House Health Committee, March 23, 2026

Transcript

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1. 0:00:00

   10:00 AM.

2. 0:00:02

   On the motion of Majority Leader Efstration, this House stand adjourned.

3. 0:08:45

   Is Senator Stills in the room? I don't see him. We don't have either senator here yet, so we'll stand at ease until we get a senator to introduce their bill. And if they don't show up, meeting will be adjourned.

4. 0:12:08

   I was gonna let, uh, your partner go first, 'cause I figured his would be... Well, I figured, I figured his would take less time. Um, but he said he was on his way. Do you know? Y- y- he said-- He's in Rules. Sean Stills, Senator Stills.

5. 0:12:28

   I'm sure he's still in Rules.

6. 0:12:30

   You're not in Rules?

7. 0:12:31

   I thought you were more important than I was.

8. 0:12:35

   You get to go first. Then to hell with the order. All right.

9. 0:12:41

   Mine will take longer.

10. 0:12:42

    You're up.

11. 0:12:42

    No, y- we'll go-- He'll be right here. Just give-- Mine's gonna go longer than his, so-so-

12. 0:12:47

    I know. So you okay waiting a few minutes for him?

13. 0:12:48

    I'm-I'm fine, yeah. They're just about to the point to pick them. Well, you're kind to give me a hearing, so I appreciate it.

14. 0:12:55

    Folks, this guy and I went into the Senate together in two thousand and seven. We are the class of two thousand and seven senators, he and I. And so, yeah. So we got in enough trouble. We got called in a couple times. I didn't do as bad as he did, though. He, uh, vetoed-- Well, no, didn't ve-- voted against the chairman's bill. Remember that? The first vote you cast.

15. 0:13:17

    My first vote, uh, in committee.

16. 0:13:21

    Yeah.

17. 0:13:22

    And, uh, Bill Hamrick walked behind me and patted me on the shoulder, said, "There goes the pharmacy school." I had offended the subcommittee chair on higher ed.

18. 0:13:33

    Yeah.

19. 0:13:33

    And, uh, which was pretty important for somebody from Athens to, uh... Wasn't very sophisticated move.

20. 0:13:42

    Yeah. You remember I asked you, uh, what-what you did wrong when we got called in the office, and you said, "I voted against the chairman's bill." "What did you say when you told him that?" "Well, I didn't tell him." Apparently, he could read your mind.

21. 0:14:01

    Somebody's here. I thought...

22. 0:14:03

    Dr. Neal.

23. 0:14:04

    Dr. Neal.

24. 0:14:04

    Okay.

25. 0:20:35

    Okay, let's go ahead and get started. It's late in the day, and, uh, I think Senator Stills is doing an obligation that he must do, and that's staying in the Senate rules. Uh, Senator Cowser, you are up with Senate Bill 367, SB367/CSFA.

26. 0:20:58

    Thank, thank you so much, Mr. Chairman. I appreciate you giving me a chance to present this bill.

27. 0:21:03

    This is a hearing only.

28. 0:21:05

    I, I understand.

29. 0:21:06

    Yeah.

30. 0:21:07

    And, uh, you know, when I first presented this in our, uh, regulated industries committee, I had three or four senators that immediately told me, "Just need to be fair warning to you, we're probably against this bill." They changed their minds by the time it was over, and partly was because of the testimony that I'm hoping you'll be able to hear here today. I can define this easily.

31. 0:21:32

    Can you hear me?

32. 0:21:32

    Can you hear okay?

33. 0:21:33

    Stills just walked in.

34. 0:21:34

    All right.

35. 0:21:34

    Do you mind if I switch gears?

36. 0:21:35

    Don't mind at all. That'd be fine.

37. 0:21:37

    You're such a gentleman.

38. 0:21:38

    Thank you.

39. 0:21:38

    Uh, Senator Stills, would you like to come forward? I know you've had a long couple weeks and, um, he's had a family, uh, daughter, that was in an automobile accident. Uh, you want to do 411? And that way you can get out of here 'cause, uh, Senator Cowser's bill's gonna take some time.

40. 0:21:59

    Uh, I would love to.

41. 0:22:00

    Yeah, well then, come on up.

42. 0:22:02

    We just picked some really good house bills, uh, you know, to be on the floor. Uh, so hopefully a lot of y'all will be happy. Uh, while I'm presenting, if you just want to glance, the circled ones are what we, uh, went with.

43. 0:22:13

    Oh, thank you.

44. 0:22:15

    A little, little Christmas gift for the chair. There you all.

45. 0:22:18

    Christmas gift.

46. 0:22:19

    Where do you want me to testify, sir?

47. 0:22:21

    Yeah, right there.

48. 0:22:23

    You want me to pop right here? Yeah.

49. 0:22:25

    Right.

50. 0:22:32

    Okay. Uh, this is, uh, Senate Bill 411, LC 4742 ADS.

51. 0:22:50

    Chairman, is this the one with the amended HP 1428 on it?

52. 0:22:54

    Yeah. Uh, I don't have the amended version. I know we're, I know we're going to amend it, uh, I think, on what you and I agreed upon. And you and I-

53. 0:23:04

    Do you just want me to go off the original?

54. 0:23:05

    ... amended it on what we didn't agree upon.

55. 0:23:06

    Oh, yeah, yeah. Yeah.

56. 0:23:08

    You just want me to go off the original then, and then we'll amend later with-

57. 0:23:13

    Yeah. Yeah

58. 0:23:13

    ... 1428?

59. 0:23:14

    Yeah.

60. 0:23:14

    Okay.

61. 0:23:15

    Yeah.

62. 0:23:15

    So Senate Bill 411 is, um, the result of three study committees, probably a dozen constituent and other related meetings that brought together the Medical Licensing Board- The traditional Chinese medicine acupuncturists, the physical therapists, and the, thank you, uh, and the occupational therapists to study and examine the differences between acupuncture and dry needling, define those differences, to put an element of truth in advertising so that PTs and OTs could not represent themselves as doing acupuncture, that what they do is dry needling, so explaining the difference in that.

63. 0:24:06

    It ensures that if occupational therapists are going to offer dry needling, that they have to have the same number of hours of training as PTs. So there's no change for PTs in this, except for the truth in advertising component that they have to adhere to. OTs are reinstated back up to the PT level. And then, uh, for the traditional Chinese medicine acupuncturists, it, um, takes away the need for their supervised hours after they complete their 2,500 hours of, um, academic studies and training with that.

64. 0:24:42

    And then, um, as a, a, a help to, uh, to our friends in the engineering field, uh, because it's in the same title code section, um, not related to this, but it's regarding the Professional Engineers and Lansayer- Land Surveyors Licensing Board, uh, which is House Bill 1428, uh, would be, um, in section 5, uh, of the bill, um,

65. 0:25:17

    which you see there. Um, and that is in, uh, your version. So those are the two bills, but, uh, but that is the origin of SB 411. Happy to answer any questions.

66. 0:25:32

    I see no questions, but we do have two people signed up to speak. Oh, who was that?

67. 0:25:38

    It's me. I'm sorry.

68. 0:25:40

    Representative Mathiak.

69. 0:25:41

    I just have... Thank you, Mr. Chairman. I just have one question. There isn't anything added on here with, um, tr- athletic trainers, correct?

70. 0:25:51

    Correct.

71. 0:25:51

    Everything's the same as it was that we saw before?

72. 0:25:54

    Yes, ma'am.

73. 0:25:54

    Thank you.

74. 0:25:57

    Okay.

75. 0:25:57

    It's okay.

76. 0:25:59

    Uh, first up to speak to the bill, Kristi Torello.

77. 0:26:07

    Here, Kristi, just take my seat.

78. 0:26:11

    Thank you.

79. 0:26:15

    Hi. I've never been in front of the House Health Committee before, so this is exciting. Uh, my name is Kristi Torello. I'm with ACEC Georgia. We are the trade association for engineers. Um, we are-

80. 0:26:25

    Okay

81. 0:26:25

    ... supportive of section 5 and really appreciate the committee, um, including that in SB 411. All section 5 does is clarify that the Professional Engineers and Land Surveyor Licensure Board can retain incidental revenue, um, from stuff like licensure verifications, um, collection fees like credit card fees, um, those types of items. All boards are, um, able to retain this revenue. Um, unfortunately, it's ambiguous for the Professional Engineers and Land Surveyors Board because they are independent, um, as of 2022 with House Bill 476 by Representative Dale Washburn.

82. 0:27:01

    Um, OPB told us back in the fall that, uh, the authority for the PELSB to retain this, uh, fee, these fees are, um, is ambiguous. So 1428, uh, was the original bill. That passed out of House Regulated Industries unanimously. I've yet to, uh, meet someone that is opposed to the bill. Um, and the senator was really kind enough to allow us to hitch a ride on his Title 43 bill. So happy to answer any questions.

83. 0:27:29

    Thank you. I see no questions. How about Ben, uh, Braxley? Is that right, Braxley?

84. 0:27:38

    Correct.

85. 0:27:40

    Thank you, Mr. Chairman. Uh, Dr. Ben Braxley, physical therapist in Georgia. I've been licensed in Georgia as a physical therapist for 20 years. I really just wanted to briefly speak to the, the process and express, um, my profound appreciation to Senator Still. Uh, we were invited to this collaborative process, and the resulting legislation was, uh, very supported by, uh, the individuals that, that I represent within APTA Georgia. We came prepared to discuss our education, you know, getting into the details of gross anatomy, undergraduate, graduate, graduate-level anatomy, cadaver work, training in neuromuscular skeletal system, uh, processes, and I think that the, the outcome for Georgia physical therapists is positive, as well for occupational therapists and for the acupuncturists.

86. 0:28:27

    So again, uh, thank you, Senator Still.

87. 0:28:30

    Thank you. All right. I see no questions.

88. 0:28:36

    That's the best kind.

89. 0:28:38

    All right. Uh, do I hear a motion? Motion to do pass.

90. 0:28:42

    Second.

91. 0:28:43

    Second. Okay. We, we have an amendment, uh, that, uh, the author and I have agreed upon, is add physician, uh, on, on beginning of line 26. We've left physicians out. This is the folks who can do dry needling. We have heard from a number of ATs around the state, uh, some taking care of college kids, some taking care of professional folks, but that is unclear at this point and needs, and should be addressed sometime in the future, but not to hold this bill up at this time.

92. 0:29:21

    So do I hear a motion on the amendment? To insert physician on line- Beginning line 26. I move that.

93. 0:29:30

    Second.

94. 0:29:30

    I mean, you would like physicians to be able to do it, do this too, right? You would hope so. That's why they trained.

95. 0:29:37

    Yeah.

96. 0:29:37

    Yeah, yeah. So Chairman, it would be physician, comma, acupuncturist, so forth. Yeah. For line 26. Yep.

97. 0:29:44

    Yep. Sir. Do I hear a motion? So moved. Second? Second. All those in favor of the amendment say aye. Aye. All those opposed say nay. Back to the main body of the bill, which is, ah, substitute to H1 amended. Ah, SB 411 as amended. All those in favor say aye. Aye. All those against say nay. Congratulations, you have your bill, sir. Thank you, Chairman. Uh, who is your, uh, House sponsor?

98. 0:30:16

    Alex Gulibeth. You and I had discussed it- Yep ... at one point in time, but if you're able to, great. If you need me to find- Okay. Yeah ... that's great, too. Thank you. Thank you, sir. Thank you again. Okay. Um, Senator Cowser, you're back on- All right ... the deck. Back to my story then. Yeah. Uh- And thank you for allowing me- That's of- ... course. I appreciate it ... no problem whatsoever. So as I was getting prepared to present this bill in, in committee in the Senate, several members, including top leadership in the Senate, told me they just wanted to give me a heads-up.

99. 0:30:51

    They probably were not gonna be able to support this bill. And I asked them, "Just give me a chance to listen to it." Something I'm very passionate about, and the testimony was just absolutely overwhelming, and obviously it changed the minds of a lot of people on that committee. And I ask you, uh, all, I appreciate the, the opportunity for this hearing. I understand it's a hearing only, but I ask people to listen closely and be as, as to the point as you can with your questions, 'cause my concern is cancer is the second leadest, leading killer in the state of Georgia.

100. 0:31:28

     And I'd venture to say most everybody in this room has been touched by it, some spouse, parent, child, relative, close friend. It is just so prevalent these days, and it seems to be striking younger people than it used to. I have a very close personal friend who is widely reputed, it's Dr. Cody Gunn, as the breast cancer guy in Northeast Georgia. Um, and he has literally a cult following amongst women.

101. 0:32:04

     He is so good and so empathetic and, and so skillful in doing that. And I learned from him some of the limitations of his practice. He's with UCBC, which, in Athens, which will testify today. They were having difficulty getting a PET scan machine couple of years ago because you had to have a CON to get that, and it was being blocked. And that is a fancy CAT scan, for lack of a better term, that's particularly effective in diagnosing tumors.

102. 0:32:35

     It's especially good in diagnosis, discovering them early, so you can have a better chance of cure. But it's also very effective in the course of radiation or chemotherapy to track the tumors to see, are they responding to the treatment and shrinking or, or not? So are you targeting your treatment at the right place? And one thing in the last CON repeal bill that went through for rural hospitals largely a couple of years ago, it had a provision in there that eliminated the need for CON on a PET scan machine.

103. 0:33:12

     They had one literally the very date after that bill went into effect. And I'm told that they have reduced the wait time for these tests enormously from a number of, uh, four to six weeks to just a number of days or maybe a week, and that they are confident they have saved quite a few lives by having this technology. And it just struck me that this is crazy that Georgia would be limiting access to cancer care, that our citizens ought to have as many options as available as geographically close to them as possible, and so they can have the comfort of using the course of care that they wanted.

104. 0:33:55

     I was particularly ru- worried about rural areas of the state where folks are having to drive to Atlanta for the treatment, uh, and of different types, or else they're having portable screening come to their communities. And it's, it's aimed as a rifle shot at one horrible disease to lower requirements, bureaucratic red tape to provide that service. But it is a shotgun approach to all cancer treatments, diagnosis, research, treatment, uh, to eliminate the need for CON.

105. 0:34:32

     In the course of presenting this through the Senate, some of the rural hospitals were concerned about competition and protecting the investments that they had in cancer care. My initial thought was that there was very few facilities in South Georgia in particular that provided cancer care, because I kept hearing these stories of people who would have to travel to Atlanta to be with their family members that were getting chemotherapy or radiation or surgery or whatever, mostly at the large hospitals in Atlanta.

106. 0:35:04

     And I, I learned that there were some sole community hospitals that did offer cancer treatment, chemotherapy or radia- radiation therapy predominantly, and they presented an amendment. We're a little more freewheeling in the Senate than, than the House generally. Uh, we had a floor amendment that exempted what amounts to 10 sole community hospitals that do provide cancer services. And I, that, I deemed that a friendly amendment 'cause the idea is to get cancer treatment as close as possible to Georgians.

107. 0:35:37

     And if they already had services in their area and those people wanted to opt out of this and continue going through the CON process, that was fine with me. So this bill- Cuts out any sole community hospital, which my understanding is there are 10, and a 35-mile radius around each of those, um, you, you would still have to go through the CON process. So it's a compromise to that extent.

108. 0:36:08

     I think that, um, you're gonna be amazed at the people that testify in favor of this. Uh, Emory Winship Cancer Institute, that's one of the nationally accredited, supports the bill. The old CTCA, now called the City of Hope Hospital, that's a destination cancer center, embraces the bill. Several other cancer treatment centers are basically, "Bring it on. We are happy to have whatever competition that wants to come.

109. 0:36:39

     If it makes treatment more available to patients and probably less expensive, we welcome that because it's best for the people of Georgia." I will not ramble on and on. I will just say that this does ham- cover, uh, expansions, acquisitions, relocations, operating healthcare facilities, purchases of equipment that is exclusively or primarily, uh, related to cancer treatment. There are many of these cancer treating facilities that have some peripheral treatment, is why it says primarily or exclusively, because, for example, the, uh, University Cancer and Blood Center, they have some blood diseases that you end up having to do some treatment that is not specifically on cancer, but is related.

110. 0:37:25

     If you get cancer of certain organs, oftentimes the treatment might be for, uh, other damage to the organs other... But it came about because of cancer. So it was to leave it, uh, that that's predominantly what you do, the majority of what you do. Primarily, what you're doing is this, just for cancer treatment. That's the only question I had that came up, was, "What do you mean by primarily?" We looked up about 10, 15 other synonyms. They're either predominantly or mostly or majority. You call it what you want to, but these are cancer treatment places that might have some peripheral services.

111. 0:38:01

     Uh, and I would just, uh, thank you for allowing the folks to speak. I don't know how many have signed up, but a, quite a few have told me they wanted to be heard, uh, from various places around the state. Uh, one of the things they wanna do is be able to do some outpatient procedures. Uh, I mean, you can imagine, like, the seed therapy for prostate cancer. Some of these lumpectomies or mastectomies can be done outpatient rather than needing, uh, the more sophisticated treatment in hospitals. Certainly, radiation therapy and chemotherapy can be done outpatient.

112. 0:38:34

     Now it can't be. Research is big. Uh, clinical trials, et cetera. This helps our state, and I, uh, would just invite the witnesses to share as much detail and perspective as they can on specifics, uh, how this will help. Thank you.

113. 0:38:49

     Okay. We've got, uh, 15 votes to sign up, so we're gonna have to 15-minute shot clock. I, I apologize to you that some of y'all may wanna get, get more time, and I get emotional, but that's what we're gonna do. Good. Thank you. So, uh, the first up, uh, well, let's let Dr. Graham, he's the first one to sign. Let's go ahead and ha- have you come to the mic, please. Children's Healthcare of Atlanta.

114. 0:39:26

     Yeah, so, um, thank you, Mr. Chairman. Good to see you, and I appreciate the chance to speak to the committee today. Um, so we, uh, do acknowledge that there are, uh, quite a bit of merits for this bill, particularly on the, uh, adult cancer care, uh, related to patient care access. However, I, I appreciate the chance to talk specifically about pediatric cancer today. So I'm the physician leader of the Pediatric Cancer Center at Children's Healthcare of Atlanta, and, uh, our concern is that there might be, um, unintended negative consequences that could occur for pediatric cancer.

115. 0:39:59

     So we'd just like to highlight some of that today, because pediatric cancer is quite different from adult cancer, uh, in terms of how care is provided. So if you look at just the numbers across the state of Georgia in 2024, there were 63,000, uh, adults that were diagnosed with cancer in the state of Georgia. In contrast, 653 children. So 1% of all the cancer diagnoses in the state of Georgia are children. Um, of those 653 patients, 467 of them were cared for at Children's Healthcare of Atlanta, and 50 of them roughly in Savannah, Augusta, and Macon.

116. 0:40:33

     So Children's Healthcare of Atlanta cared for 72% of the children diagnosed, uh, with cancer in Georgia, serving 77 of the counties. Um, over the last 15 years, our faculty size has increased exponentially to be able to cover every single type of rare cancer that can occur in children. So if you look back 15 years ago, we had 18 faculty, and today we have 133 faculty, making us one of the largest centers in the country. Um, more than 200 centers care for children with cancer. Our center is one of the top three or four in the country in terms of volume of caring for kids with cancer.

117. 0:41:08

     So until just a few years ago, we had areas that we would have to say, "We don't have quite the expertise to care for that," and we'd have to send our children out of state to other states to have specialized and escalated care. But now with the ability to, um, have this expanded faculty that we have, we've been able to have highly specialized programs that are unique to Georgia, um, and really unique to the Southeast, and, and even in some cases, only a few places in the country. Programs like precision medicine and cell therapy and the high-risk leukemia program, in which there's only one other, um, uh, program like this exactly in the United States.

118. 0:41:42

     We also know that clinical volume drives participation in national trials, and you have to have a, a certain number of pediatric cancer patients to be involved in cancer consortia. Um, and this is how we... This is another difference, is that in adults, a much smaller number of adults are on clinical trials than children. In children, we actually try to find a trial for almost every child that we can that comes to our cancer center because we know, and it's been documented, that the best way d- we deliver care is through participation in clinical trials. So at Children's, we have over 230 clinical studies that are open, and 30 of them are ideas that are investigate-initiated trials that we came up with with our faculty in Atlanta.

119. 0:42:18

     So we were the thought leaders and came up with the idea, but we can spread this, um, access to these, uh, therapeutics to other p- centers across the country. So, uh, we have been able to change the narrative from having to send some patients outside of the State of Georgia, um, to now being able to bring patients internally. Um, over the last few years, we've seen patients from 45 different states. I'll just say this has enhanced outcomes, and I have examples of that on slide six, showing that relative to, um, leukemia, uh, and national benchmarks of being 95%, we're 98%.

120. 0:42:51

     AML, another type of leukemia, the national benchmark is 60 and we're 78%. So what we are showing is that this has enhanced national reputation. This has allowed us to recruit and retain some of the best physicians in the country, having access to the latest treatment and provide the, the best care. So just in summary, what I'd like to say, if you look at what could happen, um, in a state like Florida, in which there are more children that are diagnosed with cancer, than 1,000 children a year, they have 16 different places within Florida in which children can get care.

121. 0:43:21

     Um, although, although that's-

122. 0:43:22

     Doug, I hate to interrupt you-

123. 0:43:23

     Every day

124. 0:43:23

     ... but we got a lot of folks.

125. 0:43:25

     Okay.

126. 0:43:25

     Can you just get to the point of you're in favor or you're against?

127. 0:43:28

     We are-

128. 0:43:28

     I-

129. 0:43:28

     We are against it for children-

130. 0:43:30

     Okay

131. 0:43:30

     ... um, because we think that it would, uh, it would allow us to lose some of the specialists that we have, decrease the therapy, and, and decrease the outcomes that we provide.

132. 0:43:38

     Thank you.

133. 0:43:38

     Thank you very much.

134. 0:43:39

     I apologize. You do have a question. Uh-

135. 0:43:41

     Uh-huh

136. 0:43:41

     ... Chairman Newton.

137. 0:43:43

     I'll try to be quick, Ch- Chairman. Um, I, I appreciate what all y'all do, and the seventh in the nation-

138. 0:43:47

     Thank you

139. 0:43:47

     ... is impressive, and thank you for getting those there for one of us that might need this.

140. 0:43:50

     Sure.

141. 0:43:50

     Is there... Um, you mentioned about the clinical trials. Are the, are the people who might be able to use these facilities if this were to pass, are they somehow not able to participate in clinical trials if you're just in private practice as opposed to practicing in the hospital? Or can all oncologists participate in clinical trials that you mentioned was the, was the best case for children?

142. 0:44:11

     Yeah. So, um, thank you for the question. So the issue is that there are some trials that can be opened up at many, many centers across the country, but there are other trials that you have to be selected to be in a consortium that offer some of the latest trials. And in order to do that, you have to have a certain volume of patients that would make them want to have you one of the participants in the trials.

143. 0:44:30

     Thank you.

144. 0:44:32

     Okay. Had another question, I think. Is it Representative Mitchell?

145. 0:44:37

     No, it's, uh, Representative Lim.

146. 0:44:39

     Lim.

147. 0:44:42

     Uh, thank you. I... D- Doctor, I, I understand your argument, and I appreciate that you laid out that of the remaining 30, nearly 30% of children that are diagnosed, they're getting care, um, in the other, you know, some other places. Is it your opinion that because the care there is, I suppose, more fragmented or they essentially don't have a natural monopoly that you all are arguing that you have, are they getting... Like, what's the type of care they're getting because there are fewer of them?

148. 0:45:10

     You mean in the State of Georgia specifically?

149. 0:45:12

     Yeah.

150. 0:45:12

     Yeah.

151. 0:45:12

     In, in the other facilities.

152. 0:45:13

     Yeah.

153. 0:45:13

     I'm curious what your opinion is.

154. 0:45:15

     So, so let me just say that, um, there are many different, uh, guidelines that are national guidelines that would direct standard care treatment for children with cancer, and the children that are in these other centers are getting excellent care, exceptional care for, for guidelines that would be standard of care treatment. Really, the question comes when you need to escalate the care. So you have to have certain places that can not only take care of standard of care, but can pr- provide the most complex care and access to new drugs and new treatments. And so only a few places ar- around, uh, in different areas of the country are referral centers for that.

155. 0:45:47

     And right now, children are being flown, um, from states in the Southeast to Children's Hospital Philadelphia and Cincinnati and Seattle and Children's of Los Angeles for escalated care. So our goal in, uh, is to be the safety net for patients that are in Georgia, but also in the Southeast that need escalation of care.

156. 0:46:08

     Thank you.

157. 0:46:09

     All right. Thank you.

158. 0:46:09

     Thank you.

159. 0:46:10

     All right. Thank you, Doug. Uh, he and Dr. Higgins, uh, both Kristen Higgins were on our study committee this summer, Access to Cancer Care. I appreciate both of y'all. There's a lot of traveling around. Okay. Up next, Dr. Nick.

160. 0:46:34

     Thank you, Chairman. It's an honor to be here to advocate for patients. I'm the president of UCBC. I'm a, that, uh, Senator Cowherd, um, mentioned previously and generously supported this, uh, this important bill. I'm a medical oncologist by training. Um, I've been in Georgia since 2009. I moved here from the University of Texas MD Anderson, and I moved to Georgia because there was an opportunity here to do something, um, in Athens, Georgia, that I couldn't do anywhere else, which is to build a cancer center, uh, which we finished in 2023, and build a clinical research program.

161. 0:47:10

     We have over 100 clinical trials, and we're an independent practice. Um, also hire and recruit physicians. Outside of medical oncology, we have 12 medical oncologists and, uh, two radiation oncologists, and we have six surgeons right now all dealing with cancer. That's two surgical oncologists, two breast surgeons, two colorectal surgeons. We also have a GI service. We have palliative care and a physician that heads that program. Um, and, uh, as I said, we have a big, uh, research program, which I'm the director of.

162. 0:47:40

     Um-

163. 0:47:43

     I'm still a practicing medical oncologist though, even though I'm president of this, this, uh, practice. I just finished clinic this morning, um, and drove up here to advocate for this, just like I did for the PET scan. For the PET scan was interesting because we spent two years in court getting opposed for it. But, um, we were fed up with the wait times for patients amounting three or four weeks to get a diagnosis of cancer to get started on treatment, which is unacceptable. Um, after we acquired the PET scan, the hospital, um, volume stayed the same.

164. 0:48:15

     We filled up, and we need another one, and another one after that. And so these obstacles that are artificially imposed on the care of cancer patients, I think are just not acceptable from the cancer patient's perspective. Um, and that is true for surgeries, certain surgeries that they need to do, certain procedures they need to have, and we need to have access to these things so they can get the treatment in a timely fashion, so they don't have to go to Atlanta or go somewhere else or a different state to get these treatments. There's a financial burden to do that to the patient, and there's an emotional burden.

165. 0:48:50

     Families get uprooted and moved out of state or across the state to get the care they can get locally. My mission coming here to Georgia was to provide care locally, to provide care to the patient without uprooting them and causing them a lot of toxicity to move out. So in order to do that, I need all the tools that are available to me to provide that care and not have to send them anywhere. Um, and they deserve that, and we serve a population of about six hundred thousand people. Um, we serve people from almost sixty counties around the state in the northeast.

166. 0:49:22

     We collaborate with the University of Georgia. We have a research program with them. I need to be able to do all that stuff as much, uh, as close to home as possible. Um, and that involves having a multi-specialty ambulatory service where we can do the small procedures, the diagnostic biopsies, simple surgeries. We're not taking away anything from the hospital. The hospital needs to keep the big stuff that cannot be done outpatient and fill those ORs with important procedures, uh, where they make all their money from anyway. These ORs, they can't expand ORs fast enough.

167. 0:49:53

     It takes them years to do all that, and meanwhile, patients are just sitting, waiting. We need to expand our radiation services. We need to expand our diagnostic services. We need to provide a lot of care to a lot of patients that are waiting to get treated. And I'm tired of explaining to the patient that they need to go somewhere else to do something because we can't do it locally, and it's frustrating, and it's difficult. These COA laws are antiquated. Um, they don't apply today. There's a lot of technology. A lot of treatments are available. Hundreds of cancer treatments are available.

168. 0:50:22

     Excuse me. I hate to cut you off.

169. 0:50:23

     Sure. I'm almost done.

170. 0:50:24

     We need to do the three minutes. We got a lot of-

171. 0:50:26

     Am I past it? Who's counting?

172. 0:50:28

     Yeah. That's what that alarm was. Yeah.

173. 0:50:30

     Oh, I didn't hear it.

174. 0:50:31

     Oh, okay.

175. 0:50:31

     Thank you, sir. Thank you, sir.

176. 0:50:33

     Yeah.

177. 0:50:33

     I will cut it. I'm done.

178. 0:50:36

     Thank you very much. I appreciate it.

179. 0:50:38

     Great job.

180. 0:50:38

     I tried to ex- Was that too fast? Because I thought I was racing through it.

181. 0:50:44

     Okay. Up next, uh, Dr. Ramalingam.

182. 0:50:51

     Turn the volume up. I apologize. I thought that was loud. Who's up here?

183. 0:50:57

     Chairman Hawkins and members of the committee, my name is Dr. Suresh Ramalingam. I'm a medical oncologist who specializes in the treatment of lung cancer. I also have the privilege of serving as the Executive Director of Emory's Winship Cancer Institute, which is the only National Cancer Institute Designated Comprehensive Cancer Center in the state of Georgia. Over the past year, I also had the distinct honor of serving on the House Study Committee on Cancer Care Access under the leadership of Chairman Hawkins. I also have the honor of serving on two different advisory committees to the National Cancer Institute.

184. 0:51:32

     I'm proud of the fact that the research we've conducted has resulted in new standards of care for lung cancer. I'm here today to ask for your help in improving timely access to cancer care for patients in our state. This year, approximately sixty-eight thousand individuals in Georgia will hear the dreaded news of a cancer diagnosis. This is a fifteen percent increase in the number of new cases compared to just the year twenty twenty-two, and this number will unfortunately continue to rise because of the population aging dynamics.

185. 0:52:05

     This year alone, over twenty-one thousand new patients with cancer sought care at Emory. While we've made tremendous advances in improving treatment options for cancer in the past two decades, access to high-quality cancer care remains a major hurdle. At Winship, our mission is to discover cures for cancer and inspire hope for our patients. We are working to reduce the burden of cancer in all one fifty-nine counties in Georgia, not just for those who come to us for care, but for communities across the state.

186. 0:52:36

     We do this through statewide partnerships that focus on cancer prevention, early detection, detection, and cancer navigation. Members of the committee, cancer care is advancing at a very rapid pace. New treatment modalities and options are coming in faster than ever before, which is great news for our patients. However, the present CON regulations hinder rapid adoption delivery of care, not to mention the significant hurdles faced by our patients to receive care. For instance, the nearly three thousand patients we provide care at Emory Johns Creek Hospital have to drive to Emory Saint Joseph's Hospital several days a week if they need radiotherapy.

187. 0:53:15

     We believe that every patient with cancer in the state of Georgia should have access to high-quality care in a timely manner. It's our strong belief that passing the Senate Bill three sixty-seven will increase access for patients. One of the common questions I'm asked related to my role as the Executive Director of Winship is, "Who is your main competition?" My answer to that is time, because our patients are running against the clock after a diagnosis of cancer. It is for this reason that I believe that removing burdensome CON restrictions will accelerate access to high-quality, timely care for every Georgian.

188. 0:53:52

     Therefore, I respectfully ask for your favorable consideration of Senate Bill 367. Thank you very much.

189. 0:54:02

     Thank you.

190. 0:54:02

     I tell you what, he and his team, he and his team at Emory are very impressive. We appreciated the hospitality and all the information we got. We had a couple visits over there with you, so I appreciate that very much.

191. 0:54:15

     Thank you, Chairman.

192. 0:54:16

     Okay. Up next, Dr. Squires, I think. David Squires.

193. 0:54:26

     Oh, thank you for having me here. I'm David Squires.

194. 0:54:29

     Thank you. Thank you for testifying.

195. 0:54:31

     Yes.

196. 0:54:32

     No, no, no, no.

197. 0:54:32

     Love it.

198. 0:54:33

     Yeah.

199. 0:54:33

     So I'm a medical oncologist. I've been practicing in Augusta for 22 plus years, and I have... I went through three years of chemotherapy while I was going to medical school, so I'm a survivor. Had acute lymphoblastic leukemia.

200. 0:54:48

     Hmm.

201. 0:54:48

     I love hospitals. I love what they do. I recognize their needs and the value that they create for our community. But we can have multiple care models that coexist simultaneously that benefit both those who need inpatient services and those who have outpatient services. The CON laws in Georgia were passed in 1979. If those same CON laws would've been passed for telecommunications, we would not have anything like this right now. We would still be using landlines. Technology has advanced massively in the last five to 10 years.

202. 0:55:20

     Are you for or against this bill? I think a rotary phone just sounds better every day.

203. 0:55:26

     Yeah, for some. But as, as I went through three years of chemotherapy while going to medical school, I decided I want to do whatever I could to help the patients, number one, but also find better therapies, better detection and better therapies for their cancer so that it would not be so difficult for them. There is so much waiting going on to get procedures done, to get the diagnosis, and we have amazing technology, but we are impaired in providing that technology to our patients in the State of Georgia because of these CON laws for outpatient oncology services.

204. 0:56:01

     I'm not saying revoke them for every, every service, but for outpatient oncology services, things have changed so much even the last five years, it doesn't even look the same. Like, five years ago, it was horse and buggy. And what's gonna happen in the next five years? Georgia will be far behind every other state by retaining the CON laws for outpatient oncology services. We have massive innovation coming, and we have to be on top of it. I have one of the patients that you may have read the story on, Ronnie Yanasaki. He is one of my patients I've taken care of for nine and a half years for pancreatic cancer.

205. 0:56:34

     He has had so many procedures over the years for metastatic disease, and it is miraculous that he is still alive and has disease still. I've been treating him for years. He's in his mid-50s. And he has had so many procedures done, but many times we have to wait weeks to have procedures done because they're just not available. At one point, he had to go to a children's hospital to get a CT scan 'cause there wasn't anything available in the whole city of Augusta. We decided to have radiation oncology services in Georgia, in Augusta, Georgia, to be a- tha- to be able to provide the newest, most advanced AI-driven radiation technology that is beyond what most people can even comprehend to reduce side effects to radiation and improve the kill to the cancer cells.

206. 0:57:18

     We applied for a CON and were rejected because other hospitals had it in the community. We placed one in South Carolina, 100 yards over the river, because we cover both South Carolina and Georgia. South Carolina got rid of their CON laws. We put a radiation center there with the newest technology in all of the State of Georgia and all the State of South Carolina, and now people from Georgia, constituents, our patients, have to drive over the river to South Carolina to get their care. So yes, I would be in favor of modifying the CON laws so that they help our cancer patients in the State of Georgia.

207. 0:57:53

     You've heard from plenty of others, but innovation is coming at such a speed. And back in 1979, there were issues where we had all this technology and expense, but not enough demand for it. That has flipped. We no longer live in a scarcity environment. We have the opposite for adult oncology. We have an overabundance of patients and not enough facilities. As soon as you put a new PET scan or a new radiation facility, a new anything that is related to cancer, it's gonna get filled up rapidly, and there's not gonna be any loss to the hospitals.

208. 0:58:27

     Okay. You have a question, uh, Chairman Newton?

209. 0:58:30

     Thank, thank you. C- appreciate your work in, in Augusta for the whole two state area. The, um, the kind of the question I asked earlier, how often is it only a National Cancer Institute or a, um, a specialty hospital can enroll in, um, studies? Or do, or do private practice oncology practices like yours, um, enroll in trials, clinical trials that, uh, that offer? And then occasionally, how frequently do you have to refer somewhere else, I guess, is the question.

210. 0:58:57

     That's a great question. And, you know, as a medical oncologist, as a physician who's taken the Hippocratic Oath like you-

211. 0:59:04

     Mm

212. 0:59:04

     ... we view things very differently than people who are just looking at the numbers and how much money they can make. We collaborate with all physicians. Our purpose is to take care of the patients, and we work very closely with MCG and with other hospitals around the region because we send patients there for clinical trials. In regards to CON and, and all this stuff, if you're running a business like I am with Augusta Oncology as the CEO, you have to look at the pro forma. For anything, any service you're gonna bring in, you're gonna look at the pro forma, and if it makes sense financially to bring a service that is gonna create value in the community, you're gonna do it.

213. 0:59:38

     And if it doesn't make sense financially, you're not gonna do it. It does not make sense financially for our business, our cancer corporation to take care of patients on clinical trials. It is very cost ineffective for us. That's why we refer these patients out. We refer patients for transplants, for specialty therapies, for CAR T, all these specialty therapies, we send them directly over to the hospitals and they capture all those patients. So this does not affect that at all.

214. 1:00:05

     Thank you.

215. 1:00:06

     Okay. Thank you very much.

216. 1:00:07

     Yeah.

217. 1:00:08

     Thank you very much. Okay, up next, Kristen Higgins, City of Hope.

218. 1:00:16

     Thank you, Mr. Chairman. My name is Kristen Higgins, and I am the chief clinical officer of City of Hope, Atlanta, and also a radiation oncologist. City of Hope is one of the top 10 cancer organizations in the country, and we have the privilege to offer care to Georgians in Newnan, right here in our state, about 40 miles south of Atlanta. And as a radiation oncologist, I want to bring the CON back to the patient. When I talk to patients about radiation, I say, "This is not your grandmother's radiation." Many people have, um, stories of their family members that have had these awful side effects and weren't able to eat or drink and suffered so much from radiation.

219. 1:00:52

     And the toxicity has gotten so much better in the last 10, 20 years. Patients are able to get radiation treatment for breast cancer and go back to their job 30 minutes later, come on their lunch break. It's like nothing happened. They're able to maintain their normal lives. And why is that? That's because the advancement in technology, and we need that for Georgia. We need to continue to advance technology. If I, as the chief clinical officer for City of Hope, Atlanta, want to buy a new linear accelerator that has adaptive radiation planning, right now I'm not able to because, uh, my request would be contested by a local hospital system.

220. 1:01:27

     If I brought this adaptive radiation planning unit to my facility, I would be able to open a trial for pancreatic cancer where I can dose escalate, and we have preliminary data that shows that this improves survival for one of the deadliest cancers. But I'm not able to do that right now because of our current structure and our current CON. So by repealing the CON, we're able to bring technology to other centers throughout our state, accelerate, um, improvements in outcomes for patients of all different types of cancers.

221. 1:01:57

     The cancer patient is the consumer in this situation, and this patient benefits from competition. And the fact of the matter is, there is enough business to go around for the hospital systems and for the private practices. And we need to take away the barriers. We need to make sure that our cancer patients get the best care in Georgia. And these are people's mothers, your spouse, your aunt, your uncle, your child. We all are affected by cancer, and I think we need to do everything for cancer patients in our state. And so I, I am in great support of this bill.

222. 1:02:30

     Happy to answer questions.

223. 1:02:33

     Uh, you have no questions? Oh, you have no questions. Thank you, Kristen. Up next, uh, Jamie Kavanaugh.

224. 1:02:47

     Good afternoon, Mr. Chair, members of the committee. My name is Jamie Kavanaugh. I'm an attorney with the Pacific Legal Foundation. Um, and I'm not a, not a doctor, not an oncologist, but I have looked at CON policy for years now. I've worked with legislators in more than a dozen states on, um, repealing and reforming these laws. So Pacific Legal Foundation stands in strong support of this bill. We also bring litigation and often represent healthcare entrepreneurs, um, suing the state when they can't get a certificate of need and can't offer their needed services to the community.

225. 1:03:19

     Um, and I want this committee to feel confident that the research shows that patients in states with certificate of need laws wait longer for appointments, travel further, and pay more. So obviously, the opposite is also true. Once you take the bold step of repealing some of your certificate of need laws, patients have an increase in access to care, it's high-quality care, and costs and spending actually go down, which is great for the patients and for the state, frankly. Um, and the Senate had a certificate of need study committee a couple years ago that recommended full repeal of certificate of need.

226. 1:03:52

     We heard about the benefits happening in South Carolina, where they repealed certificate of need for everything except, um, long-term care. So Georgia's definitely going in the right direction, and we strongly urge this committee to support this bill.

227. 1:04:05

     All right. Thank you. I see no questions. Okay, up next, Tony West.

228. 1:04:17

     Good afternoon, Mr. Chairman, members of the committee. My name is Tony West. I'm the state director for Americans for Prosperity here in Georgia. I'm here to support this bill. Um, as previous speakers have said, CON is meant to limit access and necessarily drive up the cost of these important services. Uh, we support legislation, uh, that is meant for constitutionally limited government, that is for economic freedom, and CON is the antithesis of those things. So I just wanted to sh- sit down today and share our support with you. Thank you so much.

229. 1:04:47

     Thank you. All right, I see no questions. But I've got a question. Uh, is Anna Adams here?

230. 1:04:56

     Yes, I am.

231. 1:04:56

     Could you come to mic for just a second? I, I know you're not signed up to speak, but I just, a thought just hit me.

232. 1:05:05

     Happy to. I'm always ready.

233. 1:05:06

     Georgia Hospital Association.

234. 1:05:09

     Hi.

235. 1:05:09

     How many hospitals you represent?

236. 1:05:11

     We represent 151 hospitals. Um-

237. 1:05:14

     Oh, okay

238. 1:05:15

     ... large metro, small rural, specialty.

239. 1:05:17

     To your knowledge, how many hospitals support this legislation?

240. 1:05:20

     We have, to my knowledge, two members that are supportive of this bill.

241. 1:05:25

     Two out of 151. Okay. All right.

242. 1:05:27

     One is a system, but-

243. 1:05:28

     Yeah

244. 1:05:28

     ... yes, sir.

245. 1:05:29

     Okay. Thank you. That's, that's all. That's, I mean, that's the only question I had.

246. 1:05:32

     Thank you.

247. 1:05:33

     Thank you.

248. 1:05:33

     Thank you.

249. 1:05:33

     Well, I mean, it seems like we're getting a lot of... You have a question for her?

250. 1:05:37

     Can we just clarify that that, is that, the remainder, do, what position do they take, if any?

251. 1:05:47

     I don't want to speak on behalf of them individually. Um, I know we have some in that other subsection that are opposed, and I think you've heard from some of those today. But we have encouraged all of our members to reach out to their elected officials to share their own beliefs-

252. 1:06:00

     Yeah

253. 1:06:00

     ... on this legislation.

254. 1:06:02

     Yeah.

255. 1:06:02

     So the two that we know that are supportive, um, I think you also heard from today.

256. 1:06:07

     Okay. Thank you. Yeah, I'm not trying to add pluses and minuses, um, but I just felt like we're hearing a whole lot of from one side.

257. 1:06:15

     Yeah, I just wanted to-

258. 1:06:16

     That's all. Good question

259. 1:06:17

     ... I, I think it was improper just to assume that the rest opposed.

260. 1:06:20

     Okay.

261. 1:06:20

     So I just wanted to clarify. Thank you, Mr. Chairman.

262. 1:06:22

     Always the smart lawyer. No, you are. That's good. That's... Uh, up next, Monty Veazey. And I think Kathy's gonna join you.

263. 1:06:32

     Uh, yes, please.

264. 1:06:33

     Povino.

265. 1:06:36

     I want to bring Kathy Povino up, who's our general counsel and who is a legal expert in certificate of need in Georgia. Mr. Chairman, members of the committee, I'm Monty Veazey, president of the Georgia Alliance of Community Hospitals, representing about 90 not-for-profit, locally-owned hospitals across state. We are opposed to Senate Bill 367.

266. 1:07:08

     We attempted to work with the senator in the Senate on language that would narrowly define the bill, uh, but they chose not to accept that. So as you know, two years ago, Georgia passed major certificate of need reform. That reform has already affected our hospitals, and the full impact will not be known for years to come.

267. 1:07:38

     Senate Bill s- 367 is just another carve-out

268. 1:07:45

     of a group seeking to expand and establish ambulatory surgery centers across the state, which would further undermine our community hospitals. Georgia hospitals have invested hundreds of millions of dollars to expand cancer care and provide treatment across the state. We have 67 rural hospitals, 30 are which are critical access. Many of those offer cancer care today. Today, the City of Hope, St.

269. 1:08:15

     Joseph of Savannah, Northside, WellStar, Piedmont, Northeast Georgia, and many others are partnering with rural hospitals to offer cancer care. Our hospitals, I submit to you, provide some of the best cancer care in the country. We reinvest hundreds of millions of dollars back into patient care, training, research, technology, also clinical trials, investments ASCs typically do not make at the same scale.

270. 1:08:49

     And at the same time, we're members of the National Cancer Institute and many others.

271. 1:08:57

     At the same time, hospitals are legally required to treat everyone that comes through our doors regardless of their ability to pay. We also treat the Medicaid patients even though reimbursement does not cover our cost. ASCs, by contrast, can pick and choose the patients they treat and often focus on commercially insured patients. The Department of Community Health, for example, maintains a list of ASCs it has fined for not taking their share of the Medicaid or the indigent care.

272. 1:09:35

     We're not afraid of competition, but it must be a level playing field. The trend nationally in Georgia, and nationally, is that entities seek a CON exemption. They expand and they turn around and sell out to private equity. Investors cash out, communities are left with higher costs and less accountability. The General Assembly is working this year to address p- private equity's role in housing.

273. 1:10:08

     It's the same dynamics in healthcare. They have decided to enter the healthcare market and they're disrupting the healthcare in this nation. Since the passage of 1339 two years ago, we've seen out-of-state private equity-backed firms apply for CON exemptions, but only to the wealthiest ZIP codes where the payer mix is most favorably.

274. 1:10:38

     And I'm gonna ask, uh, Kathy in a minute to address some of those issues. Many of our rural hospitals have contracts in place to provide PT scanners at their local hospital by mobile PT. Uh, this bill would undermine those contracts.

275. 1:10:56

     Okay.

276. 1:10:56

     Under the big beautiful bill Congress passed, added $50 billion for rural hospitals. Georgia will receive over $200 million out of that. Many of our rural hospitals are planning to use some of those funds to offer cancer care at their local hospitals to provide greater access.

277. 1:11:17

     Okay. Thank you.

278. 1:11:17

     Thank you.

279. 1:11:18

     You've got a question, uh, Representative Clark.

280. 1:11:22

     Can we do this mic?

281. 1:11:24

     We have one?

282. 1:11:25

     Yes.

283. 1:11:25

     That, that should be-

284. 1:11:26

     Okay. There we are. Perfect. Can you hear me? Yes. Um, thank you. Um, at the very beginning of... Uh, first thank you, um, for your presentation. At the very beginning you said you tried to talk to the senator, um, that is the, um, author of the bill, and, um, they did not want to do some of the things that you suggested. Do you mind kind of outlining some of the things-

285. 1:11:51

     Well, I'll let Kathy address that, but we tried to, uh, define, uh, it more narrowly. Um, and, uh, so we just did not come a- to agreement on that. And I have all the respect in the world for the senator.

286. 1:12:10

     Okay.

287. 1:12:10

     Uh, Kathy, you want to address?

288. 1:12:12

     Yeah, Kathy, would you think of my chart?

289. 1:12:14

     Yeah.

290. 1:12:16

     Let's swap seats.

291. 1:12:22

     Thank you, Mr. Chairman. Um, and if I could address just at a high level some of the concerns we have. The first que- the first major concern is that this would deregulate ambulatory surgery centers, and there's a lot of room for abuse. There have been a lot of studies recently about the effects of private equity in ambulatory surgery centers. There's one that was recently published in October of 2025 by the Private Equity Stakeholder Project, which has found that private equity investment in ambulatory surgery centers is leading to what we would expect, which is higher prices, lower quality of care, and facilities making dangerous decisions to boost revenues, which includes using less qualified staff to perform the same services.

292. 1:13:04

     We're worried about that in the surgery context. We're also worried about it in the context of radiation therapy. We're not just talking about radiation therapy, but we're also talking about stereotactic radio- surgery, which would be deregulated, which is millimeters count. Um, the CON laws are the only laws right now that have quality standards for that. So requiring you to have a board-certified radiation oncologist trained in, for example, CyberKnife or some of these really advanced technologies, all of those quality benchmarks and standards are in the CON laws.

293. 1:13:39

     So if those go away, there are no quality standards for any of these technologies. Another concern we have about the unequal playing field is right now if someone gets a CON for, um, PET/CT or radiation therapy, they have to take Medicaid patients, Medicare patients, and they have to provide 5% of their adjusted gross revenues for indigent and charity care patients. These entities that we're talking about now that would be exempt have no financial accessibility requirements.

294. 1:14:11

     Zero. So that is another unev- uh, uneven playing field. So we propose that those be changed. We also, you know, there is a need for quality standards. We're very concerned about lines 39 to 40, which says that the exemption applies regardless of ownership structure. I mean, that is opening the door to private equity and telling them they're welcome here. Um, a few other just high level co- comments is the exception that was introduced on the floor that Chairman Cowser discussed.

295. 1:14:44

     It, as he mentioned, only applies to 10 hospitals. Some of those are urban hospitals. We have a map that's available at the State Office of Regional Healthcare that shows all of the critical access hospitals and rural hospitals in Georgia. There are 67 of them. 80% have no protection under this bill. So that is a concern to all of our members that do not fall within that exemption. Um-

296. 1:15:11

     I'm counting this as your testimony.

297. 1:15:13

     Yes, absolutely.

298. 1:15:15

     Okay. And you've got a number of questions, so can you start taking some questions?

299. 1:15:20

     Yes.

300. 1:15:20

     Thank you. Uh, I don't know who...

301. 1:15:26

     Representative Schofield. Schofield.

302. 1:15:28

     Thank you. Thank you. I just had a quick question, 'cause I'm just a little bit curious. Do your members accept private equity?

303. 1:15:35

     So, um, the nonprofits are, are nonpro- you know, the nonprofits can't joint venture with private equity-

304. 1:15:42

     Okay

305. 1:15:42

     ... which are a for-profit model.

306. 1:15:43

     Okay.

307. 1:15:46

     Okay. Representative Mathiak.

308. 1:15:51

     Thank you, Mr. Chairman. Um, uh, uh, line 34, it says, "We'll comply with applicable federal and state regulations for oncology care." So wouldn't that cover, um, ownership structure?

309. 1:16:07

     It does not.

310. 1:16:08

     Tell me why. Oh, excuse me. Can I ask a second question?

311. 1:16:12

     Sure.

312. 1:16:12

     Thank you. Um, can you walk me through that?

313. 1:16:15

     Sure. Um, years ago, uh, the legislature in- told the Department of Community Health to develop, um, standards for things such as radiation therapy. Never happened, so there are no licensure standards. There are no ownership restrictions. Um, all of that, you know, we have exemptions in Georgia for ambulatory surgery that have ownership restrictions, making sure it's hospitals and physicians, for example. All of those restrictions right now are in, um, the CON laws.

314. 1:16:46

     They're, they're, d- they don't exist anywhere else. What you have are some requirements with respect to, for example, calibration of some of the types of equipment, but not, for example, requiring you to have the board-certified trained, um, radiation oncologist or physicists or other staff.

315. 1:17:08

     Okay. Thank you.

316. 1:17:09

     Thank you.

317. 1:17:10

     Uh, Representative Lim.

318. 1:17:13

     C- could you clarify, because I, I hear the, the concern very much, but it was also stated earlier that some, uh, ASCs had been fined by DCH for w- what I heard was not necessarily serving whom they should. Could you elaborate on who is getting fined for that?

319. 1:17:32

     So when a facility, the legislature, um, I think it was, it was either 2018 I mean 2008 or, um, 2019. But there were changes to the CON laws to make sure that imming- imaging centers and ambulatory surgery centers that were not having to, um, comply with the CON laws had to make a minimum indigent and charity care commitment. For example, if you're a surgery center and you took Medicaid, your indigent and charity care commitment was 2%. If you did not, it was 4%.

320. 1:18:03

     And imaging centers, likewise, if they were going to expand and add additional equipment, they had to take Medicaid patients or provide indigent and charity care. And what has happened is that imaging centers are not reporting any data to the department, so whether they're doing anything, we don't know. And with ambulatory surgery centers, they are routinely getting fined by the Department of Community Health for shortfalls. But the shortfall funding doesn't get patients the care they need. You know, what you want is not for somebody to pay a fine for not doing what they're supposed to do, you want them to actually provide the care, and that's where we're seeing this discrepancy.

321. 1:18:39

     All right.

322. 1:18:39

     Is it your opinion that that regulatory regime, if it were stronger, would resolve the issue, at least in part? Because I hear you. What I'm hearing is they're not being forced to internalize the costs of not serving everyone.

323. 1:18:54

     I, um... Right now, the, the Department of Community Health does not have the resources to just, you know, follow up on all of these. And so they used to actually weekly report who was not complying with their commitments. They no longer... They stopped doing that about a year ago. Just, I just think they're underfunded and understaffed at the moment.

324. 1:19:15

     I would say something to that. If the federal government would pay for the healthcare they promised, we wouldn't be in this mess we are in, uh, right now.

325. 1:19:22

     Mm-hmm.

326. 1:19:22

     You wouldn't have the competition we've got.

327. 1:19:25

     Well, we do not have time for-

328. 1:19:26

     And well, that's enough from, from me. Uh, Representative Davis. Were you on? Didn't you want on?

329. 1:19:31

     Oh, yes. Thank you. Thank you, Chairman. My question is this. Uh, I know that there's, um... people worry that this may harm the safety net hospitals. Um, can you give me some examples of some guardrails that can be put up if we moved forward that could protect your safety net hospitals?

330. 1:19:58

     W- And we, that was some of the proposals that we had, um, to Senator Cowserd, is having certain, um, considerations for, um, ability to staff and have workforce, because that's one of the biggest issues that safety net hospitals face is, you know, workforce shortages and the cost of having adequate workforce. And also making sure that this was not an excuse to just go drop new facilities nearby hospitals. So, um, we had proposals that this be, if someone get a new cancer, um, service, that it be tied geographically to where they exist, whether as a physician office or as a hospital within a, you know, 100, 1,000 yards is what's in the s- in the CON statute now as a kind of parameter around a hospital.

331. 1:20:43

     And we proposed the same kind of parameter around existing physician groups and hospitals so that this was not used to just go put services next to hospitals, which is what we typically see.

332. 1:20:57

     Representative Stinson.

333. 1:20:58

     Yes, sir. Yes, sir. Thank you, Mr. Chairman. Um, quickly, I'm just gonna share two quick things, then I ask a question. Um, I think everyone in this room know that I went through breast cancer last year. And when I was first informed that it was a, a, a lump, um, I need to have a mammogram. And I was under the care of Emory. And, uh, Emory was booked up for several months just for a mammogram. And so I end up going to an imaging center in Warner Robins, Centerville, Georgia, got the imaging done, and, and was able to move things along faster because we had a imaging center in, in nearby.

334. 1:21:33

     But it wasn't in my district. It was several miles away. And so because of that, we were able to move the, you know, I was able to address the pro- issue immediately and, and start treatments. Um, but so I wanna know, this bill, what I just shared, how would this bill, uh, affect what you're saying and what I just went through? Tell me how what you're stating would, uh, would my story would've been any different? And then lastly, uh, you mentioned about the, uh, the lack of resources from the Department of Community Health.

335. 1:22:05

     Are they prepared to share any comments on any lack of resources, or what we probably could do to help them more maybe in that case? But I just, that's-

336. 1:22:15

     Yeah

337. 1:22:15

     ... that's just a question I know they can answer, but I just wanted to put that out there since you brought up about the lack of resources from the Department of Human, Community Health.

338. 1:22:23

     And I, I don't want to speak for the department.

339. 1:22:24

     Yes.

340. 1:22:24

     I'm just talking about what's published in tracking reports. You know, what was-

341. 1:22:28

     Right

342. 1:22:28

     ... and was not. And so I, I do not want to speak for them. But as to the question about how it would help your, this bill would help your scenario, it wouldn't at all. Right now, ultrasound, mammography, um, are not regulated under the CON laws. Chemotherapy is not regulated. MRI, CT, PET CT, PET can all be provided in a hospital, in a doctor's office. A lot of those issues in terms of access, um, delays are often insurance-related. Um, the UCBC discussion we talked about, they're, the reason they were turned down the first time is because the complaint about patients waiting, it was found by a hearing officer that the delays in patients getting care was due to insurance pre-authorizations, not unavailability of services.

343. 1:23:16

     And so there's so many factors that go into why people face delays that have nothing to do with the CON laws. And so mama- mammography, that delay has nothing to do with CON. Likewise, a lot of the, the PET CT and other delays are not CON-related. They're part of the bigger, you know, complexities of the healthcare system.

344. 1:23:35

     And a quick follow-up, Mr. Chairman, if I may. Just wanna say Emory did a great job of providing care for me. I just went through this other facility for the imaging, but E- Emory did a great job. Thank you.

345. 1:23:46

     Thank you. Where I graduated from Okay. Uh,

346. 1:23:53

     okay. Um, uh, can you press your button, see if it'll come on? I've, I've got nothing up here. You wanna share Stinson's?

347. 1:24:00

     There we are.

348. 1:24:00

     We can try it.

349. 1:24:00

     There it is. All right. Um, so really quick, I'm hearing a lot of the arguments, and a lot of them do make sense when it comes to dropping whole facilities.

350. 1:24:14

     Mm.

351. 1:24:15

     If this bill was tailored to specifically allowing equipment in existing facilities, how would that impact the hospital? Like, how would that... Uh, would that... Would you be as opposed or still opposed if it was specific for equipment? Because all the arguments I'm hearing are very specific to, like, facilities, ambulatory surgery centers, and things like that.

352. 1:24:41

     I, I know I can't speak for all the members because we haven't asked that question. I know that the opposition to ambulatory surgery facilities is broad. I know the concern about, you know, dropping new radiation therapy f- facilities kind of next door to hospitals is a concern. Um, if there are ways to limit this bill, um, to reduce the risk of that, it's something we would continue to have... W- we've been trying to do that from the outset, and we would be interested in continuing to try to have those discussions.

353. 1:25:10

     So just as a follow-up, there's not as much pushback against allowing existing facilities to get important equipment, state-of-the-art equipment that right now, because of CON laws, they're not necessarily able to get in a timely manner. They still can get them. They just have to do the application, all this... And I, and I'm, I'm gonna be very candid. I'm, I'm speaking from the perspective of the daughter of a parent going through cancer treatment right now. So when I'm talking about this, I'm just trying to make sure that patients have access, and, um, if it's an equipment...

354. 1:25:46

     'Cause there's a lot of stuff in here, but if it was narrowed to equipment, is there as m- is there strong opposition?

355. 1:25:54

     What we would say is that we would ask that, um, the House and this committee wait until next year. The department has convened technical advisory committees, which are experts, which include experts on workforce shortages. I'm sure the Winship Cancer Institute will be on it. I'm sure UCBC will be represented and others here. But the department is, has convened tasks to study both PET scan, um, radiation therapy, which is, includes all the stereotactic radiosurgery, um, ambulatory surgery.

356. 1:26:25

     They're, they're convening those tasks right now to come up with recommendations to modernize the rules and component plans, which some of which haven't been updated for 20 years. We fully support modernizing the standards. We fully support getting clinical support. Um, w- our concern is that this bill is premature, and the, those technical advisory committees should be allowed to do their job.

357. 1:26:46

     Okay. Thank you very much.

358. 1:26:48

     Thank you.

359. 1:26:48

     Up next to speak to the bill is Chris Denson.

360. 1:26:59

     Mr. Chairman, members of the committee, my name is Chris Denson with the Georgia Public Policy Foundation and Georgia Policy Impact. I am testifying in support of the bill. Uh, in your packet, you have a story from a patient of UCBC. Um, in 2024, both the House and the Senate had study committees on this issue, and actually, during that time, uh, that man's name was Gary Galloway, and he reached out with us to share his story. And, um, we've provided that in your packets, and that helped spur some of the cha- uh, changes that took place in 1339.

361. 1:27:29

     But his story is basically that he was having to go to the, receive treatment at UCBC and then as an immunocompromised patient, having to go inside the hospital to have his imaging done. Um, but I know the hour is long, and I just wanna close by saying, um, pediatric oncology came up at the beginning of this hearing. Uh, according to the Georgia Board of Healthcare Workforce, we have 89 pediatric oncologists in this state as of 2024, and 58 of them practice in DeKalb County, another 18 in Fulton.

362. 1:28:02

     So we have a serious concentration, or serious lack thereof in the rest of the state that are not those two counties. Um, and with that, those are my remarks.

363. 1:28:11

     All right. Thank you very much. Uh, Senator Cowtzer, I bet you would love to wrap up. Be glad to. And I'll, I'll, I won't rebut every single thing said, but I, I think it's just quite interesting how few hospitals are against this. Now, you, you hear that there are, you know, two in favor from one whole institution, but I think most of them must be neutral. The vast majority do not provide cancer oncology services.

364. 1:28:42

     This is not like cherry-picking profit centers away from those hospitals that are making money at it now. We carefully, at the request of community hospitals, put in the amendment to protect those sole community hospitals with oncology care now, so they can continue to have their monopolies in a 35-mile, uh, zone around them. This is not to hurt those. Couple other points I would make. In, in the 1339 was the number of the bill two years ago for rural hospitals, and it had only the PET scan on oncology care.

365. 1:29:19

     Since that time, not a single rural hospital has closed due to new competition. Nobody has ceased doing oncology services that was previously doing oncology services. Going back to you're in my days when CTCA was an exemption to CON, all the big hospitals said, "You're gonna run us out of business. You're gonna cherry-pick the pa- people that can pay, et cetera." Nobody has closed. They've only expanded, and, and it is good to collaborate.

366. 1:29:51

     A lot of these- major hospitals like Winship and CTCA or New- City of Hope now and Northside can work with local communities to develop their oncology treatment. And it's easier for them to do that without having to jump through these CON hoops. They can do it faster, more efficiently, without wasting the time. There is way more than enough cancer to go around for all the medical providers to treat. The other thing, and I'll wrap up 'cause I know it's, it's late, is the big beautiful bill that was mentioned, the, all the hundreds of millions coming to Georgia.

367. 1:30:27

     One of the factors to allow a state to access that money, and we got 280 something million more than other states, is if you have rescinded CON laws. The fact that we passed 1339 helped us get over $200 more million than we would have. In that bill, it says even more favoritism is given to states that completely rescind CON. And we're seeing where South Carolina did it and Florida has done it.

368. 1:30:58

     That is the trend, and they have more accessibility to care. Their healthcare systems are not collapsing. They're not having people close down as a result of that. Uh, and I'll just leave it at that. It, it just, it, it's, um, very disheartening to hear hospital associations oppose the availability, accessibility, affordability of cancer care, especially when they're non-profits and are not supposedly in this for the business.

369. 1:31:25

     Thank you. Thank you. Do you have a question, Representative Parsons?

370. 1:31:30

     Thank, thank you, Chairman. I have a question. I don't know whether, um, if the senator can answer it or r- uh, refer to it. Comment on it, then that'd be fine, and maybe the chairman needs to. You know, I remember, uh, I think it started about 20 years ago. I couldn't... When you mentioned the Cancer Centers of America, I think that's what it's called.

371. 1:31:52

     Yeah.

372. 1:31:52

     I had forgotten about that. Well, I hadn't forgotten about it. Nobody could forget about it because they spent, God only knows, they had spent millions and millions of dollars in Georgia to get that. And a very, uh, uh, th- they were not easy to deal with. And then they came back after they got what they wanted, then they came back I think two or three times after that to get more. My question is, did we just carve out something for that particular, uh, whatever it be called, uh, not a hospital, but a facility?

373. 1:32:22

     Did that what we do? Did, is that what we did then so that some of these others that the senator's talking about, you know, couldn't apply for the same thing that they, that they were g- granted? But it, was it just a, was it just a carve out for them, that particular facility?

374. 1:32:36

     At that time.

375. 1:32:37

     Yeah, I, I can answer that. It was.

376. 1:32:39

     Okay.

377. 1:32:39

     We called them a destination cancer center, and we did require that they do the same level of indigent care, which is roughly 3%. I thought that had been put in this. I had expressed that I'm happy for this to require indigent care as well. It should to, a- and to protect the sole community hospitals. What I didn't feel like was appropriate for us to do was get into all this private equity and putting contingencies on that for one set of hospitals and not others.

378. 1:33:07

     Just one comment. If they s- if they had spent the money they spent on lobbying and contract lobbyists here in Georgia for healthcare, they could've taken care of a lot of people.

379. 1:33:18

     And the chairman has a lot of passion. Thank you. And I want to thank my friend, the senator, for, for bringing this.

380. 1:33:24

     Thank you.

381. 1:33:24

     Um, you have a lot of patience, too. You have a good heart. And, um-

382. 1:33:28

     Thanks a lot

383. 1:33:28

     ... I wish you very well in the future. Thank you.

384. 1:33:30

     All right. Thank you very much.

385. 1:33:31

     This meeting is adjourned. Thank you, uh, committee members. I appreciate your time.