From the Well | December 9, 2021

At the center of the West Virginia state Capitol is an area known as The Well.

It is the informal gathering place for lobbyists, reporters, constituents and lawmakers.

Centrally located between the chambers of the House of Delegates and Senate,

The Well is often where information is shared, alliances are formed, and deals are made.

Pack attributed most of the vacancies to low pay, high caseloads and overall burnout.

Discussing DHHR’s Child Abuse and Neglect Hotline, witnesses said it sometimes does not refer cases to the proper authorities if information doesn’t rise to the level of child abuse.

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He also said 14% of babies born in West Virginia suffer from Intrauterine Substance Exposure (IUSE) or exposure to drugs. The average cost to taxpayers per case of NAS or IUSE is $2 million from the time of birth until the child reaches adult age.

“It’s an enormous expense, so you start to look at that percentage of kids born with NAS or drug-exposed and then look at the broader DHHR budget …,” Samples said. “You really start to see what could be a growing tsunami of expense that’s going to be very difficult for the state to sustain unless we can bring that number down.”

According to 2018 data, 54 percent of child removals from homes are the result of parental substance abuse. While removals for adult substance abuse have risen at a constant rate since 2012, removals for child behavior or neglect have decreased over the same time. As of November, 6,796 children are in the state’s foster care system.

Some departments in West Virginia are fully volunteer and some departments are part volunteer and part paid firefighters.

W.Va. Code 33-3-14d says, “Each volunteer fire company or department shall receive an equal share of the revenues allocated for volunteer and part-volunteer fire companies and departments.”

However, W.Va. Code 33-3-33, says funds shall be disbursed “… to each volunteer fire company or department on an equal share basis.”

Currently, the Treasurer is reducing the distribution to hybrid or partly paid departments based on the ratio of paid to unpaid firefighters, interpreting 14d as directing that reduction. The Treasurer seeks clarification on how those funds should be distributed – equally to all departments or with deductions to a portion of those fees to the partly paid departments.

West Virginia has 427 volunteer VFDs and only 12 partly paid departments. Reversing the Treasurer’s current distribution formula would me a small reduction – roughly 1.5 % – to all-volunteer VFDs and a corresponding increase to partly paid departments.

The legislation is in draft form, and the committee requested further input from VFDs to help clarify the bill before a final draft is submitted for consideration.

Jaclyn Schiffour, counsel for the committee, presented proposed legislation seeking clarity and broader latitude on allowable expenses for certain VFD funds. Under current law, items such as bottled water on scene and Internet and cell phone services at the department are not allowable.

Additionally, when seeking clarification or advice regarding allowable expenses, the interpretation of what is allowable varies from auditor to auditor. The bill seeks to modernize, expand, clarify and make uniform what is an allowable expense while also protecting the public from misuse of funds.

As with the other bill, the legislation is in draft form. The committee requested further input from VFDs to help clarify the proposed bill before a final draft is submitted for consideration.

Drennan said an involuntary commitment proceeding to one of the state’s hospitals — Bateman in Huntington and Sharpe in Weston — should take three to six hours, although some of them can continue for days.

Drennan said a task force has met for a year, and he offered highlights that are to be included in a bill that will be introduced in the upcoming session:

·    Allow transport by law enforcement officials other than sheriffs’ deputies. Emergency medical technicians may handle some transport post-adjudication.

·    Require the Department of Health and Human Resources secretary to provide information identifying contacts for admission to state hospitals.

·    Require the DHHR Secretary and the West Virginia Supreme Court of Appeals to perform civil involuntary commitment audits.

·    Require mental health centers to make available trained individuals to conduct competency hearings generally via video conferencing.

·    Change the language for instituting a proceeding from “reason to believe” to “direct and specific knowledge” that an individual may be of harm to the individual or others.

·    State hospitals must be made aware of the filing for involuntary commitment within 30 minutes.

·    A health care provider must determine the individual is medically stable and provide that information to the state hospital within 30 minutes. The determination of medical stability is somewhat limited, not requiring a substantial and often time-consuming battery of tests.

·    A hearing to determine whether the person meets involuntary hospitalization criteria must be held within two hours.

·    The examiner, within 60 minutes of completing the examination, must notify the mental hygiene commissioner, circuit court or magistrate and state hospital of the outcome.

·    A probable-cause hearing must be held promptly before a magistrate or mental hygiene commissioner. A cadre of mental health commissioners could be trained by the Supreme Court to conduct the hearings through telehealth.

·    The bill sets out timelines and requirements for how long an individual can be kept in a facility under an involuntary commitment order.

·    If there is not a bed in a state facility, the individual is required to be sent to a diversion facility. The diversion facility must be identified within two hours.

Advocates object that the expedited version of commitment may not allow them time to preserve an individual’s constitutional rights. There also was discussion about getting individuals to enter into voluntary commitment agreements to preserve their ability to own firearms.

The task force also recommended:

·    Extensive, independent data collection without gaps and prompt evaluation with 10 percent of total funding to be directed to evaluation.

·    An allocation of $1.6 million annually for the West Virginia Quitline.

·    Increased funding for nicotine cessation medication. Third-party payers and providers should be required to pay for longer treatment times and higher doses of medication because of the state’s high number of heavy smokers. Current protocols may not be sufficient to address the therapeutic and prescription needs of heavy smokers.

·    School providers should become tobacco treatment specialists.

·    A total of 14 tobacco treatment specialists should be funded in areas served by regional behavioral health centers.

·    Community tobacco control networks should be re-established throughout the state, which once led the country in such networks. Additional money should be allocated to communities abnormally affected by smoking.

·    A youth-specific, media-focused intervention should be developed, as well as funding for a media campaign to bring all tobacco-cessation messaging under one roof.

·    Taxes on cigarettes should be increased $2.20 per pack with a 43% increase for all tobacco products.

·    Flavored tobacco should be removed from sale.

·    Local indoor clean-air ordinances should remain in force.

She said the center helps document an individual’s wishes for medical care.

“It’s a process,” Funk said.

She encouraged individuals to not do end-of-life planning once and then forget about it. She noted a medical power of attorney document says who an individual wants to speak for him or her if he or she is unable to speak. A living will describes the kind of care an individual wants.

Amy Wirts, MD, chair of the State Advisory Coalition on Palliative Care, said palliative care is not hospice care or end-of-life care and can begin as long as 12 months before a person’s death. Hospice care generally occurs during the last six months of an individual’s life.

Wirts said West Virginia is one of a few states that has a mental health advanced directive, a seven-page document that details the kind of care an individual experiencing mental health issues wishes to receive.

Legislation will be introduced in 2022 to have Medicaid pay for palliative care.

Shirley said West Virginia is a prime location for entities looking to offset their greenhouse gas emissions. He said California companies are entering into 30-year agreements with West Virginia landowners, mostly in southern counties, and the trees on those specific tracts cannot be timbered.

In addition, Shirley said, the non-public nature of the agreements and a lack of specifics and data could create potential consumer sales and property tax concerns at the State Tax Department and on the county level.

By the end of the meeting, committee members appeared to believe they would see legislation during the upcoming session to address the topic.