By PAULA TRACY, InDepthNH.org
CONCORD – The Senate will be asked to approve two consolidated and amended bills that would set into law limits of some chemicals in drinking water believed connected with a childhood cancer cluster on the Seacoast and one related to the study of the safety of residents and staff of nursing homes, particularly now during the pandemic.
Following virtual public hearings on amendments to the two existing bills Tuesday, the Senate Health and Human Services Committee voted 5-0 to pass House Bill 1264 and House Bill 578-FN as amended, to the floor of the Senate where the retiring Senator Martha Fuller Clark, D-Portsmouth, will make the case for passage.
“As we look at reopening the state, we must take a hard look at those most impacted,” Fuller Clark said. “It is our job as legislators to put new systems in place to protect our vulnerable populations and do everything we can to prevent future loss of life, including adequate testing for both residents and staff, greater access to PPE and making it possible for families to video conference with their loved ones.”
The vote on HB 1264 was opposed by several representatives for the health insurance industry who voiced opposition to amendments that would require their coverage for blood testing for levels – which cost about $800 each – claiming they have no benefit to helping direct care.
Sen. Tom Sherman, D-Rye, chair of the committee, who is a physician, argued that the tests can help doctors like himself understand baseline exposure to such chemicals as PFAS and PFOAs, which are at the heart of the study committee’s investigation.
Others indicated a hope that the current lawsuit related to the state’s levels of such chemicals, now at the state Supreme Court, would resolve the issues, but Sherman said waiting for that result does not help address a problem that is impacting the health of citizens now.
The consolidated bill would also extend the study committee through June 2022 on something that Sherman said is a matter of science that is changing by the day.
State Rep. David Meuse, D-Portsmouth, testified and thanked Sens. Sherman and Jeb Bradley R-Wolfeboro, for consolidating the bills.
He said that since 2017 a legislative study commission has been looking into the occurrence of two very rare cancers, particularly in children in the Seacoast. One, RMS, led to several deaths around the former Coakley landfill near the former Pease Air Force Base, and another where a higher than normal pediatric lung cancer cluster has been found.
“There are no easy answers or quick solutions to this problem,” Meuse said. “The information on this is quickly changing and evolving.” Meuse and the new science on the subject is “coming at you” both nationally and locally.
The commission needs additional time to do its work and he supported the extension until June 30, 2022, with two reports along with way.
Sherman said cancer has been a major focus of his work for the past six years. “This work is voluminous,” Sherman said, and “far from done, so I ask everyone’s support for this,” extension.
State Rep. Renny Cushing, D-Hampton, testified in support of the request for the extension.
“I commend the committee for having this public hearing,” Cushing said.
Mindi Mesmer, the former state representative for Rye and Newcastle who has been part of this investigation from the outset, and is running for the Executive Council, said this is a very complicated issue and very important.
“We have high rates of cancers in children and elevated rates in adults,” Messmer said. Mesmer said there has been a focus on “a big Superfund site called Coakley Landfill, but there are other factors that may be impacting which we have not gotten to yet.”
“We are not seeing the action required,” to protect drinking water and the state has just “kicked the can down the road.”
Messmer said New Hampshire has high rates of a number of cancers around the state.
Jason Randall, superintendent of the Plymouth Village Water and Sewer Department, superintendent applauded the committee for taking PFAS on, noting it is a challenging topic, and he confirmed for Sherman that Plymouth has a PFAS problem with its wastewater.
He noted, however, that the amendment leaves out money for state resources for wastewater cleanup while it has a fund for drinking water protection.
The bill allows for municipal immunity and provides a loan forgiveness plan to clean up the water. Leaving the costs out of remediating would result in higher costs for water users, he argued.
Bradley said while there is a plan to get the funding from the responsible party who polluted the water, “this legislation and the underlying (Department of Environmental Services) rules have not set a standard for wastewater yet.”
Bradley said the bill puts in law the limits on PFOAs and starts a funding mechanism to mitigate the impact for end-users. Until that is set, he said, the $50 million bond in the bill will at least cover the first few years of implementing these standards.
Sherman said the state standards are “science-based” and noted that similar levels have just been passed by New Jersey.
While some have raised concern that we are putting standards in statutes, it has been done before, noting that is the case with lead paint.
David Creer, director of public policy for the Business and Industry Association, said the BIA is against the amendment. He said the levels for the chemicals were set into rules last summer and are now enjoined from enforcement due to litigation.
He said the BIA “thinks at this time it wouldn’t be prudent to extend these large costs, without justifying the health benefits. We ask you do not apply MCLs into statutes….and let that lawsuit continue on to Supreme Court where it now sits.”
Sabrina Dunlap, senior director of government relations at the insurance company Anthem, expressed concern the bill which would require insurance coverage of such blood tests in patients. She questioned whether the blood tests have any clinical use or value and asserted the results cannot be used to make a diagnosis.
Sherman said he has a patient who lives near Pease with ulcerative colitis which has been identified by the CDC as being associated with PFAS exposure. The baselines drawn were quite high.
“As a clinician, it is really quite critical,” to have those test results, Sherman said. “I would take exception to your testimony.”
“I cannot get a repeat level to see if he has cleared this and see the impact on his ulcerative colitis. Wouldn’t Anthem consider it…necessary for my ability to treat?” Sherman asked.
Dunlap said she is not a doctor, as he is, but looking at what NH DHHS and CDC has to say, they say the tests are quite limited to pinpoint a health problem.
Katie Cole, public policy director for the Tufts Health Freedom Plan, also opposed the bill.
“This mandates coverage for tests,” said Cole, “which have no clinical utility.”
Shelagh Connelly, president of Resource Managment Inc. of Holderness, a recycler of biosolids from areas of the state including Nashua and Plymouth, have been active in the conversation related to PFAS and reuse of biosolids for fertilizers.
While she said she supports the continued study, she does not support the amendment, which establishes a new low limit through statute rather than the DES process of rules which require a cost-benefit analysis. She said it also becomes political in an election year.
“It feels like an end run,” Connelly said.
Peter Bragdon, a former senator speaking on behalf of Harvard Pilgrim Healthcare, spoke in opposition to the amendment requiring insurance coverage for blood testing.
He, too, said the test doesn’t have value in the treatment of an individual.
Despite the concerns raised, the committee voted unanimously to support the amendment and unanimously to pass the bill on to the full Senate for consideration.
Nursing Home Safety
House Bill 578 started as bill to address a problem with the transition of the developmentally disabled from child to adult support and now it will include an amendment to study the safety and health of residents and employees at long-term care facilities. The bill and amendment both received unanimous support from the committee.
Of the 245 residents who have died due to COVID-19, 203 were in health-care facilities of some kind that suffered an outbreak of three or more cases in the same facility.
Sen. Fuller Clark, who has announced she is retiring from the Senate recently, said that as a result of the pandemic, the time is important to look at impacts on health safety in these institutions.
Sen. Jon Morgan (D-Brentwood), said: “New Hampshire’s long term care facilities have disproportionately felt the effects of the coronavirus pandemic. Nearly 80% of the fatalities in New Hampshire have taken place in our nursing homes and long term care facilities. Now, more than ever, we need to take a deeper look at the safety of the residents and employees at these facilities.”
Sherman added an amendment that would have the study committee look at issues related to access to personal protective equipment, infection control, human resources, staffing, and testing at these facilities. Fuller Clark added that this amendment respects the intent of the original amendment but formulates it in a slightly different way.
Sen. Cindy Rosenwald, D-Nashua, said the bill is fiscally responsible and “what the people of New Hampshire want.”
Kate Horgan, representing the New Hampshire Association of Counties, said it was not opposed to the intent of the bill, but feels there is a better way.
“We have concerns about how rates are set, which could dramatically increase costs,” she said, noting there needs to be a more complete review of health care services and the bill “needs some tweaking and more thoughtful approach before moving forward.”
Sherman offered a committee amendment that in light of the impact of COVID-19 on long-term care facilities the committee will also study, “acquisition and inventory of PPE, policies on infection control, adequacy of staffing and resource support, adequacy of testing capacity, and support and communication with federal and state government agencies.”
While he said the only additional aspect would be looking at the financial impact, he said he thought that might be separate and Fuller Clark agreed.
“That is a huge task unto itself,” Fuller Clark said. “It might prevent getting the information we need in a timely fashion. Perhaps there is another way to get that information.”
The committee voted to support the measure unanimously. The Senate Health and Human Services Committee will meet again, virtually, on Thursday at 8 a.m. June 4 to tackle a telemedicine bill.