Department of Health And Senior Services – Missouri House of Representatives Newsroom

Guidance on non-opioid pain management options would be offered under House proposal

Many Missourians want to avoid opioids when given an option for dealing with pain, and one state representative wants to make sure they know what their choices are.

*Representative Melanie Stinnett (Photo: Tim Bommel, Missouri House Communications)*

House Bill 2182 would require the Department of Health and Senior Services to create an educational pamphlet on the use of non-opioid options for pain management. It would cover pharmacological and non-pharmacological treatments and related advantages and disadvantages.

It’s sponsored by Springfield Republican Melanie Stinnett.

“Some people know that if they are presented with or given an opioid within their care, that they are at a higher likelihood of becoming addicted to that, and we want to give people as many choices as possible to say, ‘I want to choose something else,’ and so if they don’t know that there are other options, then they don’t know that they can provide that other option when they’re talking with their physician,” Stinnett said.

“I think many of us are familiar with opioids and what opioids are and what they do, and maybe there are people who would say, ‘Well if an opioid’s my option, I want pain management when I go to the doctor for a certain procedure,’ but if they know there are other, non-opioid options that could present the same pain relief for them, then maybe they would make that choice instead.”

To Stinnett, this would be a continuation of the legislative efforts that have surrounded opioid abuse for many years.

“I think every step that we can take, when we’re talking about decreasing opioid use, is an important step toward making sure that our communities are safe and the people within our communities have options to choose for themselves, so they can maintain their safety.”

The proposal has not been referred to a committee. With the session entering early March, Stinnett knows that isn’t encouraging, but she’s hopeful the one-page provision can be added to some other legislation. Even if it does not gain traction this year, she said the Department has been receptive and could create a pamphlet anyway.

In any case, she wants to see her idea become law to make sure such pamphlets are created, maintained, and updated as an ongoing educational tool.

Even in the absence of a pamphlet, Stinnett encourages Missourians to talk to their doctors and ask about their options.

“If a physician, or another provider, or maybe you talked with somebody who had a similar procedure and they said, ‘Oh, these are the pain medications that I took,’ ask about your options. It’s important that we’re always inquisitive about what’s available or us in our healthcare so that we can make choices.”

“I think it makes sense for us to be prepared consumers of health, so before you go into a doctor’s office before you go in for any kind of healthcare, you need to be prepared with any kind of questions or thoughts that you might have,” Stinnett said.

HB 2182 has been referred to the House Committee on Healthcare Reform.

House panel told Missouri is ready for coronavirus

A Missouri House panel today heard from three doctors, including the Director of the Department of Health and Senior Services, about how ready the state is for the coronavirus.

Doctor Randall Williams, Director of the Missouri Department of Health and Senior Services (Photo: Tim Bommel, Missouri House Communications)

Legislators heard Missouri is very prepared and that the best thing Missourians can do to prevent the disease from spreading is wash their hands.

“We have been meeting daily since January 27,” DHSS Director Randall Williams told lawmakers. “I believe we are very well prepared. Our motto is, ‘Hope for the best, prepare for the worst,’ and we think we are prepared for both.”

More than 100 people had been confirmed to have the coronavirus in the United States and it is responsible for six deaths in this country as of Monday afternoon. The disease has killed more than 3,000 people globally. House Speaker Elijah Haahr (R-Springfield) created the House Special Committee on Disease Control and Prevention to assess Missouri’s readiness for the disease to appear here.

Doctor Stevan Whitt with the University of Missouri Health System deals with infectious diseases. He told committee chairman Jonathan Patterson (R-Lees Summit) the current rates of infections and deaths suggest a 3.3-percent mortality rate with coronavirus.

“Which means you have about a 97-percent rate of survival even if you get the virus,” said Whitt.

“And that number’s probably even lower given that there’s been underreporting of the cases,” said Patterson.

“We know there are asymptomatic people who would never have gone to a doctor and never gotten tested, so in all likelihood those numbers are higher,” said Whitt.

Representative Jonathan Patterson (Photo: Tim Bommel, Missouri House Communications)

Williams noted that the mortality rate is twenty times greater than the flu.

“It’s two percent and the flu is one in 1,000, so you’re talking about two out of 100 versus one in 1,000, so that’s concerning,” said Williams.

No cases of coronavirus have been confirmed in Missouri. Williams, who has been in regular contact with federal officials and his counterparts from other states, said samples from fewer than 15 patients in Missouri are being tested for the virus, while California has tested more than 460 people.

Whitt said corona is very much like the common cold or flu in the symptoms that a person presents.

“You get it from coughing, sneezing, runny nose; all the usual things, contact, close contact with somebody who’s had it, inhalation of droplets – especially a large amount of droplets from somebody who you’re very close to, distance wise,” said Whitt. “We know that cases can be everywhere from completely asymptomatic to death. Most of the deaths are associated with lung involvement and inability to appropriately oxygenate, similar to influenza.”

The doctors told lawmakers that the state has a plan in place for dealing with a pandemic and those plans were made available to lawmakers and the media. They also said the best things the public can do to protect against coronavirus and stem its spread are the same things commonly recommended to keep healthy.

“Starting today we’re pushing out to all 50,000 state employees our messaging that the most important thing that will keep people from dying in this epidemic is that … soap. It’s public health 101,” said Williams.

“If you’re sick, please stay at home. If you’re sick and need to go see a doctor please check in, tell them about your symptoms. Usually you’ll be given a mask if part of your symptoms are fever, cough, and/or shortness of breath, and please put on the mask,” said Whitt. “If you’re sick and do not need to be in the hospital or see a doctor just stay home, call in sick. I would encourage [legislators] to help us encourage employers to give very lenient practices to people who are sick and want to stay home during this time.”

Whitt said another concern is the “classic hoarding mentality” applying to things like masks. He said for people who are not sick to wear those affords them very little protection.

“They protect mostly the person from disseminating the disease. For instance the regular surgical masks that are the recommended masks for people who are ill, they don’t really filter air. What they do is they trap particles … that’s what happens when you cough into one, that’s what happens when you sneeze into one,” said Whitt. “If, on the other hand, the person who is the source of infection is not wearing the mask but you are, you still breathe around the edges, you still breathe around the gaps in the top around your nose. It’s not very protective for individuals who are not sick. It’s protective of groups of people to put it on the sick person.”

The doctors also recommended that those who haven’t gotten a flu shot go ahead and do so, as cases of the flu continue to rise.

Williams said the state health lab in Jefferson City now has the capability to test for coronavirus and have a result in six hours.

Doctors said another concern if the disease reaches Missouri will be in hospital and clinic staffing if staff members begin getting sick.

Speaker Haahr said the legislature is prepared to act as needed to support the response to coronavirus, including by appropriating funds or giving authority for the spending of federal funds. He said the citizens of Missouri should know their government is prepared to protect them from the virus, and said he has complete faith in Williams to head up the state’s response.

The committee will hold additional hearings on an as-needed basis.

With victim’s family present, House passes bill to require reporting of sexual assaults in nursing homes

Several years ago a woman living in a Missouri nursing home died after being sexually assaulted in that home, and the identity of her attacker will likely never be known. On Friday the Missouri House completed passage of a bill aimed at keeping that from happening to anyone else.

Maribeth and David Russell of Russellville, Missouri, listen as the House passes legislation Maribeth advocated for, for five years, after her mother-in-law was victimized at a nursing home and the crime was not reported to law enforcement. (photo; Tim Bommel, Missouri House Communications – click for larger version)

That woman was Maribeth Russell’s mother-in-law, and Russell spent the past five years pushing for a change in Missouri law. That culminated Friday with the passage of House Bill 1635, which requires that law enforcement be notified when it is suspected that a long-term care resident 60-years of age or older has been sexually assaulted.

Russell was in the House when it gave final passage to HB 1635, 139-0.

Russell said that law enforcement was not notified by the nursing home or the hospital of the crime against her mother-in-law. The family assumed such notification was made when the Department of Health and Senior Services was contacted. By the time the family learned that was not the case, it was too late.

“Sexual assault is timely. You have to quickly jump on it to try to collect evidence and that wasn’t done, so there was never an arrest made or a prosecution made at all, and I simply wanted to prevent this from happening to others down the road,” said Russell. “Let’s change this law, let’s fill this gap that’s in the statute and prevent this from happening again.”

HB 1635 would expand Missouri law that requires abuse or neglect to be reported to the Department of Health and Senior Services. Its reporting requirement applies to in-home care providers, adult day care workers, medical and mental health care providers, medical examiners, funeral directors, and those in numerous other professions.

Representative Mike Bernskoetter (R-Jefferson City) has worked for several years, with Russell, on the language that became HB 1635. He agreed with other lawmakers that the issue was, “unsettling.”

“Especially a situation like this where somebody went through this kind of heinous act and then there was basically nothing [that] could be done about it because there was a hole in our statutes,” said Bernskoetter. “Just thinking about what could have happened to [Maribeth Russell’s] mother-in-law, it could happen to your mom or your grandma or somebody that you knew.”

Russell said the passage of HB 1635 amounts to closure for her.

Representative Mike Bernskoetter (photo; Tim Bommel, Missouri House Communications – click for larger version)

“Knowing that we’re helping others down the road – people who may never know we’ve helped – but we’re trying to prevent others from having to experience what we’ve experienced here,” said Russell.

She said the nursing home and hospital that treated her mother-in-law have made it their practice to report possible sexual assaults to law enforcement, and she’s thankful for that. She wants HB 1635 to ensure that all agencies in the state are doing the same.

Bernskoetter is hopeful that, while it is unlikely, the person who attacked Russell’s mother-in-law will one day be identified. In the meantime he hopes that 1635 will be signed into law by the governor, and will prevent the same thing from happening again.

Budget proposal maintains House’s steep cuts to DHSS after dispute over virus data

House and Senate conferees have agreed to a budget that would make significant cuts in the Department of Health and Senior Services’ director’s office. House members say that department is needlessly withholding information about a virus outbreak that killed two people in Missouri, including one state employee.

House Budget Committee Chairman Scott Fitzpatrick (in foreground, right) and Senate Budget Committee Chairman Dan Brown (foreground, left) speak to Senator Jamilah Nasheed while House Budget Committee Vice Chairman Justin Alferman (top, center) speaks to Senators Dan Hegeman (top left) and Kiki Curls during a break in the conference committee hearing Monday. Those senators had concerns about Reps. Fitzpatrick’s and Alferman’s intentions to cut money that amounts to the salaries of several people in the Department of Health and Senior Services’ Director’s office, including the director. (photo; Mike Lear, Missouri House Communications – click for larger version)

The conference committee agreed to cut money equal to the salaries of eight positions in the director’s office, including the director.

House Budget Committee Vice Chairman Justin Alferman (R-Hermann) is one of several lawmakers who have asked how many people in Missouri have tested positive for the antibodies to the Bourbon virus. The House has also subpoenaed the Department seeking that information, and the Department still hasn’t provided it.

The Director of the Department of Health and Senior Services, who had not appeared before the House Budget Committee for any of its public hearings, did appear before the conference committee between House and Senate members that met Monday night to agree on a budget proposal for both chambers to vote on this week. Dr. Randall Williams maintains he can’t release what Alferman and others are asking for.

“Missouri law and HIPAA are very clear that if I provide information that can identify you in a small sample size, [that’s a violation],” said Williams.

The Department’s General Counsel, Nikki Loethen, told the committee, “The issue here is that there is already significant information already available regarding who was tested and with all of that information that’s already available, for us to disclose the information that [l awmakers are asking for] could lead to the identification of individuals.”

Alferman said the Department’s argument that the information could lead to the identification of individuals is “ridiculous.”

Some senators on the conference committee wanted to restore what they called “drastic” cuts to DHSS, but Alferman and House Budget Committee Chairman Scott Fitzpatrick (R-Shell Knob) did not want to back down. Alferman had already agreed to reverse another of his amendments in response to the situation that shifted control of the state health lab from DHSS to the Department of Public Safety.

“I don’t know how I’m supposed to negotiate with someone who doesn’t come to the table,” said Alferman about the Department.

Fitzpatrick noted that Williams was once before at the center of a controversy with serious implications for public health.

In 2016 Williams, while the public health director for the State of North Carolina, joined another state official in rescinding a “do not drink” notice regarding well water potentially contaminated by coal ash. The state’s toxicologist at the time said North Carolina was telling people the water was safe when it knew it wasn’t, and went so far as to accuse other state officials of “playing down the risk.”

“It would just seem to indicate that there’s a pattern of behavior that Dr. Williams has made a controversial decision in the past,” said Fitzpatrick. “I just don’t think that allowing that to continue to happen in Missouri is a good idea.”

Democrats who opposed the cuts to DHSS noted the positions cut in the Director’s office would include the lawyers who interpret for the Department how it must act to comply with state and federal laws.

“I do find it concerning that when we ask the Department to interpret laws, both federal and state, and then they interpret it, if we disagree with their interpretation that we’re then going to cut their funding, of the very people who makes those interpretations,” said Springfield representative Crystal Quade (D). “We’re dealing with very sensitive information and very dangerous, life-threatening things, often, with these viruses, and it’s important that we are following the law accordingly so that we can make sure people are protected, so it was concerning to me that was the decision of the committee.”

Fitzpatrick noted that the cuts would remove 8 people from a department of more than 1,700 employees.

“I doubt those eight people are going to make it impossible for the mission of the Department of Health and Senior Services to be met. I think if anything, several of those people were part of obstructing the General Assembly from finding the information that I think [it’s] entitled to,” said Fitzpatrick.

Backers of the cuts said they are concerned about the safety of the public, and that includes Missourians knowing whether they should be concerned about a bourbon virus outbreak.

“I can’t go home and confidently tell my constituents that I believe that the state department of health is working on their behalf when they shut me out and shut all the members of the House out completely,” said Alferman.

The House and Senate are expected to vote Wednesday on the budget proposal for the fiscal year that begins July 1. The deadline for the legislature to submit a budget proposal to the governor is at the close of business on Friday.

Fitzpatrick said he would consider restoring the money for those positions if the Department gives the House the information it has asked for, but the next opportunity to do that would likely not come until work begins on a supplemental budget bill in January of 2019.

Earlier story: House Budget Committee adopts stiff cuts to DHSS over Bourbon virus data dispute

House budget committee adopts stiff cuts to DHSS over Bourbon virus data dispute

House Budget Committee leaders have proposed deep cuts to the office of the Department of Health and Senior Services’ director because the Department has not provided data on a recent virus outbreak that left a state employee dead.

Representative Justin Alferman (photo; Tim Bommel, Missouri House communications – click for larger version)

Committee Vice-Chairman Justin Alferman (R-Hermann) said prior to last week’s budget markup hearing that he would make such cuts if the information was not provided. The Department continued to stand by its argument that it cannot release the requested data without violating the Health Insurance Portability and Accountability Act (HIPAA).

Alferman’s proposal would cut more than $239-thousand in state revenue and another $925-thousand in federal funds from the director’s office. That represents the salaries of seven attorneys in the director’s office, the director, the assistant director, and the legislative liaison.

“We have very little resources at our disposal in order to put checks in with some of these departments, and one of the checks and balances is the power of the purse, and we are absolutely using it right here to get information for the six million Missourians who live in the state,” said Alferman.

Alferman and House Budget Committee Chairman Scott Fitzpatrick (R-Shell Knob) say the information they want – the number of people in Missouri who tested positive for the antibodies to the Bourbon virus, indicating they have had it – would not include specific patient information that would violate HIPAA.

A department spokesperson on Wednesday night told the House Budget Committee two people in Missouri have tested positive for Bourbon virus, but did not offer information on how many have tested positive for the antibodies. The superintendent of eastern Missouri’s Meramec State Park died last year after contracting the virus from a tick bite. Alferman said he wants to know whether there is a risk to public health from the tick-borne illness.

“All of the released information up until this point, 40-percent of all cases of the Bourbon virus have happened in Missouri, so for a state parks worker to pass away from this disease, I don’t think it’s an unrealistic expectation for us … we know testing was done. We want the results of that testing to know … we’re policy makers. Do we need to make a policy change in the state of Missouri to combat this virus? We don’t know because we’re not getting any information back from the Department,” said Alferman.

He said the Department’s rationale is that releasing the number of people tested could allow someone to question park employees about whether they were screened and use a process of elimination to identify who was and was not tested – something Alferman called a “ridiculous” interpretation.

Representative Peter Merideth (photo; Tim Bommel, Missouri House Communications – click for larger version)

Democrats on the budget committee said while they might agree with Alferman about whether the Department should release that data, they don’t agree with cutting the department’s funding.

St. Louis Democrat Peter Merideth said the proposed cut could result in the firing of people in positions which work to enforce laws protecting Missouri’s seniors.

Merideth told a DHSS spokesperson, “I know that [Representative Alferman] has said that he is not trying to be punitive with this but it strikes me as that is all this is. It is punishing you for something that you did that you shouldn’t have done … Maybe there is a very real complaint here that we should have gotten more information from you on a timely basis, but I don’t see how this cut to your budget actually helps address the problem and it looks to me like all it actually does is hurts the people of our state.”

Other Republicans, however, agreed with Alferman. Representative Don Rone (R-Portageville) told the DHSS spokesperson that with as long as this issue has been developing, the DHSS’ director should have been in front of the committee and not a spokesperson. The director was instead in the nation’s capital that night.

“There’s nothing can be, in Washington D.C., any more important than letting the citizens of this state know that if there is a problem … we’ve got a job to do here and that is protect the people of the state of Missouri, and it’s not right that the director is not here, sitting here, taking these questions,” said Rone.

Alferman’s proposed cut was adopted as part of the committee’s budget proposal, which the committee has voted to send to the House floor. It will be debated there next week when lawmakers return from spring break.