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Senate Health Committee bill advances despite clash between ophthalmologists, optometrists

Brandon Moseley

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The Alabama Senate Health Committee last week narrowly voted to give a favorable report to a bill that would allow Alabama optometrists to expand their scope of practice to include seven procedures that are currently performed exclusively by ophthalmologists.

Senate Bill 66 is sponsored by State Senator Tom Whatley (R-Auburn).

Whatley said that he has eye issues and has been treated by both ophthalmologists and optometrists over the years. This bill would improve access to care for people in rural Alabama.

Ophthalmologists are doctors who have been to medical school and have chosen to specialize in eyes. Optometrists are doctors who have to optometry school to study treating conditions of the eye.

The Chairman of the Senate Health Committee is Senator Jim McClendon, R-Springville. McClendon is an optometrist and is a cosponsor of the legislation.

The bill would expand the scope of practice of optometrists to perform: injections, excluding injections into the posterior chamber of the eye to treat any macular or retinal disease; incision and removal of a chalazion; removal and biopsy of skin lesions involving the lid and adnexa; laser capsulotomy; laser trabeculoplasty; laser peripheral iridotomy; and corneal crosslinking.

Ophthalmologists like Dr. Chris Girkin Chair of the Department of Ophthalmology at the University of Alabama oppose the bill.

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Optometrists support expanding their scope of practice to include these procedures, which currently are only performed by the ophthalmologists. The ophthalmologists and the Alabama Medical Association oppose expanding the scope of practice of the optometrists. These medical doctors say their objection are relayed to patient safety not a turf war between professions.

A similar bill was defeated in the legislature last year. That bill, also sponsored by Sen. Whatley, would have expanded the scope of practice for the optometrists to make those seven procedures. That bill also would have allowed optometrists to perform LASIK surgeries and make injections into the posterior chamber of the eye to treat conditions, such as diabetic retinopathy and macular degeneration. LASIK “laser-assisted in situ keratomileusis” is the most commonly performed laser eye surgery to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.

Chairman McClendon said that the optometrists have dropped the LASIK surgeries and the injections into the posterior chamber of the eye. McClendon said that the optometrists have offered to compromise and the ophthalmologists have refused to accept any expansion of the current scope of practice for optometrists.

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Whatley said that SB66 would expand healthcare options for Alabamians particularly rural Alabamians. There are ophthalmologists in just 24 Alabama counties while 57 counties are served by optometrists.

Dr. Brendan Wyatt said, “I am a board-certified ophthalmologist and Vice president of the Association of Ophthalmologists. I practice in Dallas County.”

Dr. Wyatt said that SB66 would be, “Giving non-surgeons the ability to perform surgery on our poorest most vulnerable citizens.”

Wyatt disputed that there was an “Access to care problem. That is not true.”

Wyatt said that the optometrists said that the information provided by the optometrists, “Shows Autauga County as not having an ophthalmologist. I pay $2000 a month for a satellite office there.”

Wyatt said that another ophthalmologist has a satellite office in Marengo County. “You guys have been fed false information. We did our own research using Medicare billing data. Over 91 percent of our population is within a 30 minute drive to an ophthalmologist and 98 percent are within an hour drive to an ophthalmologist.

Wyatt took, “Issue with this being safe and no harm will be done. These lasers cause controlled explosions in your eyeball.” “I implore you to do the right thing and kill this bill.”

McClendon said that optometrists are being trained how to do all of these procedures in optometrist school and that Alaska, Kentucky, Arkansas, Louisiana, and Oklahoma all already allow optometrists to perform these procedures.

Senator Cam Ward, R-Alabaster, said, “I want to make sure that we don’t do something that ham string us going forward.”

Dr. Josh Driver is an optometrist and the immediate past president of the Alabama Optometric Association.

Dr. Driver said that passing SB66, “Would improve access to care for thousands of Alabamians.”

“This bill would address some of the open ended questions in the bill last year,” Driver said. “These are seven in office procedures that do not require anesthesia.” All of them are being taught in optometry school. UAB is graduating optometrists and they are leaving our state for states where they can better practice their profession. This is about improving access to optometry care for all of Alabamians not just those who live in a major city.

Dr. Chris Girkin is the Chair of the Department of Ophthalmology at the University of Alabama.

Girkin said that he is currently researching model of providing access to care for rural Alabama more effectively through other models including telehealth that can be done without increasing the scope of practice of optometrists.

Dr. Girkin warned that if this bill passes then every optometrist will add a laser to their practice and up to 20 percent of their patients could be negatively impacted.

Dr. Rob Pate, an optometrist, told the Alabama Political Reporter that medical doctors spend time learning to birth babies and do all of the things that they do before deciding what they want to specialize in. We spend all of our education studying the eye and conditions of the eye.

McClendon said that there are quite a few scope of practice bill that are ready to come forward soon. All of these bills were killed last year by the Alabama Medical Association who doesn’t want to compromise on anything.

The legislature limits the scope of practice of optometrists, nurse practitioners, pharmacists, chiropractors, nurse midwives, lay mid-wives , etc. Many of these professions want expanded scopes of practice.

Whatley made a motion to give a favorable report to the bill. There were several ayes. McClendon did not ask for nays and said the ayes have it. This meeting is adjourned.

Sen. Tim Melson, R-Florence, said that he wanted it on the record that he is opposed to this.

Sen. Larry Stutts, R-Sheffield, said that Robert’s rules of Order were violated in the vote.

SB66 now can be considered by the full Alabama Senate.

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House

House passes landfill bill allowing alternative materials as temporary cover

Brandon Moseley

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The Alabama House of Representatives passed a bill Thursday to change the statutory definition so that temporary “cover” in landfills can be a material other than “earth.”

House Bill 140 is sponsored by State Rep. Alan Baker, R-Brewton.

The bill allows landfills to use alternative daily covers in place of earth to cover landfills until the next business day. “The EPA has allowed this since 1979,” Baker said. It would save landfills the cost of using earth for daily cover.

“This does not change anything in the operating rules for landfills,” Baker said.

A number of members from both parties expressed concerns about this bill on Tuesday, so the bill was carried over until Thursday.

Speaker of the House Mac McCutcheon told reporters, “Sometimes in a debate you can see that the debate is not a filibuster or anti-debate; but rather is an honest effort by members to understand a bill.”

“There was a lot of misinformation out there,” McCutcheon said. The Environmental Services Agency and ADEM were brought in to explain the members and address their concerns.

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McCutcheon said that human biosolids is a separate issue and that Rep. Tommy Hanes has introduced legislation dealing with that issue.

Alternative daily cover is often described as cover material other than earthen material placed on the surface of the active face of a municipal solid waste landfill at the end of each operating day. It is utilized to control vectors, fires, odors, blowing litter, and scavenging. Federal and various state regulations require landfill operators to use such earthen material unless other materials are allowed as alternatives. (Mitchell Williams writing on Oct 31 in JDSUPRA)

Soil cover can use valuable air space. Further, it can generate the need to excavate and haul soil to the facility. Alternative daily covers are often advocated to be a more efficient and cost-effective means of cover. (Williams)

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Baker said that it would be up to ADEM (the Alabama Department of Environmental Management) in the permit whether to allow a proposed alternative cover or not.

Baker said, “This bill does not change any of the materials used as cover.” “This would keep us from having to use that good earth in landfills when other materials are available. If it becomes a nuisance ADEM can revoke a cover on the permit. Daily cover has to be approved at the discretion of ADEM.”

Baker said that only materials not constituted as a risk to health or are not a hazard can be used.

An environmental attorney shared the list of ADEM alternative covers with the Alabama Political Reporter. The list includes: auto fluff, excavated waste, synthetic tarps, coal ash, petroleum contaminated soil, automotive shredder residue, shredder fluff, wiring insulation, contaminated soils, paper mill (including wood debris, ash shaker grit, clarifier sludge, dregs, lime), 50% on-site soil and 50% tire chips, spray-on polymer-based materials, reusable geosynthetic cover, automobile shredder fluff, tarps, foundry sand, clay emulsion known as USA Cover Top clay emulsion, non-hazardous contaminated soil, non-hazardous solid waste clarifier sludge, steckle dust all generated from Nucor Steel Tuscaloosa Inc., non-coal ash from Kimberly Clark operations, lagoon sludge from Armstrong World Industries operations, meltshop refractory material from Outokumpu Stainless USA operations, paper mill waste (non-coal ash, slaker grits, dregs, and lime), biodegradable synthetic film, fly ash, residue from wood chipper or paper, slurry with a fire retardant and tactifierl,Posi Shell Cover System, waste Cover, foundry waste, 50% soil and 50% automobile shredder fluff, incinerator ash, green waste to soil
Sure Clay Emulsion Coating, alternative cover materials (manufactured), compost produced by IREP Montgomery-MRF, LLC, 50% saw dust mixed with 50% soil, and waste soils considered to be special waste.

McCutcheon said that members did not understand that these were just temporary covers. That was explained to them.

Alabama landfills have used alternative covers for years; but three people sued saying that this was not allowed under Alabama law and that ADEM had exceeded its mandate by permitting alternate covers. On October 11, 2019 the Alabama Court of Civil Appeals found in favor of the plaintiffs.

HB140, if passed, would address this oversight in the Alabama legal code so that ADEM and the landfills can legally continue to use alternate covers and not have the added expense of quarrying dirt for daily cover.

A Senate version of the same bill received a favorable report last week from the Fiscal Responsibility and Economic Development Committee.

HB140 now goes to the Alabama Senate.

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House

Alabama lawmakers advance bill banning transgender athletes in K-12 sports

Jessa Reid Bolling

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A House committee voted Wednesday to advance a bill that would ban transgender teenagers from playing on the sports teams of the gender they identify with. 

House Bill 35, titled the Gender Is Real Legislative Act, or GIRL Act, would require student athletes in K-12 schools to participate as the gender listed on their birth certificate, preventing transgender athletes from competing as the gender they identify as.

Sponsored by Rep. Chris Pringle, R-Mobile, the bill passed the House State Government Committee on an 8-4 vote. The bill will now go to the full House. 

The bill, according to Pringle, is aimed at preserving the accomplishments of women and to prevent women from having to compete against athletes who were born male.

“Gender is real. There are biological differences between boys and girls that influence athletic performance,” Pringle said in a statement. “The GIRL Bill seeks to support female student-athletes, so that they may compete against each other and not have to compete against male students with an unfair advantage.”

Opponents say that HB35 was born out of prejudice against transgender youth rather than seeking to protect women in athletics. 

Carmarion D. Anderson, Alabama state director of the Human Rights Campaign (HRC), an LGBTQ+ rights organization, called the bill a “political advertisement” with no supporting evidence

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Anderson said she believes this bill will do harm to young transgender youth by segregating them from competing in sports events, further contributing to the ostracization trans youth feel in society.

“We’re concerned about a student’s mental health when they cannot participate in the sports that are comfortable for them, and the level of dysphoria they already face when they are transitioning,” said Anderson. 

Anderson also said that while it is unfortunate that this bill passed the committee, HRC will be at the forefront to try to see the bill defeated. 

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The bill now heads to the full House.

 

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Legislation may harm pets locked in hot cars, not help, vets and advocates say

Eddie Burkhalter

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A bill passed by the Alabama Senate last week lawmakers say will help keep pets trapped in hot cars safe, might actually endanger the animals, according to some animal advocates and veterinarians.

That bill was written by a dog breeder who some worry purposefully wrote the bill to make it harder to keep animals safe, and to instead protect breeders from having animals confiscated, they told APR this week. 

Mindy Gilbert, The Human Society’s Alabama state director, told APR by phone on Tuesday that she’s certain that the senate bill’s sponsor, Alabama Sen. Jimmy Holley, R-Elba, “does have good intentions, but I think the devils in the details.” 

Several attempts this week to reach Rep. Holley were unsuccessful. 

The bill would grant criminal immunity to a civilian who rescues an animal from a vehicle, and would provide civil and criminal immunity to first responders who do so. The legislation also makes it a misdemeanor crime if a pet dies in a hot car. 

Gilbert said that while those might also sound like great ideas, the bill would actually reduce criminal penalties for allowing a pet to die in a hot car. 

“Our current cruelty statute, which has been used in cases like this, would define that as a class C felony,” Gilbert said. 

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A Trussville woman in 2018 was charged with felony aggravated cruelty to animals for leaving her dog in a locked car while shopping in Walmart. The dog died after police broke out a window and removed the distressed animal. 

The bill also states that the ambient temperature of the interior of a vehicle must be 99 degrees or hotter to be charged under the legislation. 

Gilbert said she’s spoken with numerous veterinarians who all said that 99 degrees is too hot to be safe for pets trapped in cars. 

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Gilbert said that for many breeds of pets, and pets with compromised health, “that requirement in order to rescue them will absolutely sentence them to death,” and there are other aspects of the bill that trouble her. 

“I think everybody was very focused on providing immunity to first responders, which I think is fabulous,” Gilbert said of the legislation, but worried that it doesn’t include animal control personnel in its definition of public safety officials and covered by the bill’s immunity clause. 

Holley’s legislation defines public safety officials as “An individual employed by a law enforcement agency, fire department, or 911 emergency service.” 

Dr. Mark Colicchio, a veterinarian in Spanish Fort, reached out to Sen. Holley and all of the members of the state Senate Judiciary Committee about his concerns with the bill prior to its passage in the senate. Holley put Colicchio in touch with the man he said wrote the bill, Norman Horton.

Colicchio said he spoke to Horton, owner of the Dale County german shepherd breeding company Triple S Shepherds, at length about his concerns, but that none were addressed in the final legislation. 

“There are a lot of temperature references in there which make no sense whatsoever,” Colicchio said. 

Colicchio said he spoke with Horton about the bill’s language that required the ambient temperature of the interior of a vehicle to be 99 degrees or higher before a person could be charged. He said he told Horton that there’s no practical way for a public safety official to measure the ambient temperature inside a locked vehicle from outside, to which he said Horton suggested they call carry digital temperature readers. 

Such devices measure surface temperatures, and wouldn’t  be able to read the temperature inside a locked car, Colicchio said. 

After speaking with veterinarians at Auburn University’s College of Veterinary Medicine Cholicchio said they looked at data that suggested that if the outside temperature of a vehicle, which can be more easily measured, was 78 degrees an animal trapped inside with no ventilation could be in jeopardy. 

Colicchio said he suspects the legislation was purposely written to protect owners from having their animals taken from them in the event they’re left in hot cars. 

“He doesn’t want breeders to risk having their valuable dogs stolen out of the car because somebody thinks they’re at risk,” Colicchio said. “…When you structure a law to benefit yourself, and animals suffer for it, that just gets to me.” 

Horton, speaking by phone Wednesday,  told APR that he wrote the bill to protect animals and to establish the proper way to rescue an animal in distress. 

“This is America, and this is Alabama, and if someone’s gonna be guilty of a crime or charged for a crime then they need to have committed that crime” Horton said. 

Horton said “we don’t need vigilante justice” so he wrote the bill to make clear how best to enter a vehicle if an animal is in need of help. 

Asked how he decided that 99 degrees inside a vehicle was the temperature at which a pet was in danger, Horton said “I got the figure after talking to several veterinarians.” 

Asked which veterinarians he spoke to get that figure, Horton said “that’s immaterial” and declined to name them. 

Horton likened the matter to speed laws, and said while some speed limits are set at 70 MPH, some people, such as police officers, can drive safely at speeds up to 113mph. 

Asked why the bill doesn’t include animal control officers in the immunity protections, Horton said that “it does.” 

Horton pointed to the bill’s language that defines public safety officials as “An individual employed by a law enforcement agency” and said “go to Tuscaloosa. Go to any of the cities around, and animal control officers are employed by the police department. They’re sworn officers.” 

Some animal control officers who work in municipal law enforcement agencies are sworn officers, Gilbert said, but many are not, and in the counties, where animal control is operated as stand-alone agencies, animal control officers are not sworn officers and wouldn’t be immune from prosecution under the legislation. 

Asked why his bill didn’t include all animal control officers, whether they were sworn officers working in law enforcement agencies or not, Horton suggested that it was to ensure owners could be charged with crimes 

“Do we want to charge for the crime when they do something like this or just let them go?” Horton said. 

Horton declined to answer a question about the bill’s language that limits the charge of killing an animal in a hot vehicle to a misdemeanor and soon after ended the interview. 

“It’s not to help the animals,” Colicchio said of the legislation. “That’s the wolf in sheep’s clothing.” 

It was unclear Wednesday if Holley’s bill had a sponsor in the state House. There were no similar bills filed Wednesday, according to the state Legislature’s website.

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Senate Committee approves medical marijuana bill

Brandon Moseley

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Wednesday, the Senate Judiciary Committee gave a favorable report to a bill that would allow Alabama residents to obtain medical marijuana on an 8 to 1 vote. Senate Bill 167 was sponsored by State Senator Tim Melson (R-Florence).

SB167 would create a tightly regulated network of state-licensed marijuana growers, dispensaries, transporters, and processors. Patients would have to get a recommendation for the drug from their physician. Only physicians who have received the approved training would be able to dispense the cannabis-derived treatments. There would be no smokable products allowed and consumer possession of marijuana in its raw natural form would remain illegal in the state.

Sen. Melson is a retired anesthesiologist who now works in medical research.

“I would not have carried this bill three or four years ago,” Melson said. But there is a growing body of medical evidence that there are medical benefits.

Melson said that while this bill does have provisions for growing and processing marijuana in states there is also, “An option for it to come from outside.”

Melson said that under this bill we will know what is being grown, being processed, and reaches the consumer. The medical association will recommend the training and the education component for the physician. Patients will be issued a medical cannabis card. “The card will not be good in other states.”

Melson said that Alabama dispensaries will not accept out of state medical cannabis cards except one time a year they can get a one-time emergency order. The number of dispensaries will be limited to 34 total. Patients will be allowed to get just a 70-day supply. There is no smoking and no vaping. People in rural areas will have to go far to get one of the dispensaries. There is a, “Balancing act between convenience and safety. There are fifteen qualifying conditions.”

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Rick Hagans is a minister with Harvest Evangelism, which runs Christian rehabs for both men and women drug addicts.

“The gateway that led to methamphetamines and opioids began with marijuana,” Hagans said. “We have found in forty years of work that it is a gateway drug.”

Hagans dismissed the medical benefits claims, “Medical profession said the same thing with opioids. I ask that you proceed with caution and concern. I get tired of burying your sons and daughters,”

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“Thank you for giving us Leni’s Law, but it is not enough,” Christie Kaine said. “I am the Mother of a child with intractable epilepsy. We know from our research that there are other cannaboids that can help with Hardy’s condition, but they can not be used in Alabama due to the level of THC. If Hardy did not live in Alabama he could be seizure-free.

Caleb Crosby with the Alabama Policy Institute said, “It is a real issue and something has to be done about it. Our concern is unintended consequences.”

Crosby said that Republicans, “Run on small government, but this does the opposite.”

“We still have a litany of laws carried over from Prohibition one hundred years ago,” Crosby said. “You will not be able to get rid of all of these regulations and taxes.”

Cynthia Atkinson’s husband was longtime WSFA meteorologist Dan Atkinson, who was also on the Weather Channel.

“Dan had Parkinson’s for ten years,” Atkinson said. “The last five years he suffered from tremendous pain.” He had excellent doctors at the Mayo Clinic and Kirklin Clinic. They did their best.” Dan was prescribed Oxycodone, hydrocodone, lorazepam, and as he got progressively worse morphine. We learned that Israel has been studying cannabis since the 1950s. In 2015 we went to Colorado.” He used patches with 10 mg of CBD and 10 mg of THC. The leg cramps went away. We wanted to bring it back but couldn’t because of the law.

“The opioids and synthetic drugs were racking his body,” Mrs. Atkinson said. Dan passed away in 2017. I can’t help but think that if we lived in another state he could have lived to see his son graduate from Auburn and join the Space Force.

Captain Clay Hammac commands the Shelby County Drug Task Force

“Just because we do not put medical in front of marijuana does not make it medicine,” Capt. Hammac said. Under Alabama law, we already have Leni’s law and Carly’s law and there are cannabis-based medications that have been approved by the FDA.

Hammac warned that this was an “Incremental step toward the decriminalization of a multi-$billion industry. This bill should be before the Health Committee instead of the Judiciary Committee.”

“Law enforcement was never invited to the table to share our experience,” Hammac said of the Alabama Medical Cannabis Study Commission.

“A Harvard medical researcher was brought to the commission and virtually laughed out of the room,” Hammac said. “I stand with our Attorney General.”

Hammac blast the “casual way” that this has been handled.

“The reason this is before the Judiciary Committee instead of the Health Committee is that this is the most deliberative thorough committee in state government today,” Judiciary Committee Chairman Cam Ward (R-Alabaster) said. “That nature of the people on this Committee is why this is here.”

“The State has no authority to usurp federal law,” Hammac said.

“I want to make sure that everybody understands where I come from,” Dustin Chandler said. “My daughter Carly obtained CBD oil through Carly’s Law. My daughter was able to get relief through the CBD oil. Studies show that medical cannabis has medical benefits for many people.”

Lori Herring said, “I have been a nurse for 30 years.”

Herring said that the American Academy on Pediatrics opposes the legalization of cannabis. The American Medical Association does not endorse medical cannabis. The Multiple Sclerosis Society can not recommend cannabis as a treatment.

“The side effects, system effects, and long term side effects are not clear,” Herring said. “It has not been shown to be medically effective and could be dangerous. “It has only been approved for two severe forms of epilepsy. We don’t know what a pediatric dose, an adult dose, or a geriatric dose would be.”

Herring warned that marijuana can cause nausea and vomiting unrelieved by current nausea medication and has resulted in death. Legalization has led to increased emergency room visits, paranoia, schizophrenia, and psychotic breaks.

“The marijuana today is more addictive than marijuana in the past,” Herring said. “Legislators should not be taking the place of scientists.”

Dr. Alan Shackelford of Colorado said, “I have seen 25,000 patients in my practice in the last ten years. I doubt you will find anybody who has as much experience with patients than I do.”

Shackelford said that Marylin was a helicopters pilot in Iraq who was shot down and had severe injuries and PTSD did not have a job rarely left her house and now has a job at the VA helping other veterans and is married

Shackleford said that Mason is age 68 and has Parkinson’s. He could not move now he plays baseball and is a deacon in his church. He also said that he treated Charlotte, a girl with Dravet Syndrome with tremendous effect and now she is a healthy twelve-year-old.

“Not all of them are as dramatic as these,” Dr. Shackelford said. Arthritis, autism, PTSD, cancer, pain, Parkinson’s, chemotherapy-related nausea can all be treated with cannabis.

“The people of Alabama deserve the same access to treatment as people in 33 other states,” Dr. Shackelford concluded.

“A number of amendments have been worked out in the last couple of weeks,” Ward said.

The amendments were added and Ward advised Melson to incorporate all the amendments into a substitute to introduce when the bill is on the Senate floor.

The most notable amendment dealt with workmen’s compensation. An employee who is injured or killed on the job is ineligible to receive compensation if his death or injury was due to the employee’s impairment under medical cannabis.

SB167 received a favorable report on an eight to one vote.

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