Ohio Senate Health Committee - 6-10-2026

The chair recognizes Senator Romanchuk for a motion. Thank you, Mr. Chairman. I have moved to favorably report the slate of governor's appointments to the Senate Committee on Rules of Reference.

The chair will recognize Senator Nugger for a motion. Thank you, Mr. Chairman. I move that we adopt Amendment 1864.

Yeah, I'd be happy to. This amendment came directly from the Ohio State Medical Board to rectify their concerns with the background check process in the compact. This amendment requires an individual who holds a respiratory care interstate compact privilege in Ohio to complete within 60 days a criminal records check in accordance with Ohio law unless the individual has already completed an equivalent criminal records check in their home state and authorizes the state medical board to take action on the compact privilege based on the results.

And the chair recognizes Senator Rogner. Thank you, Mr. Chairman. I move that the committee favorably report Senate Bill 149 to the Committee on Rules and Reference.

Thank you, Mr. Chairman. I move to favorably report Senate Bill 324 to the Senate Committee on Rules and Reference.

The chair recognizes Senator Liston for a motion. Thank you, Chairman. I move to amend Senate Bill 423 with Amendment 2993.

Sure. This amendment changes the look-back period from 14 days to 21 days. So when determining that a person who has booked a shift is exempt from existing employment relationship, They must not have been in employ as a W-2 worker 21 days prior instead of 14 days prior. This amendment is supported by Senator Manchester and was proposed by the Ohio Nurses Association.

Thank you, Senator Huffman. I move to amend the same bill with Amendment 2994.

This bill requires that those that are no longer considered an employee do have access to benefits and occupational accidents insurance that is greater than that provided by workers' compensation.

No.

Yes.

Yes.

Yes.

Thank you, Mr. Chair. I move that we favorably report Senate Bill 423 to the Committee on Rules and Reference.

Yes.

Yes.

Yes.

Yes.

Yes.

enact the Patient Protection Act Chair recognizes Senator Romanchuk for a motion Thank you Mr Chairman I move to adopt substitute Bill 1373

David Cerrello, MD, the Academy of Medicine, Cleveland in Northwest Ohio.

Hello, thank you. Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee. Thank you for this opportunity to provide opposition for testimony related to Senate Bill 230, and raise our concerns about the impacts that it may have on the practice of medicine in Ohio. The Academy of Medicine of Cleveland in Northern Ohio represents more than 7,300 physicians and medical students in Northeast Ohio. For more than 200 years, we have worked to protect public health and promote the highest quality of practice of medicine for all Ohioans. We appreciate this body's dedication to filling the gaps in rural healthcare and understand the role of pharmacy test and treat program in the Ohio's Federal Rural Health Grant Award. As an organization of physicians, we have some concerns that we hope will be addressed in the subsequent revisions of this bill and related regulation to ensure patient safety. Pharmacists are experts in drug mechanisms and interactions and indispensable members of the healthcare team. However, pharmacy training does not adequately cover the diagnosis and management of patient health status, which is why working in a team-based model is so critical. We urge this committee to consider amending SB 230 to require the involvement of the state medical board in writing the protocols for the treatment of respiratory conditions in conjunction with the Ohio Board of Pharmacy. We believe that working together, these two boards can determine the type of reporting requirements and documentation that need to happen in order to ensure that patient health records are consistent between pharmacy and medical settings. Furthermore, we believe that any change in the scope of practice for pharmacists should be limited to those pharmacists who operate in consult agreements with physicians. Patients deserve to have their full medical history considered by anyone who is diagnosing a condition or prescribing medications. There are, for instance, several complications and conditions associated with group A streptococcal infection that pharmacists may not be trained to look for or follow up with patients about This is especially worrisome for children who are at the higher risk of associated illnesses like scarlet fever rheumatic fever and post-structoccal glomerulonephritis. These conditions need to be treated by a physician, and we believe that requiring a consult agreement helps ensure that there are oversight by a medical doctor should these complications arise. Part of why we value physician-led, team-based care is because there is so much complexity to managing the health of individuals. When we seek to simplify those processes by allowing just one provider to test, assess, and sell medications directly, we remove the important checks and balances that exist in the healthcare system. Physicians rely on their pharmacist colleagues' expertise to properly care for patients. We ask that you consider this bill. We ask as you consider this bill, you ensure that pharmacists are still relying on the physician expertise for diagnosis and treatment. Thank you for the opportunity to comment on this legislation.

Thank you, Mr. Chairman. I move to favorably report substitute Bill 230 to the Senate Committee on Rules and Reforms.

Yes.

Yes.

Yes.

Yes.

Thank you. Chair Hoffman, Vice-Chair Johnson, Ranking Member Liston, and members of the committee, thanks for the opportunity this morning to present testimony on Senate Bill 373. It's always good to work with Senator Blessing and asking for your support of this bill, which would be an integral step forward, improving our health care system across the state. This bill will address an important issue that's playing out in the hallways of our hospitals in Ohio. Our frontline health care workers are understaffed, underworked, overworked. they're overworked, and lacking representation. Senate Bill 373 takes a step in the right direction towards establishing accountability within our hospitals by reforming hospital-wide nursing care committees and requiring hospitals to adopt and implement nursing staffing plans that best reflect nurse staffing needs. Every person in this room, at one time or another, is gonna have a personal connection to a nurse. They hold our hand during our roughest medicals moments, they stay up through the night to monitor our vitals, they provide us with compassion and care when we are at our most vulnerable. Nurses are undeniably the backbone of the healthcare system here in Ohio, yet today the foundation of our healthcare system is strained to near breaking point. Current law is centralized to the hospital as a whole, Thus, staffing requirements don't properly reflect the needs of each patient care unit. This dated staffing framework forces nurses to manage impossible and unsafe caseloads. The current law may require hospitals to have nurse care committees, but it doesn't require hospitals to really adopt the staffing plan that the committee produces. This is more than just a line item on a budget. It's a direct threat to patient safety and human lives. The current framework has led to high rates of nurse burnout, the loss of exceptional care providers, and really the crippling of our health care system. The Ohio Nurses Association released a report, and it's actually very big when you print it out. It is attached to our testimony for you to read at your leisure. I strongly suggest that you have your staff take a look at it. At the very least, there are some great information in there. I've spoken with nurses from the community, and they've expressed how patients have been left unattended when they most needed care, leading to greater health complications all due to poor staffing conditions. This is not the care Ohioans deserve. The report also found that more than half direct care RNs and LPNs are considering leaving direct care health centers. Sorry. They're considering leaving direct care roles due to their concerns of patient safety and staffing. This crisis is plaguing our health care system, and it's our responsibility to find the cure. Senate Bill 373 aims to solve these issues. It will require hospitals to convene a hospital-wide nursing committee and holds a majority of representation of nurses. The bill will also require nurse staffing frameworks that are developed by the committee to be both adopted and implemented in the hospital. The current law allows for hospital administration to make the final call. This bill actually empowers the voices of nurses, enabling them to provide Ohioans with the quality care they deserve. By creating a requirement, we are setting a standard, a standard that best represents the quality of care Ohioans deserve. But I want to be clear, this is not a one-size-fits-all because it allows all hospitals to develop their own plan that reflects what each unit, even within the hospital, needs to provide the best quality care at their respective hospital. With this bill, the nurses and the hospital staff will have the ability to safely and strategically determine what is it they require to best benefit the patients and the staff because we're asking the nurses to be the experts and to share their expertise at safe staffing parameters. I'm proud to have worked alongside the Ohio Nurses Association crafting this legislation It is with the help of advocates like ONA that we can strategically work to ensure that patients nurses and hospitals all prevail through this bill Nurses will gain representation and the confidence that their professional judgment is valued. Hospitals will gain predictable standards that are internally developed and the framework that improves both retention and safety. Most importantly, patients will receive the care that reflects the true quality of the Ohio health care system. I appreciate this opportunity to testify and turn it over to my joint sponsor.

I do have kind of a lengthy testimony, but I will spare you of that, you know, given who I'm testifying in front of, that he appreciates brevity. in this. But I will just say there is definitely a financial incentive for hospitals to try to keep staffing to a minimum. And this sort of moves this to that situation where if you have two people determining what slice of cake makes the most sense, the person who does the slicing is not the one who does the picking of the slice. And it kind of ensures both sides come to a happy medium with this. So I think this bill avoids a lot of the problems that we saw in the past with respect to it should be this ratio and that ratio. There's maximal flexibility with this, even more so in the realm of if there's a public health emergency, you know, this is relaxed a little bit. But even then, if things have to be moved around with this legislation, there is some flexibility if they fall below the committee recommended staffing levels. And frankly, the fines aren't really terrible in the grand scheme of things, given that they're five times the actual wages based on what was missed. And there's a carrot in there with respect to workers' compensation premium discounts. So with that, I'm happy to be on board with my joint sponsor on this. We'll be happy to answer any questions.

Good morning, Mr. Chair and members of the Health Committee. Thank you for the opportunity to provide sponsored testimony on Senate Bill 319 regarding protective services provided by county JFS with my co-sponsor, Senator Wilson. This bill is intended to address a gap in current adult protective services law concerning the financial exportation of elderly individuals who have been admitted to in our residence of our state licensed care facilities and are being exploited by their attorney in fact. Financial exportation accounts for over half of elder abuse situations reported nationally and is a multibillion dollar problem. problem. From the National Adult Protective Services Resource Center, studies estimate the annual financial loss nationwide to be around $2.6 billion. One in nine seniors report being abused neglected exploited within the past year and only one in 44 cases are ever reported The effect of such abuses are substantial Abuse seniors are three times more likely to die prematurely and victims are four times more likely to go into a nursing home, making this a serious issue. Many cases involve family members or other trusted individuals manipulating the financial situation of a vulnerable elder. but not always. Currently, neither the long-term care ombudsman nor local adult protective services have the authority to investigate such situations. According to the National Omnibus Reporting System, NORS data within the year 2024, 14,258 or 7.6 approximately 188,592 complaints reported to the omnibus program involved abuse, neglect, and exploitation. The significance of this issue has been recognized by officials for some time. In 2009, the Attorney General's Office realized this issue was pressing after receiving many requests from victims and their families. They put together an Elder Abuse Commission to study the concerning issues of elder abuse. They met several times a year and included members of the Adult Advocacy Center, Central Ohio Area Office on Aging, the Board of Nursing, Coalition for Adult Protective Services, among many others that deal in this area. I wanted to be clear that from this commission 2024-2025 biennial report, the chair remarked that in the last years, Ohio has seen a 400% increase in the cases of elder abuse. I slowed down reading that because I think we need to stop and take a look at what is happening to our elders and our seniors. Unfortunately, under existing statute, the APS is only authorized to investigate cases of abuse, neglect, or exploitation involving individuals age 60 or older who reside in independent living arrangements. This definition excludes elderly individuals who reside in licensed care facilities, even when they are being exploited by someone on the outside. Law enforcement, meanwhile, often cannot act without clear evidence of a crime. This bill seeks to close this gap by amending the revised code to authorize adult protective services to investigate allegations of exploitation involving institutionalized adults when the suspected perpetrator is outside the facility. This will be accomplished by amending RC5101.660, subsection C, to clarify that independent living arrangements required does not apply in cases of suspected exploitation by an external actor. amending this section to explicitly include their jurisdiction over such cases in the definition of exploitation or amending RC 5101.65 to grant APS the authority to investigate these specific situations. This legislation ensures that all elderly Ohioans are protected from exploitation and that Adult Protective Services can fulfill its mission of safeguarding vulnerable adults Thank you for this consideration and I stand ready to answer questions But before that I turn it over to my joint sponsor Senator Wilson

Any questions for the... Seeing none, thank you very much. That will end the first hearing of Senate Bill 321. Next up, third hearing on Senate Bill 375, allowing physicians with revoked licenses to apply for reinstatement. There is no in-person testimony. There's written testimony from Monica Hunkel, Ohio State Medical Board, as a proponent. Stephanie Luca from the State Medical Board of Ohio as an interested party. I met with the Medical Board yesterday, and they have some suggestions. and so look for an amendment sub-bill at our next meeting to address some of those issues. That will end the third hearing on Senate Bill 375. Next up, the second hearing on Senate Bill 258, an act of better access to health care act. So we have a lot of witnesses in the next coming bill. I will be we're going to limit testimony to three minutes but we'll be liberal on that as we go and then the next time we hear opponent testimonies on these bills we will also address require that in the same way we do today so first up Angie Hoff from National Church Residencies

Senator Romachuk.

You're welcome.

Per month. Through the chair, thank you for your question, Senator Romachuk. Yes, per month. It varies on physician. We basically kind of, we look for physicians to serve as collaborators. Some of them are willing to take less money. we pay up to $4,000 a month per physician. Now, they can be a collaborating physician for up to five APRNs at a time. I didn't mention that at any given time. But we serve 10,000 patients at At Your Door in over 130 communities throughout Ohio, not just National Church Residences communities, but all senior living communities that welcome us. And we're often asked to come in and provide this care to their seniors, but we have to find a physician, and sometimes that's a challenge. And then we have to pay them.

Follow up?

So $4,000 for five nurses, up to five nurses. How many nurses do you have, and can you extrapolate that cost across all the nurses, the cost of their...

So the total cost follow-up, so that would be nine times four?

Yeah, tens of thousands, correct?

Thank you.

Thank you, Mr. Chair. And I think I asked the sponsors this question too. So what's the significance of the 2,000 hours, the 2,000 clinical hours?

Go ahead.

I guess maybe my concern is that will there be people that are grandfathered in because they already have those hours despite the fact that I not sure who keeping tabs Yes I don know that I know the answers to those questions but I can tell you that on our roster of advanced practice registered nurses

Okay.

We have more testimony. I have another one.

Through the chair, thank you, Senator Romachuk, for the question. We have availability to our physicians 24 hours a day, seven days a week. They do answer if we have questions. As I said, we're fairly autonomous as far as decision-makings. Don't have to call very often, but when we do, they're available. There's also other things that we do need our collaborators for, like signing death certificates, helping with ordering diabetic shoes and things like that.

Thank you.

Thank you. Chairman, vice chair, ranking member, and members of the committee, thank you for the opportunity to provide testimony in support of Senate Bill 258. My name is Terry Grothaus. I am a board-certified pediatric nurse practitioner and the owner of Hometown Pediatrics, an independent pediatric primary care practice serving children and families in Northwest Ohio. I opened my practice because families in my community needed access to pediatric care. Today, I provide primary care for hundreds of children. Every day, I diagnose illnesses, prescribe medications, manage chronic conditions, perform well-child visits, coordinate specialty care, and help parents navigate some of the most difficult moments of raising a child. I am educated, trained, licensed, and nationally certified to provide this care. Yet under current Ohio law, I am required to maintain a standard care arrangement with a physician in order to practice. I would like to explain what that requirement looks like in real life. Each year I provide care to approximately 900 children. The position listed in my standard care arrangement has never stepped foot in my practice. He does not see my patients participate in the day-to-day operation of my practice or routinely discuss patient care with me. The reality is that I already practice independently every day. Ohio law simply requires me to maintain and pay for a contract that exists primarily to satisfy a legal requirement. The question before this committee is not whether nurse practitioners are already providing independently, care independently. Most of us are. The question is whether Ohio should continue requiring experienced licensed healthcare professionals to maintain a state contractual relationship that adds cost and administrative burden without improving patient care Some opponents suggest that removing the requirement would eliminate collaboration. Nothing could be further from the truth. Healthcare is built on collaboration, and I participate in it every day. I collaborate with pediatric specialists, physicians, pharmacists, therapists, nurse lactation consultants, hospital staff, and WIC professionals in my community. When a patient needs expertise beyond my own, I seek it. When another provider needs my input, I provide it. These professional relationships exist because they benefit patients, not because a contract requires them. In fact, collaboration occurs throughout health care without financial arrangements. Physicians consult other physicians, nurses collaborate with nurses, therapists collaborate with physicians and nurse practitioners, and pharmacists routinely contract providers regarding patient care. Yet nurse practitioners are the only profession in Ohio that must pay another licensed professional in order to maintain permission to practice. Collaboration is part of health care. Permission is not. As a small business owner, I am accountable for every decision that I make. My name is on the door. Families choose my practice because they trust the care they receive. If I fail to provide safe, high-quality care, I answer to my patients, my licensing board, and my community. Senate Bill 258 does not expand my scope of practice. It does not change my education, training, certification, or accountability. It simply removes an outdated requirement that no longer reflects how health care is delivered in Ohio. The families I serve do not ask whether I have a standard care arrangement. They ask whether their child can be seen today, whether they can receive care close to home, and whether someone will be available when their child is sick. Those are the issues that matter to patients. I respectfully ask you to support Senate Bill 258 and allow nurse practitioners to practice according to their education, training, and licensure, while continuing the collaboration that already occurs naturally throughout health care every day. Thank you for your time and consideration. I'd be happy to answer any questions.

I do.

Absolutely.

It is a requirement.

Any other questions?

Correct.

So he just, there's no communication.

There are chart reviews at the end of every year, so the care has already been provided by the time he reviews those charts.

There really are no stipulations regarding how many charts have to be reviewed or in what fashion they have to be reviewed.

Thank you, Mr. Chairman. So under that scenario he just described, if this bill were to pass and an SCA was no longer required, and if you thought you had an issue with the patient, would you just probably reach out, talk to that primary care physician, whoever the patient, if they have one, but would you still have the opportunity need to collaborate with a physician if you thought there was a problem?

Thank you very much.

Reverend. Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee, thank you for the opportunity to speak to you today. I just wanted to let you know that I'm very passionate about this advocacy, so I've been following all the hearings and everything and prepared a very lengthy statement, which I know I will not have time to say. So I'm just going to pull out the pertinent facts from my statement. My name is Tania Morris. I'm a board-certified psych nurse practitioner and owner of Mindful Wellness, LLC, in the Dayton area. I have also pursued additional training to specialize in neurodivergent needs and perinatal mental health. I'm here in support of Senate Bill 258 because access to care is not a slogan to me. It's been a thread running through my entire career. Just a quick little background. Before becoming a nurse practitioner, I was a physical therapist assistant and went back to school to become a nurse and worked in my field in multiple areas, including hospice before going into mental health and furthering my education as a psych NP. With the collaborative agreement that we currently have in Ohio, my personal experience, I have collaborated with four different physicians now throughout my career. Um, those experiences have been, uh, positive in the sense that my physician collaborators are, um, well, you know, experienced in their field. They are, um, have always been, um, open to collaboration. However, there have definitely been barriers that I have come across. Um, one of them is, one of the collaborators that I've had, um, is a physician of family practice, which the current statute laws allows. However, because he does not specialize in psychiatric care, when we have done our chart reviews, most of that review was me providing education to him on the decision-making and medications and the process. And that is not a complaint on his expertise and experience. It is simply, it's not his field. Another collaborator that I have worked with was local. She actually worked in the same organization as me, and that was wonderful. And I did collaborate with her numerous times, but not because I was compelled to, not because I had to, but because I respected her, I trusted her judgment. And when I sought her advice, it was because my patients needed an objective outside eye to what I was able to able to think through critically at that time In fact when I decided to open my own private practice I asked that physician if she could continue to collaborate with me at my other location because the way that the laws state right now, a nurse practitioner must have a collaborator for every location that they work at. So even though she's the same physician, I had to have two separate agreements. She did agree, and I had to pay a monthly fee to her for that. And that is not a complaint either because that is a standard in our state. However, that was difficult. Starting a new practice, as I'm sure you can imagine, having another expense to add into that budget definitely was a barrier. About a year after I started my practice, my collaborator contacted me to tell me that she would have to give me a 30-day notice, which is what is stated by law because her employer was compelling her to take on another nurse practitioner, and she was already at five, and because I was an independent one from that company, they were forcing her to drop me and take on a fifth through the company. So I had 30 days to find a different collaborator. Through no change in my training, certification, licensure, and ability, I now faced not being able to provide care to my entire patient caseload at my practice within 30 days. Thankfully, I was able to locate a collaborator, but through that process, I was given quotes of upwards to $800 a month. There are sites that I found online that will connect you with physicians that charge around the same amount, plus a finder's fee, sometimes an ongoing monthly fee, collaborators that are out of state. And with the abolishment of this Standard Care Act, one thing that I think is very relevant to understand is that Nursing Foundation, from the beginning, when we first get our RN, BSN, we are taught that collaboration is part of how we provide care. There is not a single part of our training and education that denies collaboration. In fact, it is not only necessary, it is part of the elements of our education and training. So without this SCA being a mandated law, that would not change. I collaborate every day with neurology, with family practice, with pediatrics, with social workers, with schools. I collaborate with my current collaborator. I do not often collaborate with him. However, past collaborators I have. I apologize. And I just also wanted to say very quickly that currently, if you've been watching the news in Georgia, they are having a lot of meetings themselves. In May, the medical board had put out a statement about what their APRNs are able to do, as well as making it illegal for APRNs to pay the physicians. That has actually caused an uproar because now the concern is physicians will refuse to collaborate because they are not legally mandated to collaborate. And I think that is very important to say. And that has caused a terrible problem currently as we speak in Georgia.

Thank you.

I'm sorry, Summer Davis as well.

Gotcha. Thank you, Senator. So thank you for hearing us today. So Senator, or Chairman Huffman, Vice Chair Johnson, and Ranking Member Liston. We are members, and the members of the Health Committee, we're thankful for this opportunity. I am Summer Davis, and this is Mandy Cafaso. We're the co-directors of the Ohio Association of Advanced Practice Nurses, representing more than 30,000 APRNs here in the state of Ohio. Senate Bill 258 is a patient access and workforce stability bill. It retires an outdated administrative requirement for APRNs who have practiced 2,000 hours. The standard care arrangement is a state-mandated, non-funded contract that limits practice, delays care, and it does not enhance safety, as many of our opponents seem to think that it does. Retiring the SCA maintains the same standard of care that exists today, while Ohio patients do then obtain more timely access to the providers that are already caring for them. The standard care arrangement does not extend APRN's education. It does not function as a residency. It does not include any further clinical instruction. as APRNs must have already completed graduate or doctoral education. The state of Ohio requires every APRN to be nationally board certified prior to obtaining their state license before we can even get an SCA. The SCA is just that contract that we have to have signed to allow us to work. The standard care arrangement does not mean supervision. Nothing in the Ohio law requires APRNs to work under or side-by-side with the physician through the SCA. It simply lists a collaborating physician and a similar specialty to satisfy the statute. The named physician may be located hours, counties, states away that signed these agreements. Collaboration exists regardless of the paperwork. The collaboration is the foundation of modern health care, as you have already heard in prior testimonies and how we collaborate amongst various providers within the health system. APRNs are responsible for their clinical judgment, diagnosis, prescribing, and treatment that is within our scope of practice and licensure that is based off of what we are able to do. So let's be clear, retiring the SCA for APRNs that have practice for 2,000 hours, it does not expand an APRN's scope of practice or licensure, and we are upheld by the Ohio Board of Nursing, so if we have a fault, we have to answer to the Board of Nursing. That is our direct oversight. And just to kind of mention about the 2,000 hours and where that came from, It was a Wild West number that we've looked at numbers across other states of what people have done, and so we kind of took what was the average of what was going through. The majority of the U.S. and the VA have also supported removal of the SCA, contrary to popular belief or messaging. The SCA provides no clinical or safety oversight. Studies and states report in conforming that eliminating this requirement does not reduce quality or safety. it actually unlocks access, lowers costs, and strengthens the local health systems. And I know I'm a little on time, and so I'm happy to stay on point for you all. So if you guys have any questions, I'm more than happy to, and Mandy as well, answer any of them.

Chair Hoffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee, thank you for allowing me to testify today, and thank you to Vice Chair Johnson for sponsoring this legislation. My name is Dr. Jacob Wolfe. I'm a doctor of naturopathic medicine and licensed acupuncturist practicing at University Hospitals, Conner Hole Health, in Beachwood, Ohio. I'm also president of the Ohio Naturopathic Doctors Association and currently serve on the board of directors of the American Association of Naturopathic Physicians. I want to tell you a little bit about my background because it reflects exactly the standard that Senate Bill 385 will require of every naturopathic doctor in Ohio. I graduated from Sonoran University, a federally accredited four-year doctoral program in 2013, and then completed two years of postgraduate residency in naturopathic family medicine. I'm the first naturopathic doctor in Ohio to complete a multi-year CNME sponsored residency. I also hold a Master of Science in Oriental Medicine and am nationally board certified through the National Certification Board for Acupuncture and Herbal Medicine. I am board certified in Lifestyle Medicine by the American College of Lifestyle Medicine, the same certifying body recognized by physicians and healthcare professionals across conventional medical settings. I practice every day alongside physicians, nurses, and other licensed providers at a major academic health system. And yet, under Ohio law, there is currently no distinction between my credentials and someone who completed an online course who calls themselves a naturopath. This bill closes that gap. Senate Bill 385 creates a licensure framework under the state medical board, the same body that oversees physicians, acupuncturists, and genetic counselors. To earn a license, a naturopathic doctor must hold a doctoral degree from an accredited program, pass the NPLEX, a multi-step national board examination, and demonstrate a clean professional record and complete continuing education to maintain licensure. These standards are not theoretical or aspirational. Every licensable naturopathic doctor currently practicing in Ohio has already completed this level of education and examination and already holds licensure in other regulated jurisdictions. Senate Bill 385 does not lower standards or create a new pathway around existing requirements. It simply brings Ohio in line with established regulatory standards already recognized across most of the country. The scope of practice in this bill is deliberately defined and limited. Licensed NDs may order labs and diagnostic imaging, administer natural therapeutics, including vitamins, herbal medicines, dietary supplements, and provide health education and counseling. The bill explicitly excludes prescription drug prescribing, surgery, acupuncture, and chiropractic, clean boundaries with existing professions. Patients are already seeking naturopathic care in Ohio. The question before this committee is not whether this care exists. The question is whether Ohio will establish meaningful standards of who may represent themselves as a naturopathic doctor and what qualifications are required to do so safely and responsibly. We know some are already being harmed. There's a case in 2017 of a patient who was killed by a naturopath in Toledo, a person who called himself a naturopath in Toledo who did not have this education. 26 states and territories already licensed naturopathic doctors, including states with major academic medical systems and highly regulated healthcare environments. Ohio patients deserve the same transparency, accountability, and consumer protection, that patients in those states already have. I urge you to support Senate Bill 385, and I'm happy to answer any questions.

Good afternoon, Senator Romanchuk, members of the committee. My name is Laura Farr. I'm the executive director of the American Association of naturopathic physicians. And I've been asked to give you an overview of the national landscape and the experience of licensure in other states. As you've already heard, there are currently 26 US jurisdictions that license naturopathic doctors. Three states have implemented licensure laws since the pandemic. And Florida is poised to be the 27th state to license naturopathic doctors. They are just waiting for the governor's signature. So this is a movement that is picking up steam. Additionally, there are another 10 licensure bills working their way through state legislatures, including here in the Midwest, Michigan, Louisiana, Missouri, and Texas, to name but a few. Included in your materials is a chart from the Federation of Naturopathic Medicine Regulatory Authorities. The chart summarizes disciplinary actions in the regulated jurisdictions for about 14 years, and these are some of the jurisdictions that have the broadest scope of practice, including prescribing authority. And what you see is very, very few disciplinary actions, ranging mostly zero in most jurisdictions to only one to three disciplinary actions per year. And this is for prescribing. This bill in Ohio does not even include prescribing rights. So naturopathic doctors, what this exemplifies is that the effectiveness of the educational licensing examination and regulatory framework for naturopathic doctors has caused regulators to observe a very strong record of safe and professional practice. We all know that there's a shortage of healthcare practitioners, and these can help address that shortage. You have about 40 naturopathic doctors currently in Ohio who are not practicing to the top of their training and education. We know from national data that as soon as a state gets licensed, doctors move back to their home. They want to practice where they come from and where they have family. So in the last three states that recently licensed naturopathic doctors, they saw an increase in licensure from 150 to 240 percent of naturopathic doctors moving back to practice in that state. So factor in the average patient panel for naturopathic doctors. We're talking about naturopathic doctors immediately being able to provide care for over 100,000 Ohioans. This is a growing movement in the integrative medicine field. So there are already university hospitals, Cleveland Clinic, Kettering Health here have started to hire naturopathic doctors. But you have competition where you have states that provide full scope primary care for naturopathic doctors, full prescribing authority. It becomes very, very difficult for incentivizing and retaining naturopathic doctors to move to a state that doesn't even grant them licensure. So we have been tracking about four dozen now, conventional medical facilities and integrative medicine facilities, federally qualified healthcare centers are now seeking to hire naturopathic doctors. Predictably, the majority of those who are hiring are in licensed states So we know that this would come to Ohio as soon as you license naturopathic doctors I wanted to mention about the VA and I got only two more points The VA launched a whole health pilot project about 10 years ago. Whole health is basically what naturopathic doctors excel in. It's lifestyle medicine, nutrition, physical medicine, non-pharmacological approaches to medicine. And the Whole Health pilot was so wildly successful that the national academies have now adopted that model. This is what naturopathic doctors have been practicing for over 100 years. I happened to be at a meeting last week with one of the architects of the Whole Health initiative in the VA, and she confided in me, she's a medical doctor, she confided in me that the VA has not yet started hiring NDs into its Whole Health programs because of lack of licensure in the number of states that they need to provide care equitably across all their VA systems. So again, taking licensure is one step forward to being able to offer this kind of non-pharmacological approach to health care and wellness to our veterans. I think it's important, my last point, to help the committee understand the difference between a traditional or a lay naturopath and a naturopathic doctor who has gone through four years of medical school, as are the doctors that we represent. Our profession, like all professions, has undergone an evolution. Over 100 years ago, the roots of naturopathy and naturopathic medicine were the same. But several decades ago, our branch of the profession decided to pursue a more rigorous, scientifically-based approach to develop naturopathic medicine as a full primary care profession that collaborates seamlessly with conventional medicine. And we incorporate biomedical sciences and evidence-informed medicine and approaches to care. In the U.S., there are also lay naturopaths or traditional naturopath programs that follow a different path and offer certificates or degrees that are not medical school. Many are correspondent schools. They offer online programs or weekend programs of very limited duration.

Good morning, Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee. Thank you, and thank you to Vice Chair Johnson for sponsoring this legislation. My name is Dr. Tracy Cook. I am a naturopathic doctor. I'm also a licensed acupuncturist in the state of Ohio. I own Allium Naturopathic Health in Orville, Ohio, which is a small city in Wayne County. And I serve rural families and underserved patients who often have limited access to integrative whole-person health care. My patients include rural farmers, members of the Amish community, working adults, stay-at-home parents, people who are struggling to find effective care through conventional medicine alone that have chronic, complex health conditions. I also graduated from Sonoran University in 2014. My training included clinical rotations in physical examination, diagnostic laboratory interpretation, pharmacognosy, and therapeutic nutrition, among other things. Every service I provide is grounded in the same principle. Treat the cause of disease, not just the symptoms, and work with the body's natural healing systems. I am also an educator. I, having served as adjunct faculty for Sonoran University and currently on staff at the University of Akron, I was born and raised in Oroville, and I returned here because Ohio's patients, especially those in rural communities like mine, they deserve to know who they're trusting with their health care. People in my community know me. Right now, there's no way for Ohio patients to know if who they're going to is somebody who has gone through a licensed four-year medical school, has passed their boards, and is currently licensed somewhere else. My license is in Vermont for naturopathic medicine. Or if somebody has just gone through a weekend course and calling themselves a naturopath. This is not a theoretical concern. it's a daily reality that puts patients at risk and it undermines the credibility of providers like myself. Patients in my area may have to travel long distances in order to find care. They have fewer provider options, and they rely heavily on word of mouth and trust. When an unqualified person misrepresents themselves as a naturopathic doctor, it puts the patients at risk, and the harm that it can do also can harm the entire integrative medicine community, making it harder for qualified practitioners to actually do what we do. The great thing about this bill is it is deliberately defined and limited. So licensed NDs under this bill will be able to order labs and diagnostic imaging, administer natural therapeutics, including vitamins, botanicals, dietary supplements, and provide health education and counseling. But the bill explicitly excludes prescription drug prescribing, surgery, acupuncture, and chiropractic. So it's going to maintain clean boundaries with those other professions. For my patients in Wayne County, licensure means more than just professional recognition. It means they can look up my credentials. It means that there's a board that they can contact if there is ever a concern with my care. It means that they can choose naturopathic care. They're making informed decisions protected by the same standards and accountability structures that govern every other licensed health care provider in the state. I urge your support for Senate Bill 385, and I'm happy to answer any questions through the chair.

I have, sir.

So initially my license was in Arizona.

I lived in Arizona initially. Currently I'm licensed through Vermont, but my acupuncture license is here.

So both Arizona and Vermont have prescription rights in their licensing. That's not what we're looking for here. Arizona, the scope of practice is much bigger than what we're looking for here.

Thank you.

Good morning, Senator Hoffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee. Thank you again for Vice Chair Johnson for sponsoring legislation, Senate Bill 385. My name is Dr. Christy Anderson. I am a naturopathic doctor and currently practicing in both Arizona and whenever I'm here, I cannot practice. I have been here for almost two years. I moved here from Arizona. So the question that you just presented about Arizona licensure, I can absolutely speak on. And I moved here to the state of Ohio to support my daughter, who is attending Malone University in Canton, Ohio, for her undergrad in pre-veterinary studies. Moving to Ohio meant a drastic change in my career since Ohio is an unlicensed state. I've been in Arizona since 2006 when I graduated, practicing medicine with a full scope of practice, including diagnosing, treating. The medical rights in Arizona gave me a scope of practice to write labs diagnostic imaging administering natural therapeutics botanicals I do have prescriptive rights. I also have infusion rights I can inject. I can do IVs in Arizona. I do this safely with an accredited education and continuing medical education of 30 CMEs per year, 10 of which are prescriptive, and three are focusing on opioids. So we are also on the front lines of the opioid epidemic for continuing patient safety. The Governing Board of Naturopathic Doctors in Arizona ensures the safety of the population and make sure that the doctors, such as myself, keep current on our education, and there is a board for patient complaints and safety issues to be reported and investigated under. The licensure burden ensures safety for the population and keeps naturopathic doctors current on training and ethics. When I moved to Ohio, I now must seek clients, not patients. I provide very limited advice without diagnosing or treatment. Many times I have to refer to other physicians for labs, diagnostic imaging, and help educate patients on how to speak to these other practitioners because I cannot provide that service for them. The clients who see me here in Ohio have no idea if I'm accredited or if I have just a layperson degree or non-degree. And I would like to sponsor Senate Bill 385 to create this structure and create this framework so patients have the security, and us practitioners also have the security of a medical board that governs us for safety.

Thank you, Mr. Chair. My question would be, so your plan is that you would have a reciprocal license here from Arizona in Ohio?

Okay. Make sure you check with them, because it says they have to establish them. so whatever they already are. It says establish, creates licensing requirements to the practice of naturopathic medicine and requires the state medical board to regulate the licensing, et cetera, et cetera, et cetera. Okay.

All right.

Any other questions? Seeing none, thank you very much.

That will end the second hearing on Senate Bill 385. Next up, all testimony on House Bill 347, and actually wins that. First up, Robert Hood, PhD, on behalf of himself. Chairman Huffman Vice Chair Johnson Ranking Member Liston and members of the Senate Health Committee thank you for the opportunity to speak as an interested party on House Bill 347.

Any questions for the witness? Yes, ma'am. Thank you, Mr. Chair. So you've looked at the bill and you saw what was listed as a requirement to inform consent. Let me know your thoughts about what that list is really saying. Through the chair to the center, do you mind clarifying your question?

Any other questions? Seeing none, thank you very much. Next up Jordan Close Ohio Women Alliance Chairman Huffman Vice Chair Johnson

Any questions for the witness? Seeing none. I'm sorry, go ahead. I just want to ask for you to reiterate, Do you believe that this is an attempt to undo the ballot issue, which was favorably voted by Ohioans in 2023?

Any other questions? Seeing none, thank you very much. Next up, Mia Rucker, Ohio Women's Alliance.

Good morning, Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Ohio Senate Health Committee.

is mandated to continue the pregnancy for longer than necessary for no medical reason. The waiting period is also unconstitutional in terms of providers of abortion care. Physicians have an ethical duty to act in accordance with their patient's best interests. The waiting period forces providers to depart from that duty by denying time-sensitive care and putting patients' health and well-being at risk. The state-mandated information requirements are also unconstitutional. It may be irrelevant or unnecessary to a pregnant patient, and it burdens their access to abortion care, causes emotional distress, and is misleading because it is not grounded in evidence-based medical practice. The state-mandated information requirements are also unconstitutional because they mandate that every provider give each pregnant patient one-size-fits-all material. They are foreclosed from exercising their own professional judgment and considering a pregnant patient's individual circumstances, which is contrary to the applicable standard of care and informed consent practice. I see I'm running low on time, so let me just say that during sponsor testimony, it was stated that professionals who work in gender-based violence support laws like the 24-hour waiting period. This assertion is both false and insulting to those of us who have spent most of our careers working in said field. There is a reason why professionals who work in gender-based violence response and prevention have not testified in support of this bill, which has notably failed to attract anyone outside of anti-abortion individuals or organizations. This is because abortion bans themselves are coercive as they restrict autonomy and decision-making and put individuals' lives at risk for no medically necessary reason while forcing them to remain pregnant against their own wishes. And I want to be clear, reproductive coercion in any form is wrong. No one should be forced to continue or to end a pregnancy against their will. I see my time is up, so let me just conclude by saying that inflation and the cost of living are the current number one priority for most Americans with groceries and gas or transportation as the two greatest cost burdens And while Ohioans are struggling to pay for these basic needs we waste precious time advocating for violations of the state constitution that increase costs rather than making life more affordable or health care more accessible. I strongly urge this committee to vote no on House Bill 347. And I will now take any questions that you may have.

Yes. Thank you, Chairman. And thank you for your testimony. One of the reasons given for this bill was that those testifying in support didn't feel that women had information about the decision that they were making such that the state needed to step in. Are you able to talk a little bit about that?

Thank you very much.

Chair Huffman, Ranking Member Liston, and members of the committee, my name is Jamie Miracle, and I'm the Deputy Director for Abortion Forward. I'm here today testifying in opposition to House Bill 347, a bill to reinstate an unconstitutional mandatory 24-hour waiting period in biased counseling law in Ohio. As stated already, in 2023, voters overwhelmingly passed the Ohio Reproductive Freedom Amendment. I feel like everybody keeps forgetting this. So let's read the Ohio Constitution. In part now reads, the state shall not, directly or indirectly, burden, penalize, prohibit, interfere with, or discriminate against either an individual's voluntary exercise of their rights or a person or entity that assists an individual exercising their right. unless the state demonstrates that it is using the least restrictive means to advance the individual's health in accordance with widely accepted and evidence-based standards of care. House Bill 347 violates the Constitution in a multitude of ways. It is burdensome and interferes with rights. It is discriminatory against patients and providers by imposing this 24-hour waiting period and mandatory misinformation only on abortion and not other medical procedures and medications. It fails to meet the least restrictive standard by imposing a restriction on abortion using medically inaccurate and thoroughly debunked research and having failed to prove how this restriction will advance the health of individuals. A state-mandated 24-hour waiting period will harm patients by increasing additional barriers to care and increasing costs of the procedure. The goal of this legislation is not to ensure informed consent. The goal of this legislation is to make it harder for people to access the care they need. Ohio Revised Code, case law, and professional codes of ethics all dictate what is required of all medical providers providing all medical care including abortion services This bill is unnecessary because these laws already require consent before an abortion just like every other medical care House Bill 347 will force medical professionals to choose between following their codes of ethics or following the law and force their patients to wait out a state-imposed 24-hour waiting period because legislators do not trust them to make their own health care decisions. Evidence overwhelmingly shows that there is no causal link between abortion and adverse mental health outcomes. Additionally, the provisions in the bill that force a medical professional to lie about the potential of reversing a medication abortion will put the health of patients at risk. For patients facing a medical emergency during pregnancy, being forced to wait could put their lives at risk. The dangerously narrow exception in this bill will tie the hands of doctors who take care of pregnant people in our state. One of these doctors has submitted written testimony today. In her testimony, she states, I recently had a patient in the second trimester present to the emergency department with profuse vaginal bleeding from a placental abruption. Her fetus still had a heartbeat. She lost over two liters of blood, and I watched her become unresponsive from blood loss. There's only one treatment in this situation, and it is to perform an abortion to save her life. We rushed her to the operating room without delay. Arbitrary delays like those included in House Bill 347 could easily have cost her her life. In conclusion, for nearly 20 years, Ohioans endured harmful restrictions, like the 24-hour waiting period that delayed or denied abortion care altogether. Research from the Ohio Policy Evaluation Network has shown the 24-hour waiting period laws make it harder for patients to experience timely, safe, and routine health care and result in distressing challenges for abortion seekers. Since the passage of the Ohio Reproductive Freedom Amendment, some of these barriers have begun to be dismantled. As the First District Court of Appeals said in a ruling on yet another one of the now unconstitutional restrictions on abortion in Ohio, Ohio voters said what they meant. This legislature would do well to listen to Ohio voters who clearly told Ohio's elected leaders that they want government out of their health care decisions. We'll be happy to take any questions you have. Thank you very much.

Whenever you're ready. Chair Huffman, Vice Chair Johnson, Ranking Member Dr. Liston, and members of the committee, thank you for accepting my testimony in opposition to House Bill 347. My name is Dr. Elise Berlin. I have been a physician for 26 years. I've been practicing in Columbus for 19 years. My views do not represent the Ohio State University, where I am a full professor, and Nationwide Children's Hospital, where I'm a practicing physician. I prescribe medications and perform procedures every day when I'm at work. My work is primarily to take care of young people who have reproductive problems. And every single time I care for a patient, I obtain informed consent. This is required by law and professional ethical standards. We are required to determine the autonomy and decision-making capacity of our patients to talk about the proposed procedures or treatments, alternatives, and even the risks of foregoing treatment. This is defined by the American Medical Association, and we do this routinely. The risks and benefits of abortion are secured scientifically. We know that having an abortion, whether it's medication or procedural, is safer than a pregnancy. There is really no scientific or medical risk that physicians need to have a restrictive consenting bill that requires extra consent requirements for abortion care. Requiring physicians to do this is discriminatory And frankly it is patronizing to people seeking abortion That they would need extra rules and time to make this decision When I meet patients for the first time And I do this with every patient. I tell them I'm here to educate them, guide them, and care for them. I tell them I trust them and their parents or caregivers to make the right decisions for themselves. Unlike some health care decisions, such as which antibiotic to pick for an infection or which inhaler to pick for an asthma, reproductive health care decisions are sensitive to patients' priorities and values. And we really, as physicians, need to trust our patients to make those decisions with our care. I wanted to also address the misinformation in this bill. Abortion reversal is not a thing. This is false. It has not been shown to be done safely. And more than 50 years of international psychological research shows that having an abortion is not linked to mental health harms. It is highly unethical for physicians to be required to provide false information to their patients. This would be extremely morally distressing to physicians, and it would betray the trust of our patients. As has already been mentioned, Article 1, Section 22 of the Ohio Constitution grants and protects Ohioans' rights to full reproductive health care, including abortion. House Bill 347 directly interferes with an individual's voluntary exercise of that right and discriminates against medical professionals assisting individuals exercising that right. I urge you to oppose this bill on grounds that it is unnecessary, harms patients and physicians, and is blatantly unconstitutional. Thank you, Chair Huffman, and I'm happy to answer any questions.

Thank you.

Whenever you're ready. Sure. Chair Huffman, Ranking Member, Dr. Rilliston, Vice Chair Johnson, and members of the committee, my name is Annalise Solano, and I am a family medicine resident physician. I'm submitting this testimony in opposition to House Bill 347 today because I deeply passionate about patient care and recognize that imposing state mandated waiting periods while forcing providers to give misinformation to their patients disregards the expertise of medical professionals in Ohio and also damages the doctor relationship. Informed consent is a critical and heavily mandated piece of all of medical care that enables autonomy and empowerment for the patients to make the best, most educated health care decisions for themselves. All medical professionals are required by existing law and our code of ethics to ensure that patients understand the aforementioned prior to signing a consent form. What is not required by all medical professionals is 24-hour wait periods that can negatively impact health both mentally and physically, nor are others required to state misinformation regarding the reversibility or other fabricated side effects from those who disagree with a particular treatment. While the burden of additional wait periods impacts all individuals seeking abortions, the people most disproportionately impacted are those of the hard-working average Ohioan. As someone who works directly with this population, the 24-hour wait period creates significantly more barriers to care. Many of my patients are paid hourly at work, and in order to make a doctor's appointment, they have to request time away from work, get approved, figure out transportation, whether public or private, and sort out the remaining child care or other obligations. In mandatory 24-hour wait periods, this burden doubles, at least. Even if the patient had the technology and internet connection to conduct this visit virtually, the time off for work for the appointment, childcare, and lost wages are still barriers. With an already extremely limited window on medication abortions, these wait periods prevent medication availability, delay care, and instill fear in all facets of my patients' lives. This does not prevent abortion. This prevents timely access to abortion. Let's switch gears to the misinformation required to be given to patients in this bill. Considering the fact that the negative psychosocial impacts of abortion have already been heavily refuted, let us imagine that this was mandated for other routine procedures. Take something as simple as a vasectomy. I worked in urology for a number of years, and I saw the consent process for this many times. I can assure you nowhere in there was there counseling on anxiety, depression, or PTSD as a result of a vasectomy, despite the lack of sedation or irrevocability of the procedure for many. The same could be applied to countless other procedures, but it is not. Only abortion providers are targeted and instructed that this must be included as a discussion and informed consent despite the overwhelming data that says otherwise Additionally this bill would require that physicians give information about the alleged reversibility of medication abortion ACOG has already released statements opposing this idea stating that its recommendations are based on a strength of evidence and does not support prescribing progesterone to stop a medication abortion Not only would spreading false reversibility cause misinformed consent, but it would be creating significantly more severe health risks, further jeopardizing the health of our patients. As a physician, enacting this bill would be a violation of my medical code of ethics. I would not be empowering my patients. I would be legally forced to coerce my patients into doing what state legislators want them to do, not what is best for them and their family. The relationship between physician and patient is sacred. My patients deserve real information presented on their timeline so that they can decide if and when they choose abortion. I urge you to vote no on this harmful bill, and I'm happy to take any questions.

Thank you, Chairman. Thank you for your testimony. me. I think sometimes those looking at bills like this that want doctors to do something that one would say they already do might think to themselves like it's only the good actors that are doing it right and that the law is putting this in place because not everyone is. But I bet that you're in a position right now as a trainee to speak sort of towards what medical training is and what that experience was for you in medical school and the focus and in residency

Is it possible to give a patient too much information and informed consent?

Does the bill require to provide any false information to any patient?

Okay. Any other questions? Seeing none, thank you very much. That was our last witness for today.