, question. May I address the attorney? Go ahead proceed. But if the person is found by the Licencing Board and they choose not to appeal or even if they do appeal it and they're fined X. Y. Z that becomes public knowledge, right? The fact of the denial would be a public, there would be an order entered by the Board saying that the application was denied and why. Okay. Other questions or follow up. I don't believe I had a motion, is there a motion? You had the motion.   It's a move Mr. Chairman, I would move for the passage that so the proposed on house committee substitute as amended rode in to a new substitute on house bill 543 unfavorable to the region And a referral to finance.   [xx] to finance. Good thank you Representative Jones, all those in favor say I, any opposed? Thank you both for being here and stay tuned we may have a special meeting added next week we have a number of bills that have been introduced, and we are talking this afternoon about a special meeting that will try to accommodate to keep our flow of bills are moving along quite rapidly, thank you for being here, meeting is adjourned. OK, there