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House Calendar

TUESDAY, MARCH 13, 2007

59th DAY OF BIENNIAL SESSION

House Convenes at 10:00 AM

TABLE OF CONTENTS

                                                                                                               Page No.

ACTION CALENDAR

Action Postponed Until Tuesday, March 13, 2007

Favorable

H.  72   Amendments to the Charter of the City of Barre................................. 169

               Rep. Martin for Government Operations

Senate Proposal of Amendment

H. 302  Fiscal Year 2007 Budget Adjustments............................................... 169

For Action Under Rule 52

J.R.S. 20  Extension of Date for Retention of Judges ..................................... 176       

NOTICE CALENDAR

Favorable with Amendment

H. 44  Patient Choice and Control at end of Life............................................. 176

               Rep. Frank for Human Services

H. 70  Permitting Small, Renewable Energy Facilities...................................... 187

               Rep. Randall for Fish, Wildlife and Water Resources

H. 121  Protecting Air and Waters of State from Mercury.............................. 188

               Rep. Zenie for Fish, Wildlife and Water Resources

H. 169  Amendments to Charter of the Town of Williston............................... 191

               Rep. Manwaring for Government Operations

Favorable

H. 51  Amendments to Charter of the Village of Newbury.............................. 191

               Rep. Devereux for Government Operations

H. 97  Ability of Unified Towns & Gores to Incur Indebtedness...................... 191

               Rep. Evans for Government Operations


 

ORDERS OF THE DAY

ACTION CALENDAR

Action Postponed Until Tuesday, March 13, 2007

Favorable

H. 72

     An act relating to approval of amendments to the charter of the city of Barre.

     Rep. Martin of Wolcott, for the Committee on Government Operations, recommends the bill ought to pass.

(Committee Vote: 11-0-0)

Senate Proposal of Amendment

H. 302

     An act relating to fiscal year 2007 budget adjustments.

     The Senate proposes to the House to amend the bill as follows:

     First:  By striking out Sec. 8 in its entirety and inserting in lieu thereof a new Sec. 8 to read as follows:

Sec. 8.  Sec. 56 of No. 215 of the Acts of 2006 is amended to read:

Sec. 56.  Vermont court diversion

* * *

     (a)  Court diversion programs may use funds allocated in the appropriation above for increased wages to maintain salaries and benefits.

     Second:  After Sec. 9, by adding a new section to be numbered Sec. 9a to read as follows:

Sec. 9a.  Sec. 63 of No. 215 of the Acts of 2006 is amended to read:

Sec. 63.  Public safety – administration

* * *

     (b)  Of the funds appropriated to the department of public safety $26,000 shall be used to make a grant to the Essex county sheriff department. The commissioner may transfer this amount from line items in this appropriation or other department of public safety appropriations to implement this directive forthwith.

     Third:  By striking out Sec. 11(d) in its entirety

     Fourth:  In Sec. 20, by striking out the figure “242,760,326” where it twice appears and inserting in lieu thereof the figure 242,770,387 and by striking out the figure “79,565,428” and inserting in lieu thereof the figure 79,575,489

     Fifth:  By striking out Sec. 22 in its entirety and inserting in lieu thereof a new Sec. 22 to read as follows:

Sec. 22.  Sec. 101 of No. 215 of the Acts of 2006 is amended to read:

Sec. 101.  Secretary’s office-Global Commitment

          Grants                                                  792,294,238                 809,595,892

     Source of funds

          General fund                                         116,901,768                 124,205,456

          Special funds                                          12,939,662                   14,671,205

          Tobacco fund                                         19,299,711                   19,815,424

          State health care resource fund              153,832,688                 153,832,688

          Catamount fund                                                                             1,657,678

          Federal funds                                        487,041,206                 493,134,238

          Interdepartmental transfer                         2,279,203                     2,279,203

               Total                                               792,294,238                 809,595,892

***

(b)  In addition to the state funds appropriated in this section, a total estimated sum of $35,594,773 $33,133,325 is anticipated to be certified as state matching funds under the Global Commitment as follows:

(1)  $19,536,7351 $17,075,287 certified state match available from local education agencies.  This amount combined with $27,665,633 $24,379,713 of federal funds appropriated in this section equals a total estimated expenditure of $47,202,367 $41,455,000 for eligible special education school-based Medicaid services under the Global Commitment.  An amount equal to the actual amount of the federal matching funds for eligible special education school-based Medicaid services under global commitment shall be transferred from the Global Commitment fund to the Medicaid reimbursement special fund created in 16 V.S.A. § 2959a.

(2)  $1,497,110 certified state match available from local education agencies for eligible services under the Global Commitment provided to students under Section 504 of the Rehabilitation Act of 1973.

(32$7,459,137 $8,956,247 certified state match available from local education agencies for eligible services under the Global Commitment provided to students through school-based health services, including school nurses.

(43)  $4,215,210 certified state match available from local education and social service agencies for eligible services provided to students in the success beyond six programs eligible persons through the children’s collaborative services program.

(54)  $1,847,186 certified state match available from local designated mental health agencies for eligible mental health services provided under the Global Commitment.

(65)  $1,039,395 certified state match available from local designated developmental services agencies for eligible developmental services provided under the Global Commitment.

***

     Sixth:  After Sec. 22, by adding a new section to be numbered Sec. 22a to read as follows:

Sec. 22a.  GLOBAL COMMITMENT APPROPRIATIONS; TRANSFER;  REPORT

(a)  In order to facilitate the end of year closeout for fiscal year 2007, the secretary of the agency of human services, with approval from the secretary of administration, may make transfers among the appropriations authorized for Medicaid and Medicaid-waiver program expenses.  At least three business days prior to any transfer, the agency shall submit a proposal of transfers to be made pursuant to this section to the joint fiscal office.  A final report on all transfers made under this section shall be made to the joint fiscal committee for review at the September 2007 meeting.  The purpose of this section is to provide the agency with limited authority to modify the appropriations to comply with the terms and conditions of the global commitment for health waiver approved by the Centers for Medicare and Medicaid Services under Section 1115 of the Social Security Act.

     Seventh:  In Sec. 24, by adding a new subsection (c) to read as follows:

     (c)  The director of the office of Vermont health access shall not encumber or expend more than 10 percent of the $3,034,333 allocated in the appropriation above for marketing, outreach and associated internal systems for the Catamount, Medicaid and SCHIP programs until a plan has been reviewed and approved by the commission on health care reform created pursuant to Sec. 277c of No. 71 of the Acts of 2005.  

     Eighth:  By striking out Sec. 25 in its entirety and inserting in lieu thereof a new Sec. 25 to read as follows:

Sec. 25.  Sec. 109 of No. 215 of the Acts of 2006 is amended to read:

Sec. 109.  Office of Vermont health access - Medicaid program – non-Global Commitment long-term care waiver

     Grants                                             172,317 361                 167,782,587

Source of funds

     General fund                                     70,960,289                   69,092,869

     Federal funds                                  101,357,071                   98,689,718

          Total                                           172,317,361                 167,782,587

     (a)  The director of the office of Vermont health access and the commissioner of the department of disabilities, aging and independent living shall provide services to all eligible persons deemed high needs or greater.  The intent of this subsection is that for the remainder of fiscal year 2007 persons who are determined to be high or highest needs and eligible for services under the choices for care waiver shall receive services and not be placed on a waiting list.

     (b)  The director of the office of Vermont health access and the commissioner of the department of disabilities, aging and independent living shall report to the house and senate committees on appropriations by April 1, 2007 with recommendations on:  the methodology to be used for calculating program savings due to the Choices for Care waiver; and a framework for deciding how savings are to be reinvested.

     Ninth:  By striking out Sec. 34 in its entirety and inserting in lieu thereof a new Sec. 34 to read as follows:

Sec. 34.  Sec. 121 of No. 215 of the Acts of 2006 is amended to read:

Sec. 121.  Health – alcohol and drug abuse programs

     Personal services                            9,228,703                      9,216,203

     Operating expenses                         1,130,648                      1,130,648

     Grants                                            20,255,145                   20,267,645

          Total                                          30,779,496                   30,614,496

Source of funds

     General fund                                     3,370,025                     3,294,765

     Special funds                                        195,500                        195,500

     Tobacco fund                                   2,382,834                     2,382,834

     Global Commitment fund   15,235,609             15,777,640

     Federal funds                                    9,445,528                     8,813,757

     Interdepartmental transfer      150,000                  150,000

          Total                                          30,779,496                   30,614,496

* * *

     (g)  In addition to the $345,000 of funds allocated for grants to recovery centers in the above appropriation, $12,500 of funds shall be granted to the Vermont’s recovery center network.

     Tenth:  In Sec. 45, in Sec. 143 of No. 215 of the Acts of 2006, by striking out subsection (a) in its entirety and inserting in lieu thereof the following:

     (a)  In fiscal year 2007, the department for children and families may provide financial assistance and support services to families through solely state funded programs in order to maintain the separate state programs and segregated funds program established in subchapter 3 of chapter 11 of Title 33 and to assist the department in complying with the requirements relating to Temporary Assistance to Needy Families contained in the Deficit Reduction Act of 2005 pending further action by the general assembly.  This section shall not be interpreted to modify the requirements for families receiving services or the programs established in subchapter 3 of chapter 11 of Title 33, but is intended to permit the department flexibility in reporting maintenance-of-effort funds.

(b) In fiscal year 2007, the department for children and families and the department of taxes shall shift the source of funds used for the earned income tax credit from state maintenance of effort funds to temporary assistance to needy families (TANF) funds in order to maximize the state’s use of maintenance of effort funding to achieve compliance with federal law. The state maintenance of effort funds shifted from the earned income tax credit shall be used to replace the TANF funds shifted to that program. This section is not intended to increase funding for either department, but to allow for a shift in the funds source.

     Eleventh:  By striking out Sec. 53 in its entirety and inserting in lieu thereof a new Sec. 53 to read as follows:

Sec. 53.  Sec. 166 of No. 215 of the Acts of 2006 is amended to read:

Sec. 166.  Total human services                     2,334,471,503           2,364,199,280

     Source of funds

          General fund                                            485,036,701              484,632,600

          Special funds                                             55,098,746                57,469,667

          Tobacco fund                                            25,643,048                25,643,048

          Global Commitment fund                         759,799,535              775,567,996

          State health care resource fund                 153,932,688              153,932,688

          Catamount fund                                                                             1,657,678

          Federal funds                                           837,650,659              846,233,750

          Permanent trust funds                                        10,000                       10,000

          Internal service funds                                   3,322,612                  3,322,612

          Interdepartmental transfer                          13,977,514                15,729,241

               Total                                               2,334,471,503           2,364,199,280

     Twelfth:  After Sec. 56, by adding a new section to be numbered Sec. 56a to read as follows:

Sec. 56a.  Sec. 171 of No. 215 of the Acts of 2006 is amended to read:

Sec. 171.  Education - finance and administration

     Personal services                              4,619,254                     4,619,254

     Operating expenses                           1,623,008                     1,687,691

     Grants                                            14,505,600                   14,505,600

               Total                                     20,747,862                   20,812,545

Source of funds

     General fund                                     3,389,969                      3,389,969

     Special funds                                  14,924,219                   14,924,219

     Federal funds                                    1,614,782                     1,614,782

     Global Commitment fund        811,775                  876,458

     Interdepartmental transfer          7,117                       7,117

               Total                                     20,747,862                  20,812,545

***

     Thirteenth:  After Sec. 57, by adding a new section to be numbered Sec. 57a to read as follows:

Sec. 57a.  Sec. 174 of No. 215 of the Acts of 2006 is amended to read:

Sec. 174.  Education - special education: formula grants

     Grants                                            125,280,000                 125,215,000

Source of funds

     Education fund                  125,050,000           125,050,000

     Global Commitment fund          230,000                  165,000

               Total                                     125,280,000                 125,215,000

***

     Fourteenth:  After Sec. 58, by adding two new sections to be numbered Sec. 58a and Sec. 58b to read as follows:

Sec. 58a.  Sec. 177 of No. 215 of the Acts of 2006 is amended to read:

Sec. 177.  Education – adjusted education payment

     Grants                                             1,018,388,625            1,017,888,625

Source of funds

     Education fund                  1,018,388,625 1,017,888,625

* * *

Sec. 58b.  Sec. 180 of No. 215 of the Acts of 2006 is amended to read:

Sec. 180.  Education – small school grants

     Grants                                                       5,360,000           5,618,935

Source of funds

     Education fund                                5,360,000                   5,618,935

     Fifteenth:  In Sec. 60, by striking out the figure “1,778,138,935” where it twice appears and inserting in lieu thereof the figure 1,777,897,553 and by striking out the figure “1,307,222,597” and inserting in lieu thereof the figure 1,306,981,532 and by striking out the figure “1,041,775” and inserting in lieu thereof the figure 1,041,458

     Sixteenth:  In Sec. 74(a), by striking out the word “catagory” and inserting in lieu thereof the word category

     Seventeenth:  In Sec. 90(a)(3), by striking out the words “up to

     Eighteenth:  In Sec. 95, by adding a new subsection (c) to read as follows:

     (c)  The funds appropriated in Sec. 5 of H.213 of 2007 are exempt from the fiscal year 2007 general fund appropriation total used to calculate the five percent budget stabilization requirement for fiscal year 2008 in 32 V.S.A. § 308.

     Nineteenth:  By striking out Sec. 109 in its entirety and inserting in lieu thereof a new Sec. 109 to read as follows:

Sec. 109.  NEXT GENERATION FUND

(a)  Of the total sum transferred from the fiscal year 2007 general fund to the next generation initiative fund, the sum of $1,700,000 is appropriated as follows:

(1)  The sum of $500,000 is appropriated to the agency of commerce and community development for the issuance of Vermont training program grants pursuant to 10 V.S.A. § 531.

(2)  The sum of $500,000 is appropriated to the workforce education and training fund created in Sec. 157a(d) of No. 62 of the Acts of 1999 as amended by Sec. 14 of No. 212 of the Acts of 2006.

(3)  The sum of $500,000 is appropriated to the Vermont student assistance corporation for its nondegree grant program.

(4)  The sum of $200,000 is appropriated to the  Vermont state colleges for scholarships enabling dual enrollment by high school students in college courses.

     And by renumbering all of the sections of the bill to be numerically correct (including internal references) and adjusting all of the totals to be arithmetically correct.

For Action Under Rule 52

     J. R. S. 20

Joint resolution providing and relating to an extension of the date for the convening of a Joint Assembly to vote on the retention of Superior Judges and District Judges.

(For text see House Journal of March 1, 2007 Page 272)

 

NOTICE CALENDAR

Favorable with Amendment

H. 44

     An act relating to patient choice and control at end of life.

Rep. Frank of Underhill, for the Committee on Human Services, recommends the bill be amended by striking all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  FINDINGS

The general assembly finds:

(1)  The state of Oregon has been implementing its Death with Dignity Act since 1998.  According to the Eighth Annual Report on Oregon’s Death with Dignity Act, Oregon, in eight years, has seen a total of  390 terminal patients receive prescriptions to hasten death and, of those, 246 patients took the medication and died pursuant to the act.  Oregon’s annual report on the act shows that in 2005, 64 prescriptions were written, and 38 patients died after ingesting the medication.

(2)  Vermont has about one‑fifth the population of Oregon.  In the 2000 census, Oregon had a population of 3,421,399 and Vermont a population of 608,827.

(3)  In the past decade, Oregon has seen its hospice enrollment increase significantly.  In 1993, only 20 percent of dying patients were enrolled in hospice.  By 2005, enrollment increased to 54 percent.  In 2005, 92 percent of the patients who used medication under the Death with Dignity Act were in hospice care.

(4)  Oregon health care professionals report that ten terminal patients investigate their rights under the act for every patient who formally requests a prescription.

(5)  Despite continuing improvements in techniques for palliative care, most medical experts agree that not all pain can be relieved.  Some terminal diseases, such as bone cancer, inflict untreatable agony at the end of life.  Many cancer patients report that they would have greater comfort and courage in facing their future if they were assured they could use a Death with Dignity law if their suffering became unbearable.

Sec. 2.  18 V.S.A. chapter 113 is added to read:

CHAPTER 113.  RIGHTS OF QUALIFIED PATIENTS SUFFERING A TERMINAL CONDITION

§ 5280.  DEFINITIONS

For purposes of this chapter:

(1)  “Attending physician” means the physician who has primary responsibility for the care of the patient and who is willing to participate in the provision to a qualified patient of medication to hasten his or her death in accordance with this chapter.

(2)  “Capacity” shall have the same meaning as in subdivision 9701(4)(B) of this title.

(3)  “Consulting physician” means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient’s illness and who is willing to participate in the provision to a qualified patient of medication to hasten his or her death in accordance with this chapter.

(4)  “Counseling” means a consultation between a psychiatrist, psychologist, or clinical social worker licensed in Vermont and a patient for the purpose of confirming that the patient: 

(A)  has capacity; and

(B)  is not suffering from a mental disorder or disease that causes the patient to have impaired judgment.

(5)  “Health care provider” shall have the same meaning as in subdivision 9432(8) of this title.

(6)  “Informed decision” means a decision by a patient to request and obtain a prescription to hasten his or her death based on the patient’s understanding and appreciation of the relevant facts and was made after the patient was fully informed by the attending physician of all the following:

(A)  The patient’s medical diagnosis.

(B)  The patient’s prognosis.

(C)  The range of possible results, including potential risks associated with taking the medication to be prescribed.

(D)  The probable result of taking the medication to be prescribed.

(E)  All feasible end-of-life services, including comfort care, hospice care, and pain control.

(7)  “Patient” means a person who is 18 years of age or older, a resident of Vermont, and under the care of a physician.

(8)  “Physician” means a physician licensed pursuant to chapters 23 and 33 of Title 26.

(9)  “Qualified patient” means a patient with capacity who has satisfied the requirements of this chapter in order to obtain a prescription for medication to hasten his or her death.  No individual shall qualify under the provisions of this chapter solely because of age or disability.

(10)  “Terminal condition” means an incurable and irreversible disease which would, within reasonable medical judgment, result in death within six months.

§ 5281.  REQUESTS FOR MEDICATION

(a)  In order to qualify under this chapter:

(1)  A patient with capacity who has been determined by the attending physician and consulting physician to be suffering from a terminal condition and who has voluntarily expressed a wish to hasten the dying process may request medication to be self-administered for the purpose of hastening his or her death in accordance with this chapter.

(2)  A patient shall have made an oral request and a written request and shall have reaffirmed the oral request to his or her attending physician not less than 15 days after the initial oral request.  At the time the patient makes the second oral request, the attending physician shall offer the patient an opportunity to rescind the request.

(b)  Oral requests for medication under this chapter by the patient shall be made in the presence of the attending physician.

(c)  A written request for medication shall be signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that, to the best of their knowledge and belief, the patient has capacity, is acting voluntarily, and is not being coerced to sign the request.  Neither witness shall be any of the following persons:

(1)  The patient’s attending physician.

(2)  A relative of the patient by blood, marriage, civil union, or adoption.

(3)  A person who at the time the request is signed would be entitled to any portion of the estate of the patient under any will or by operation of law.

(4)  An owner, operator, or employee of a health care facility, nursing home, or residential care facility where the patient is receiving medical treatment or is a resident.

(d)  A person who knowingly fails to comply with the requirements in subsection (d) of this section is subject to prosecution under section 2004 of Title 13.

(e)  The written request shall be completed after the patient has been examined by a consulting physician as required by under section 5283 of this title.

§ 5282.  ATTENDING PHYSICIAN; DUTIES

The attending physician shall perform all the following:

(1)  Make the initial determination of whether a patient:

(A)  is suffering a terminal condition;

(B)  has capacity; and

(C)  has made a voluntary request for medication to hasten his or her death.

(2)  Request proof of Vermont residency, which may be shown by:

(A)  a Vermont driver’s license or photo identification card;

(B)  proof of Vermont voter’s registration;

(C)  evidence of property ownership or a lease of residential premises in Vermont; or

(D)  a Vermont personal income tax return for the most recent tax year.

(3)  Inform the patient in person and in writing of all the following:

(A)  The patient’s medical diagnosis.

(B)  The patient’s prognosis.

(C)  The range of possible results, including potential risks associated with taking the medication to be prescribed.

(D)  The probable result of taking the medication to be prescribed.

(E)  All feasible end-of-life services, including comfort care, hospice care, and pain control.

(4)  Refer the patient to a consulting physician for medical confirmation of the diagnosis, prognosis, and a determination that the patient has capacity and is acting voluntarily.

(5)  Refer the patient for counseling if appropriate under section 5284 of this chapter.

(6)  Recommend that the patient notify the next of kin or someone with whom the patient has a significant relationship.

(7)  Counsel the patient about the importance of having another individual present when the patient takes the medication pursuant to this chapter and the importance of not taking the medication in a public place.

(8)  Inform the patient that the patient has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15-day waiting period.

(9)  Verify, immediately prior to writing the prescription for medication under this chapter, that the patient is making an informed decision.

(10)  Fulfill the medical record documentation requirements of section 5289 of this title.

(11)  Ensure that all required steps are carried out in accordance with this chapter prior to writing a prescription for medication to hasten death.

(12)(A)  Dispense medication directly, including ancillary medication intended to facilitate the desired effect to minimize the patient’s discomfort, provided the attending physician is licensed to dispense medication in Vermont, has a current Drug Enforcement Administration certificate, and complies with any applicable administrative rules; or

(B)  With the patient’s written consent:

(i)  contact a pharmacist and inform the pharmacist of the prescription; and

(ii)  deliver the written prescription to the pharmacist, who will dispense the medication to the patient, the attending physician, or an expressly identified agent of the patient.

(13)  Notwithstanding any other provision of law, the attending physician may sign the patient’s death certificate.

§ 5283.  MEDICAL CONSULTATION REQUIRED

Before a patient is qualified in accordance with this chapter, a consulting physician shall physically examine the patient, review the patient’s relevant medical records, and confirm in writing the diagnosis of the attending physician that the patient is suffering from a terminal condition and verify that the patient has capacity, is acting voluntarily, and has made an informed decision.

§ 5284.  COUNSELING REFERRAL

If a patient is not receiving hospice services at the time the written request for medication is made under this chapter, he or she shall undergo counseling under this section.  If a patient is receiving hospice services at the time the written request for medication is made under this chapter and if, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a mental disorder or disease causing impaired judgment, either physician shall refer the patient for counseling.  No medication to end the patient’s life shall be prescribed until the person performing the counseling determines that the patient is not suffering from a mental disorder or disease that causes the patient to have impaired judgment.

§ 5285.  INFORMED DECISION

No person shall receive a prescription for medication to hasten his or her death unless the patient has made an informed decision.  Immediately prior to writing a prescription for medication in accordance with this chapter, the attending physician shall verify that the patient is making an informed decision.

§ 5286.  RECOMMENDED NOTIFICATION

The attending physician shall recommend that the patient notify the patient’s next of kin or someone with whom the patient has a significant relationship of the patient’s request for medication in accordance with this chapter.  A patient who declines or is unable to notify the next of kin shall not be refused medication in accordance with this chapter.

§ 5287.  RIGHT TO RESCIND

A patient may rescind the request at any time and in any manner regardless of the patient’s mental state.  No prescription for medication under this chapter may be written without the attending physician offering the patient an opportunity to rescind the request.

§ 5288.  WAITING PERIOD

The attending physician shall write a prescription no less than 48 hours after the last to occur of all of the following events:

(1)  the patient’s written request for medication to hasten his or her death;

(2)  the patient’s second oral request; and

(3)  the attending physician’s offering the patient an opportunity to rescind the request.

§ 5289.  MEDICAL RECORD DOCUMENTATION

The following shall be documented and filed in the patient’s medical record:

(1)  The date and wording of all oral requests of the patient for medication to hasten his or her death.

(2)  All written requests by a patient for medication to hasten his or her death.

(3)  The attending physician’s diagnosis, prognosis, and basis for the determination that the patient has capacity, is acting voluntarily, and has made an informed decision.

(4)  The consulting physician’s diagnosis, prognosis, and verification that the patient has capacity, is acting voluntarily, and has made an informed decision.

(5)  A report of the outcome and determinations made during any counseling which the patient may have received.

(6)  The date and wording of the attending physician’s offer to the patient to rescind the request for medication at the time of the patient’s second oral request.

(7)  A note by the attending physician indicating that all requirements under this chapter have been satisfied and all the steps that have been taken to carry out the request, including a notation of the medication prescribed.

§ 5290.  REPORTING REQUIREMENT

(a)  The department of health shall require that any physician who writes a prescription pursuant to this chapter file a report with the department covering all the prerequisites for writing a prescription under this chapter.  In addition, physicians shall report the number of written requests for medication that were received, regardless of whether or not a prescription was actually written in each instance.

(b)  The department of health shall annually review the medical records of qualified patients who have hastened their deaths in accordance with this chapter.

(c)  The department of health shall make rules to facilitate the collection of information regarding compliance with this chapter.  The information collected shall not be public record and shall not be made available for inspection by the public.

(d)  The department of health shall generate and make available to the public an annual statistical report of information collected under subsections (a) and (b) of this section.  The report shall include the number of instances in which medication was taken by a qualified patient to hasten death but failed to have the intended effect.

§ 5290a.  COLLECTION AND DISPOSAL OF UNUSED MEDICATIONS

The department of health shall develop a policy for ensuring that unused medications prescribed under this chapter are collected and disposed of appropriately.

§ 5291.  PROHIBITIONS; CONTRACT CONSTRUCTION

(a)  No provision in a contract, will, or other agreement, whether written or oral, shall be valid, to the extent the provision would affect whether a person may make or rescind a request for medication to hasten his or her death in accordance with this chapter.

(b)  The sale, procurement, or issue of any life, health, or accident insurance or annuity policy or the rate charged for any policy shall not be conditioned upon or affected by the making or rescinding of a request by a person for medication to hasten his or her death in accordance with this chapter or the act by a qualified patient to hasten his or her death pursuant to this chapter.  Neither shall a qualified patient’s act of ingesting medication to hasten his or her death have an effect on a life, health, or accident insurance or annuity policy.

§ 5292.  IMMUNITIES

(a)  No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance in accordance with this chapter.  This includes being present when a qualified patient takes the prescribed medication to hasten his or her death in accordance with this chapter.

(b)  No professional organization or association or health care provider may subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating or refusing to participate in good faith compliance with this chapter.

(c)  No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of this chapter shall constitute neglect for any purpose of law.

(d)  No request by a patient for medication under this chapter shall provide the sole basis for the appointment of a guardian or conservator.

(e)  No health care provider shall be under any duty, whether by contract, by statute, or by any other legal requirement, to participate in the provision to a qualified patient of medication to hasten his or her death in accordance with this chapter.  If a health care provider is unable or unwilling to carry out a patient’s request in accordance with this chapter and the patient transfers his or her care to a new health care provider, the previous health care provider, upon request, shall transfer a copy of the patient’s relevant medical records to the new health care provider.  A decision by a health care provider not to participate in the provision of medication to a qualified patient shall not constitute the abandonment of the patient or unprofessional conduct under section 1354 of Title 26.

§ 5293.  HEALTH CARE FACILITY EXCEPTION

Notwithstanding any other provision of law, a health care facility may prohibit an attending physician from writing a prescription for medication under this chapter for a patient who is a resident in its facility and intends to use the medication on the facility’s premises, provided the facility has notified the attending physician in writing of its policy with regard to such prescriptions.  Notwithstanding subsection 5292(b) of this title, any health care provider who violates a prohibition established under this section may be subject to sanctions otherwise allowable under law or contract.

§ 5294.  LIABILITIES AND PENALTIES

(a)  Nothing in this chapter shall be construed to limit liability for civil damages resulting from negligent conduct or intentional misconduct by any person.

(b)  Nothing in this chapter or in section 2312 of Title 13 shall be construed to limit criminal prosecution under any other provision of law.

(c)  A health care provider is subject to review and disciplinary action by the appropriate licensing entity for failing to act in accordance with this chapter, provided such failure is not in good faith.

§ 5295.  FORM OF THE REQUEST

A request for medication as authorized by this chapter shall be substantially in the following form:

REQUEST FOR MEDICATION

TO HASTEN MY DEATH

I, ___________________ , am an adult of sound mind.

I am suffering from _______________, which my attending physician has determined is a terminal disease and which has been confirmed by a consulting physician.

I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible end-of-life services, including comfort care, hospice care, and pain control.

I request that my attending physician prescribe medication that will hasten my death.

INITIAL ONE:

_____ I have informed my family or others with whom I have a significant relationship of my decision and taken their opinions into consideration.

_____ I have decided not to inform my family or others with whom I have a significant relationship of my decision.

_____ I have no family or others with whom I have a significant relationship to inform of my decision.

I understand that I have the right to change my mind at any time.

I understand the full import of this request, and I expect to die when I take the medication to be prescribed.  I further understand that although most deaths occur within three hours, my death may take longer, and my physician has counseled me about this possibility.

I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.

Signed: _________________________ Dated: ____________

DECLARATION OF WITNESSES

We declare that the person signing this request:

(a)  Is personally known to us or has provided proof of identity;

(b)  Signed this request in our presence;

(c)  Appears to be of sound mind and not under duress, fraud, or undue influence;

(d)  Is not a patient for whom either of us is the attending physician.

Witness 1/Date ______________________________________

Witness 2/Date ______________________________________

NOTE:  Neither witness may be a relative (by blood, marriage, civil union, or adoption) of the person signing this request, may be entitled to any portion of the person’s estate upon death, or may own, operate, or be employed at a health care facility where the person is a patient or resident.  A knowing false declaration by a witness may result in criminal penalties.

§ 5296.  STATUTORY CONSTRUCTION

Nothing in this chapter shall be construed to authorize a physician or any other person to end a patient’s life by lethal injection, mercy killing, or active euthanasia.  Action taken in accordance with this chapter shall not be construed for any purpose to constitute suicide, assisted suicide, mercy killing, or homicide under the law.

Sec. 3.  13 V.S.A. § 2312 is added to read:

§ 2312.  Violation of PATIENT CHOICE AND CONTROL AT END OF

               LIFE ACT

(a)(1)  No person shall:

(A)  willfully alter or forge a patient’s request for medication under chapter 113 of Title 18, with the intent or effect of causing the patient’s death; or

(B)  conceal or destroy a rescission of a patient’s request for medication  under chapter 113 of Title 18, with the intent or effect of causing the patient’s death.

(2)  No person shall coerce or exert undue influence on a patient:

(A)  to request medication under chapter 113 of Title 18; or

(B)  to destroy a patient’s rescission of a request for medication under chapter 113 of Title 18.

(b)  A person who violates this section and thereby causes the death of the patient shall be guilty of first degree murder and subject to the penalties provided in subsection 2303(a) of this title.

Sec. 4.  13 V.S.A. § 2004 is added to read:

§ 2004.  FALSE WITNESSING

A person who knowingly violates the requirements of subsection 5281(d) of Title 18 shall be imprisoned for not more than 10 years or fined not more than $2,000.00, or both.

(Committee vote: 7-4-0)

H. 70

     An act relating to a streamlined process for permitting small renewable energy facilities.

Rep. Randall of Troy, for the Committee on Fish, Wildlife and Water Resources, recommends the bill be amended by striking all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  PUBLIC SERVICE BOARD REPORT ON PERMITTING
                    MINI‑HYDROELECTRIC PROJECTS

(a)  Prior to January 15, 2008, the public service board shall report to the house committee on fish, wildlife and water resources and the senate committee on natural resources and energy with a recommendation for a simple, predictable, and environmentally sound process, other than the process set forth in subsection 248(j) of Title 30, for issuing a certificate of public good under section 248 of Title 30 for mini‑hydroelectric projects.  The report shall:

(1)  Recommend criteria for determining what constitutes a mini‑hydroelectric facility, including the allowable maximum amount of output capacity at the facility and the type of eligible facilities, natural features, or other sites.

(2)  Address permit application requirements, including ownership of the facility and structural safety of the mini‑hydroelectric project.

(3)  Address additional uses of the mini‑hydroelectric project such as flood control; fish and wildlife habitat; recreation; water supply; historic resource; and structural grade control for infrastructure, roads, bridges, and houses.

(4)  Address the use of flashboards to increase upstream flooding.

(5)  Address measures to prevent fish from entering turbines and penstocks.

(6)  Address the size of authorized diversions and penstocks.

(7)  Recommend, after consultation with the agency of natural resources, how to establish and fund an ombudsman to assist individuals seeking a certificate of public good for a mini‑hydroelectric facility.  The board’s proposal shall analyze how the ombudsman would coordinate with the agency of natural resources regarding application for water quality certification and the feasibility and effectiveness of incorporating the ombudsman for mini‑hydroelectric facilities into the ombudsman for renewable energy at the agency of agriculture food and markets.

Sec. 2.  AGENCY OF NATURAL RESOURCES REPORT ON WATER
    QUALITY CERTIFICATION FOR MINI‑HYDROELECTRIC
    PROJECTS

(a)  Prior to January 15, 2008, the secretary of natural resources shall report to the house committee on fish, wildlife and water resources and the senate committee on natural resources and energy with a recommendation for a simple, predictable, and environmentally sound procedure for completing a water quality certification review of mini‑hydroelectric projects as required by Section 401 of the federal Clean Water Act.  The report shall:

(1)  Recommend, after consultation with the public service board, criteria for determining what constitutes a mini‑hydroelectric facility, including the allowable maximum amount of output capacity at the facility and the type of eligible facilities, natural features, or other sites;

(2)  Address bypass flows for mini‑hydroelectric projects.

(3)  Address the need for monitoring of dissolved oxygen at mini‑hydroelectric facilities.

(4)  Address seasonal flows in bypasses at run‑of‑river facilities. 

(5)  Address the need for new fish or flow studies for mini‑hydroelectric projects. 

(Committee vote: 8-0-1)

H. 121

     An act relating to Protecting the air and waters of the state by banning certain uses of mercury amalgam, and by requiring manufacturers of mercury -added thermostats to collect those thermostats facing disposal.

Rep. Zenie of Colchester, for the Committee on Fish, Wildlife and Water Resources, recommends the bill be amended by striking all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  ENVIRONMENTAL IMPACTS OF DENTAL AMALGAM

The general assembly finds:

(1)  According to a 2004 study by the U.S. Environmental Protection Agency, titled “International Mercury Market Study and the Role and Impact of U.S. Environmental Policy,” mercury from dental amalgam is the source of the greatest reservoir of consumer-derived mercury, over 50 percent, when compared with the mercury contained in all other consumer products. 

(2)  As the rate of cremation increases, in the absence of state requirements that crematoria install expensive emission control equipment,  much of this reservoir of mercury derived from dental amalgam will be emitted to the atmosphere and eventually will be deposited into the waters of the state.

(3)  Due to concerns about mercury emissions from crematoria, the Vermont air pollution control division in December 2006 recommended that the use of dental amalgam be banned or rapidly phased out.

(4)  While dental practices in Vermont are required to self-certify compliance with best management practices, including the installation of amalgam separators on wastewater discharge systems, recent studies indicate that without proper installation and rigorous attention to ongoing and proper maintenance, the efficiency of mercury removal from pollution control devices may not be as high as removal rates in laboratory testing.

(5)  After releases of mercury from dental offices, mercury from human wastes traced to the urine and feces of people with amalgam fillings is the second largest contributor of dental mercury to wastewater treatment plants, according to a 2002 study conducted by the Association of Metropolitan Sewage Agencies.

(6)  Mercury in household wastewater can lead to mercury in sludge, the management of which in turn can lead to other routes by which mercury can enter the waters of the state and the food chain.

(7)  Reducing the use of mercury amalgam is an important step in reducing the extent to which the general populace is exposed to mercury from environmental sources.

Sec. 2.  18 V.S.A. § 12 is added to read:

§ 12.  MERCURY DENTAL FILLINGS; BROCHURE

(a)  The commissioner, after reviewing similar initiatives in other states, shall produce a brochure explaining the potential advantages and disadvantages to oral health, overall human health, and the environment of using mercury or a mercury amalgam in dental procedures.  The department shall make the brochure available on the internet or upon request. 

(b)  The brochure shall describe the available alternatives to a mercury amalgam, and the potential advantages and disadvantages posed by using those alternatives.  The brochure shall also include other information that contributes to the patient’s ability to make an informed decision when choosing between the use of a mercury amalgam and an alternative material in dental procedures, including information on durability, cost, aesthetic quality, and other characteristics.

Sec. 3.  26 V.S.A. § 726 is added to read:

§ 726.  MERCURY DENTAL FILLINGS;  INFORMED CONSENT

Effective April 1, 2008, no mercury amalgam filling shall be placed in a patient’s tooth unless a dentist has provided the patient with a copy of the brochure produced under section 12 of Title 18 and the patient has first signed an informed consent form, provided by the commissioner of health, that states:  “Dental amalgam contains approximately 50 percent mercury, a highly toxic element with potential human risks.  Such product should not be administered to a child six years of age or younger, pregnant women, or lactating women.”  A dentist shall obtain the informed consent required from a patient under this section prior to treatment of a diagnosis that requires the placement of a mercury amalgam filling in one or more of a patient’s teeth.

Sec. 4.  REPORT CONCERNING MERCURY USED IN AMALGAM
                  FILLINGS 

Annually, by December 1 of 2008, 2009, 2010, and 2011, any person that supplies mercury-containing amalgam to dentists or dental offices in this state shall report to the department of environmental conservation the volume of mercury the person supplied to dentists and dental offices in this state during the prior year.  Annually, by January 15 of 2009, 2010, 2011, and 2012, the department of environmental conservation, in consultation with the advisory committee on mercury pollution, shall report the quantity of mercury supplied to dentists and dental offices in this state to the committees on natural resources and energy and to the house committee on fish, wildlife and water resources.  For the purposes of this section, “person” means an individual, partnership, corporation, or other legal entity.

The Committee further recommends that upon passage of the bill, the title shall read as follows:

AN ACT RELATING TO REQUIRING INFORMED CONSENT PRIOR TO THE USE OF MERCURY AMALGAM

(Committee vote: 7-1-1)


H. 169

     An act relating to approval of amendments to the charter of the town of Williston.

Rep. Manwaring of Wilmington, for the Committee on Government Operations, recommends the bill be amended in Sec. 5, 24 V.S.A. App. chapter 156, § 14(a), by deleting the striking from subdivision (10) as follows:

(10)  Library trustee;

( Committee Vote: 11-0-0)

Favorable

H. 51

     An act relating to approval of amendments to the charter of the village of Newbury.

Rep. Devereux of Mount Holly, for the Committee on Government Operations, recommends the bill ought to pass.

( Committee Vote: 11-0-0)

H. 97

     An act relating to the ability of the unified towns and gores of Essex county to incur indebtedness.

Rep. Evans of Essex, for the Committee on Government Operations, recommends the bill ought to pass.

( Committee Vote: 11-0-0)

 

PUBLIC HEARINGS

Wednesday, March 14th, 2007, - Room 11 – 6:00 p.m. to 8:30 p.m.  Comments on Education issues contained in the Framework of agreed upon Legislative topics.  Email Roman at  rkokodyniak@leg.state.vt.us  or call at  828 2256; or Roz at rdaniels@leg.state.vt.us or call at 828 2250, for a copy of the Framework.

 

HOUSE EDUCATION AND WAYS & MEANS

COMMITTEE HEARING

Members’ comments on Framework

     House Education and Ways and Means committees invite all House and Senate members to attend this hearing on Wednesday, March 14th , 2:30 – 4:30 in room 11.  Please see Roman (room 31) or Roz (room 34) if you need a copy of the Framework. 



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us