2007 HB 836

With the promise of an amendment to correct bad wording that would have been dangerous to patients and health care professionals, many groups and patients originally supported HB 836 when they were approached to do so by its sponsor, Delegate Karen Montgomery.

However, the amendment was pulled from the bill at the last minute (by the sponsor promising to support it- Montgomery) before being voted on in the full House. To protect our right to be treated by Maryland doctors we had no choice other than to try and kill the bill.

Thankfully, we succeeded with the help of a few legislators who actually listened and cared.

The only amendment that was added was the one below, which was not the one the sponsor told patients and groups would be added to address the unacceptable statement above.

http://mlis.state.md.us/2007RS/amds/bil_0006/hb0836_90668001.pdf

HB0836/906680/1

BY: Health and Government Operations Committee

AMENDMENTS TO HOUSE BILL 836

(First Reading File Bill)

AMENDMENT NO. 1

On page 1, in the sponsor line, strike “and Waldstreicher” and substitute

“Waldstreicher, Barkley, Minnick, Benson, Hammen, Bromwell, Donoghue, Elliott,

Kach, Kipke, Kullen, Mizeur, Nathan-Pulliam, Oaks, Pena-Melnyk, Tarrant, V.

Turner, and Weldon”; and in line 7, after “Act;” insert “providing for the termination of

this Act;”.

AMENDMENT NO. 2

On page 2, in line 8, strike “TELEVISION, RADIO,”.

AMENDMENT NO. 3

On page 2, in line 28, after “2007.” insert “It shall remain effective for a period

of 2 years and, at the end of September 30, 2009, with no further action required by

the General Assembly, this Act shall be abrogated and of no further force and effect.”.

Documents:

Bill Text (Displayed in PDF Format): First Reading, Third Reading, Enrolled

Fiscal and Policy Note (Displayed in PDF Format): Available

Amendments (Displayed in PDF Format):

House Number: 906680/01 Offered on: March 24, 2007 at: 3:33 p.m. Status: Adopted

Roll Call Vote (Legislative date is shown):

House March 22, 2007: Third Reading Passed (138-0)

Maryland

Thanks to All!

LDA, Maryland groups, and patients thank you for your efforts in defeating the Maryland Lyme disease bill, HB 836. It died in the Senate Education, Health and Environmental Affairs Committee without the committee taking action, so it never went to the full senate for consideration, as was the plan.

Pat Smith, LDA President, and Ron Hamlen, a member of the LDASEPA board and a Maryland resident, testified against the bill at the hearing, and many others submitted written testimony. Hundreds of patients and groups nationwide reacted with emails and phone calls against the bill after the sponsor testified before the committee, citing that only one group was in opposition and "fear" as the reason the patients opposed the bill. It was an awesome grassroots effort that culminated in success for patients. Special thanks to Jean F. Galbreath, President of the Harford County Lyme Disease Support Groups, Inc., an LDA affiliate, and the Lyme Disease Education and Support Groups of Maryland for leading the effort.

Do you live or work in Maryland?

STOP HB 836 now before it STOPS your Lyme treatment!

You need to take action now. The Maryland Delegates voted for a bill that mandates the Maryland Department of Health to disseminate "latest consensus guidelines" (read IDSA) to physicians in Maryland. HB 836 is now moving to the Senate Education, Health and Environmental Affairs Committee for a hearing/vote on April 4. If it passes here, these guidelines may prevent Lyme patients from getting further treatment and those just bitten from getting a diagnosis. Stop it now while you can. Contact the Senate Committee members TODAY; don't wait!!

LDA's Maryland Senate Testimony Against Bill - April 4, 2007

Testimony of Patricia V. Smith

President, Lyme Disease Association, Inc.

March 13, 2007

Health and Government Operations Committee

Peter A. Hammen, Chair

Marilyn R. Goldwater, V. Chair

Mr. Chairman,

I am submitting testimony today in regard to HB 836 (Montgomery). While the Lyme Disease Association (LDA), a national non-profit with affiliated groups in Maryland, is pleased that an awareness bill has been introduced, the LDA feels that amendments must be added to the bill to support patient and treating physician interests.

A history in Maryland shows that patients have difficulty obtaining diagnosis and treatment for Lyme disease, a serious disease which can become chronic and attack joints, muscles, heart and the brain. Once it becomes chronic, it is difficult to control or eradicate with short-term antibiotic treatment. Patients sometimes require repeated courses of antibiotic therapy over months or years to eradicate or control symptoms.

Patients and treating physicians struggle with regulations and policies from government agencies, insurance companies, and others in order to receive the treatment necessary for the patients to live productive lives. Doctors who treat the disease are already scarce due to the controversy,and patients often travel many hours to other states to obtain appropriate treatment.

The concern here is that the Maryland Department of Health and Mental Hygiene (DHMH) will follow the path it has already begun and disseminate biased information from physician organizations such as the Infectious Diseases Society of America (IDSA). These IDSA treatment guidelines recommend against physician discretion in diagnosing Lyme disease as well as against most classes of antibiotics used by treating physicians and alternative treatments and supplements--bottom line, no treatment for chronic Lyme patients.

This supposition about the DHMH is based upon its already failed attempt to work with patient groups here in Maryland. A committee was formed and patients met with DHMH, but the direction of DHMH was biased toward short-term therapy, despite patient examples of positive responses to longer-term therapy. Patient representatives withdrew from the committee.

Maryland needs an education program. In 2005, it was 7^th nationally in total case numbers (1235) and 9^thin rate of incidence (22.1/100,000 pop.). The Centers for Disease Control & Prevention (CDC) states that only 10% of cases that meet its narrow surveillance criteria are reported, therefore about 12,350 new cases of Lyme disease occurred in Maryland in 2005. That number does NOT in any way count the number of people contracting Lyme who do not meet the CDC criteria, which are for surveillance, not diagnostic, purposes. CDC statistics indicate Lyme is most common in boys ages 5-19 and combined boys & girls, ages 5-9.

Maryland needs an educational program that will be beneficial to patients. At this time, I ask that you onlyconsider favorably the passage and release of HB 836 with the following amendments to protect the physicians who treat and the patients who require treatment−amendments supported by many Maryland Lyme disease patient organizations:

REPLACE existing Section A (2) line 15-17, (IV) with

(IV) Develop and disseminate balanced educational materials to health care providers including National Guideline Clearinghouse peer-reviewed guidelines for the diagnosis and treatment of early and chronic Lyme disease;

ADD in Section 2, as lines 27-28

AND BE IT FURTHER ENACTED, That this act shall take effect October 1, 2007. It shall remain effective for a period of two years and the provisions herein shall be accomplished by October 1, 2009, and with no further action required by the General Assembly, this Act shall be abrogated and of no further force and effect.

Thank you for your consideration. Do not hesitate to contact me. Pat Smith, President, LDA

History by Legislative and Calendar Date

House Action

2/9

First Reading Health and Government Operations

2/28

Hearing 3/13 at 1:00 p.m.

3/24

Favorable with Amendments Report by Health and Government Operations

3/21

Favorable with Amendments Report Adopted

Second Reading Passed with Amendments

3/22

Third Reading Passed (138-0)

Senate Action

3/24

First Reading Education Health and Environmental Affairs

3/28

Hearing 4/4 at 1:00 p.m.

ORIGINAL VERSION

EXPLANATION:CAPITALSINDICATEMATTERADDEDTOEXISTINGLAW.

[Brackets]indicate matter deleted from existing law.

Underlining indicates amendments to bill.

Strike out indicates matter stricken from the bill by amendment or deleted from the law by

amendment.

*hb0836*

HOUSE BILL 836

J1 7lr2342

By: Delegates Montgomery, Bobo, Bronrott, Elmore, Glassman, Hubbard,

Kaiser, N. King, Kramer, Lawton, Lee, Manno, Pendergrass, Ramirez,

Riley, Rudolph, Shewell, F. Turner, and Waldstreicher Waldstreicher,

Barkley, Minnick, Benson, Hammen, Bromwell, Donoghue, Elliott,

Kach, Kipke, Kullen, Mizeur, Nathan–Pulliam, Oaks, Pena–Melnyk,

Tarrant, V. Turner, and Weldon

Introduced and read first time:February9,2007

Assigned to: Health and Government Operations

Committee Report: Favorable with amendments

House action: Adopted

Read second time: March21, 2007

CHAPTER______

AN ACTconcerning

1

Public Health–Lyme Disease–Public Awareness Campaign

2

FOR the purpose of requiring the Secretary of Health and Mental Hygiene, in

3

collaboration with other State agencies, to establish and promote a certain

4

public awareness campaign related to the prevention of Lyme disease and other

5

tick–borne illnesses; providing for the components of the campaign; authorizing

6

the Secretary to use certain resources to carry out the provisions of thisAct;

7

providing for the terminationof this Act; and generally relating to a public

8

awareness campaign for Lymedisease.

9

BY adding to

10

Article–Health–General

11

Section18–405

12

Annotated Code of Maryland

13

(2005 Replacement Volume and 2006 Supplement)

14

2 HOUSE BILL 836

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF

1

MARYLAND, That the Laws of Maryland read as follows:

2

Article – Health – General

3

18–405.

4

(A) (1) THE SECRETARY, IN COLLABORATION WITH OTHER STATE

5

AGENCIES, SHALL ESTABLISH AND PROMOTE A STATEWIDE PUBLIC

6

INFORMATION, AWARENESS, AND EDUCATION CAMPAIGN ON LYME DISEASE AND

7

ASSOCIATED TICK–BORNE ILLNESSES.

8

(2) THE CAMPAIGN SHALL:

9

(I) REACH OUT TO THE GENERAL PUBLIC AND SPECIFIC

10

POPULATIONS DETERMINED TO BE AT HIGH RISK FOR CONTRACTING LYME

11

DISEASE AND ASSOCIATED TICK–BORNE ILLNESSES;

12

(II) DISSEMINATE THE INFORMATION ABOUT LYME

13

DISEASE THROUGH WRITTEN MATERIALS, TELEVISION, RADIO, POSTERS, OR

14

ANY OTHER MEDIUM THE SECRETARY CONSIDERS APPROPRIATE AND

15

EFFECTIVE FOR CONVEYING THE INFORMATION;

16

(III) DISTRIBUTE INFORMATIONAL MATERIALS FREE OF

17

CHARGE TO HEALTH CLINICS, SCHOOLS, THE FOREST AND PARK SERVICE, AND

18

TO ANY OTHER ORGANIZATION THAT MAY SERVE INDIVIDUALS THAT HAVE A

19

HIGH RISK OF CONTACT WITH DEER AND OTHER TYPES OF TICKS;

20

(IV) DEVELOP AND DISSEMINATE EDUCATIONAL MATERIALS

21

TO HEALTH CARE PROVIDERS ABOUT LYME DISEASE INCLUDING THE LATEST

22

CONSENSUS GUIDELINES FOR DIAGNOSIS AND TREATMENT OF LYME DISEASE;

23

AND

24

(V) INCLUDE ANY OTHER MATTER THAT THE SECRETARY

25

CONSIDERS APPROPRIATE.

26

(B) TO CARRY OUT THIS SECTION, THE SECRETARY:

27

(1) ON REQUEST, SHALL RECEIVE AID OR INFORMATION FROM

28

ANY AGENCY OF THIS STATE OR FROM A POLITICAL SUBDIVISION;

29

HOUSE BILL 836 3

(2) MAY REQUEST THE SERVICES OF INTERESTED ADVOCACY

1

GROUPS; AND

2

(3) MAY CONTRACT FOR ANY NECESSARY SERVICES.

3

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect

4

October 1, 2007. It shall remain effective for a period of 2 years and, at the end of

5

September 30, 2009, with no further action required by the General Assembly, this Act

6

shall be abrogated and of no further force and effect.

7

Approved:

________________________________________________________________________________

Governor.

________________________________________________________________________________

Speaker of the House of Delegates.

________________________________________________________________________________

President of the Senate.

Fiscal and Policy Note

http://mlis.state.md.us/2007RS/fnotes/bil_0006/hb0836.pdf

HB 836

Department of Legislative Services

Maryland General Assembly

2007 Session

FISCAL AND POLICY NOTE

Revised

House Bill 836 (Delegate Montgomery, et al.)

Health and Government Operations Education, Health, and Environmental Affairs

Public Health - Lyme Disease - Public Awareness Campaign

This bill requires the Secretary of Health and Mental Hygiene, in collaboration with other

State agencies, to establish and promote a statewide Lyme disease and associated

tick-borne illnesses public information, awareness, and education campaign.

The bill terminates September 30, 2009.

Fiscal Summary

State Effect: Department of Health and Mental Hygiene (DHMH) general fund

expenditures could increase by at least $56,300 in FY 2008. Future years reflect

annualization, inflation, and the bill’s termination date. No effect on revenues.

(in dollars) FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Revenues $0 $0 $0 $0 $0

GF Expenditure 56,300 75,800 19,100 0 0

Net Effect ($56,300) ($75,800) ($19,100) $0 $0

Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate effect

Local Effect: None.

Small Business Effect: None.

Analysis

Bill Summary: The statewide campaign must target the general public and specific

populations at high-risk for contracting Lyme disease and associated tick-borne illnesses;

HB 836 / Page 2 disseminate this information through written materials, posters, or any other medium

the Secretary determines is appropriate and effective; distribute free informational

materials to health clinics, schools, the forest and park service, and any other

organizations serving individuals with a high risk of contact with ticks; develop and

disseminate educational materials to health care providers about Lyme disease; and

include any other matter the Secretary considers appropriate.

To implement the bill, the Secretary, on request, must receive aid or information from

any State agency or public subdivision. The Secretary also may request the services of

interested advocacy groups and may contract for any necessary services.

Current Law: None applicable.

Background: Lyme disease is transmitted to humans by the bite of infected blacklegged

ticks. Symptoms of the disease are fever, headache, fatigue, and a skin rash. If not

treated, the infection can spread to an individual’s joints, heart, and nervous system.

Most individuals with the disease can be treated with antibiotics.

Other tick-borne diseases include babesiosis and Southern Tick-Associated Rash Illness

(STARI).

Babesiosis is an illness caused by a parasite that lives in some deer ticks. Symptoms

include a fever, chills, sweating, weakness, tiredness, poor appetite, and headache. Some

people with the illness do not develop symptoms. The illness can sometimes become

serious and result in death. Individuals in their forties and fifties are most likely to get

the illness, although it may affect individuals of all ages. Babesiosis is most often

reported in Connecticut and on the islands off Massachusetts and New York.

STARI is an illness that develops after an individual is bitten by the lone star tick.

Symptoms, in addition to a rash, include fatigue, fever, headache, and muscle and joint

pains, according to the Centers for Disease Control and Prevention. Lone star ticks are

found from central Texas and Oklahoma across the southern states and along the Atlantic

coast as far north as Maine.

State Expenditures: General fund expenditures could increase by an estimated $56,250

in fiscal 2008, which accounts for the bill’s October 1, 2007 effective date. This estimate

reflects printing costs ($75,000 annually) for educational pamphlets and other printed

materials that will be distributed to health clinics, schools, the forest and park service,

and other organizations. Costs could be greater if other media, such as broadcast, are

used.

HB 836 / Page 3

Future year expenditures reflect annualization and 1% annual increases in ongoing

operating expenses.

Additional Information

Prior Introductions: None.

Cross File: None.

Information Source(s): Department of Health and Mental Hygiene, Department of

Legislative Services

Fiscal Note History:

ncs/jr

First Reader - March 9, 2007

Revised - House Third Reader - April 2, 2007

Analysis by: Lisa A. Daigle Direct Inquiries to:

(410) 946-5510

(301) 970-5510