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Senate | June 11, 2015 | Committee Room | Health Care

Full MP3 Audio File

Thank you, members of the committee. We will begin by introducing some of our pages, but first I want to introduce one of the interns we have here. Anna [xx] from Charlotte with Sen. Pate is here. Could you stand up? Thank you for being here. Our pages; Cameron Rodgers from Henderson, Sen. Bryant. Is he here? Not here. Okay. Jasmine Voikings from Greensboro, Sen. Robinson. Adam Foulton, Snailville, Georgia, Sen. Robinson. Savana Bell, Forest City, with me this week. Fallon Steagle from Monroe, Sen. Tucker. Joe Bickley from Lake Glore with me as well, Thank you. Like wise men from white forest single bedroom Servinar streak on mine Olive send her a peck and Andrew Grysen from hot meal center [xx]. I think I got everyone from you the exact in life for wake up for you and thank you for the work you've done. I search in arms we have head cancelor and candloss and the two this we're bouncing our round office to the honest to a little bit today is the house and this roll house bills on house without section. right now that coming through and we are being as accommodating that as we need to be those are coming in so we will begin with house bill 467 Cleveland county corner and Senator Daniel And there is a PCS do we have a motion? Senator Davis moves a PCS all those in favor please say aye, Aye! PCS is before you. Thank you Mr. Chair members of the committee little did I now a couple of years ago that a local corner as an elected office existed but in my new district it does and in fact we had a highly contested corner race last year in Cleveland county which is irrelevant to the bill but the new corner it was a vacant seat that two people are running for but any way the new corner has come in and want to make some improvements to the office this bill just gives him just a little more flexibility and who he can appoint as medical examiners he has difficulties getting medical doctors even interested in the possibility of serving as a medical examiner and so this just give him a little bit more flexibility and serving the people of Cleveland county Senator Jim Davis I think we will start with.  Thank you Mr. Chairman and at the favorable at the appropriate time I would like to move for favorable report. OK is there is any question or comment regarding the bill? Senator Donn Davis. Thanks Mr Chair I was just wondering under what do we have to in this case, take statutory steps to actually grant the authority? Thank you Senator Davis the coroner feels that the way the state medical examiner is interpenetrating the statute currently that he is not being allowed to appoint individuals that he deems qualified to be medical examiners, and this just sort of puts that authority and statute for Cleveland county as a local bill. And then one follow up. Follow up. Does this expand the scope then in which they are actually able to identify professional way to serve is this Bill is self expanding, it scoped the existing statutory scope It does senator Davis asked to Cleveland county. Not at any medical examiner or to any coroner officer or nay other [xx]. Members of the committee I've been informed by staff that you to not have the PCS of the Bill in front of you. Thanks for coming in so we can wait for copies and displace this bill if those are the questions, they're questions we can go ahead and finish through the questions this one moving forward but Senator Burn Thank you Mr. Chairman. is deemed, well I

may not have the proper view but in other words to say in this he could appoint a taxi driver or somebody who ever he wished or is their some type of qualification, does he have to have any forensic expertise or anything? I'm kind of puzzled here. Mr. Chairman Mr. Chairman can I ask a question? Yeah go ahead. Senator Birmigam that was the original version of the bill was that language to choose these seeing at the end of that phrase I might think the feeling was that that language is a little too broad so what we did was that the PCS which I I think when had an email which you don't access the PCS eliminates that phrase puts the period after the word paramedic and after the word corner comma it adds a sister corner and so that's how the PCS amends is so I I think your concern was addressed kind of in the PCS. Members of the committee I'm going to allow staff to explain the differences between the PCS natural bill Welcome committee staff and as soon as I follow up the comic is small. Essentially in the content of the bill as you know there is a prevailing general statute 130A, 382 that pertains to the election of the corner the bill the PCS or the bill originally allowed the cleven and county conner o get prevalence to physician's license to practice medicine instead but may also apply licenced phycisians as it's nurse practinttioners conners emergency medical technicians and individuals here she otherwise didn't qualify, so that was a little more frexbility that the currrent general statute the bill is amended to delete that language that insert as this are conner, I mean the PSC are apologize, the PSC and so it's assist our conners to the West, physician as it states it most practitioners, nurses conners, assist conners and emergency medicaltechician puremedics and it delete the language that said individuals he will see otherwise things qualified, so it's a little more consisted with the current general statute. Senator Wake. Thank you Mr. Chairman, my question is what is an said Conner. I mean did they have any training or licence or? Senator Davis, mine is stunning is that the corner has some disgersion on who he can appoint assist the conne but I don't now the statutory definations is just that now the conner connot appoint assistance corners.  And so down just follow up corners I think we are down to seven lift in the state men elected position is that correct.  I don't know how many, but it's very few and it is elected, yes sir. Follow up? Follow up.  Do the coroners have any training? and you can't follow up. Follow up. So you just having trouble finding anybody to fill these, because this is about. Mark coroner, he is a funeral director by trade, was elected as a coroner and yes that's what he says, that he's having trouble cover 24/7 if you are going to do a good job in the county and he's having trouble getting enough people who are willing to do the type of person that he's interested in is perhaps someone who had a career in EMT and retired and didn't keep their satisfaction active and so technically of our statute they may not be qualified because their satification is not active. senator Mikisi I think I understand and I appreciate this corporate bill appropriate time to make it more favorable report senator Bane let us all the motion as you, unless you pass away in Cleveland county I don't think this will protect you. I will say senate JIm Davidson of move for a favorable report unfavorable to the original report, any more questions or comments. Hearing none those in favor signify by saying aye. Aye. Opposed no, the ayes have it, thank you Mr. Speaker, you'll be running this one the floor. Whatever it is, tell me tell me you [x].

Next up we'll hear house floor bill 766 amend CBD old statutes, there is a PCS for this do we have a motion, senate Wade moves to consider the PCS before the committee, all those in favor sing probably saying aye. Aye. Opposed no, the ayes have it before you Senator Tucker. Thank you. Thank you Mr Chairman this bill is back before us last year we a passed a CBD oil bill for those of you who don't know this is a byproduct of the Cannabis plant. We passed hope for heliac[sp?], but unfortunately the patients in North Carolina had not been able to access this oil. Originally we passed a pilot program but no money to have the university Hospitals do research on this. The three Medical universities were involved in clinical trials last year with epidarex that does work some for children and some it does not. Of course this bill really allows the neurologist that has association with the hospital and they can recommend CBD oil for these parents. We have people who are living in Colorado that are North Carolina residents who have to have tremendous seizures, dietary problems and other issues, the content is less than half a percent of tetrahydro cannibal all. And so therefore you rub on the child's gum and it subsides some of the seizures that they have the diet's better it just it works better for some children who on what's available here in the state and we simply want to make it available in the state for the folks also to federal law to prohibits of CBD or across State lines, in states that do not have the permission or permissive to hemp like Colorado does, and it's my understanding that, currently congress right now is getting ready to pass a law that will allow states to be able to go out to Colorado or wherever they have access to CBD and get it all and bring it back and they will not face any penalty. That's basically what the Bill I would be glad to answer any question Mr. Chairman.  Before we do have we did have one member of the public who asked to speak on this bill the gentleman here is on the back thanks for coming in if you would pass that microphone their we will recognize you for two minutes to speak on the contents of this bill. Thank you my name is Scott Louis I'm from Gramble county, I appreciate this, it was great last year and then the dressing again to make it and so unattainable because it really just not happening and there a lot more families are struggling harder than mine but I can tell you that most of the states in the east coast have done the same thing some of our closer states that would be Georgia who did it this year Alabama. so the kind of Virginia that's have a THC rating that's higher than. 5% is very hard to obtain and very expensive to a register purchase the oil that is that. Georgia has a 5% THC and an equal to or more CBD, the THC may get you high, the CBD does not or if you put them together, you still have an even, so I don't want you to worry about too much THC because it's just not possible if done the right way by the right people. So I appreciate what you've done, I don't want you to, I want you to pass the bill, or if you would consider some changes but if you want to do changes just pass it today so we can get it and take care of it next session if we have to. Thank you. Thank you. Mr. Chairman, just a last comment also to CBD will help adults, as well who have seizures, and just to let you know just last week a federal amendment was that prohibits the Federal Government from using any funds to interfere with states who have enacted CBD legislation just like what we doing here today, and that the Federal CBD [xx] bill which would completely remove CBD [xx] from the controls [xx] act

is moving through Congress, now I just don't want you to think we are getting out in a limb here, there are many, many states that are moving towards this so it would be my hope that we would get favorable consideration from this committee. Sen. McKissick. Thank you for that motion Senator [xx] question. Well, I actually will move for favorable [xx] time but I do have a couple of questions. Yes sir. Because I think it's important that this be available I hear form Mr Louis back there and he's actually in my district but I also met with young lady [xx] of Charlotte had a six year child who desperately needed this oil to improve her quality of life so the thing I want to make here of We talked about nurlities case being able to be involved in this process at least to make recommendation to become available is this nurlities case who is at how the state before we did this and restricted it only to four hospitals and they were talking about all the hospitals in the state is that correct? Yes sir on line G this is defined as an individual who is licensed on article 1 of chapter 90 of the general status who is board certified in neurology and is affiliated with the neurology department at one or more of the hospitals licensed in the state  OK  so we have broadened yes sir there just four hospitals you are all correct And Mr Cubine just a follow up.  Final follow up now I heard that Mr Luois speak of the THC levels does this bill address that THC level issue at all because I'm not seeing anything here that would but perhaps I'm over were looking at because I do want to make sure that we are allowing CBD oil that's a The appropriate quantities to provide relieve that were trying to obtain for this patience who critically need it and if you can't answer that Senator Tucker perhaps there's somebody would technical background that might be able to assist us in resolving that issue. Thank you sir again for that question the only thing I can side in the last half if they need to add additional information is on line 11 of the PCS says is composed of five counts of 1% of the PCH per weight and that is composed of at least 5% of the cannibal bio weight campaigns, no other cycle act of substance so it does address well. Is that what your question sir? And perhaps if you're in doubt with. additional follow up Additional follow up. Mr. Louis spoke specifically of the THC levels. and that not something under whole about, and perhaps if I can ask him if the bill as presently drafted and constituted will allow for the type of oil that we need needed by your child, or likewise others. Mr Louis can come back at the pondium at the back Thank you, that's a great question. If your back hurts, the doctor may say, take 800 milligrams of Ibuprofen, if you don't get to the doctor and in your medicine cabinet you have 200 milligrams tablets, you may take one may make you feel better, you still may not be able to rest at night or have a normal day. So, the content, the weights will do some people good, some people not, some people would need way more Ibuprofen am not saying way more, am saying in purpose in a less. The THC has the And time, flamatory properties, and TA CA which is an hided cannabis. So you can help a much larger group of peoples patients with brain tumors, who suffer from swelling, that could reduce seizure. The broader it gets the better it gets yes but I understand that, we don't want anyone getting high, and propersate TFC and equal to or more CBD will not you high, for working lap and giggle or that kind of stuff, it will make you, stop hurting or stop moving and watch TV, or walk without using your balance. So, 200 milligram Sehaviprofen is better than nothing, it's not quiet 800 milligrams that will make you feel better.  But, yes like I said it if the bill cannot be adjusted and be passed today do that.

If it can be adjusted and passed the session please consider that simply a finale concluding comment, and what I'd like to do, Senator Tucker is to meet with you later today, and see what we might do to get some ten co expertises here. We need to modify that standard, because we do want to provide the maximum flexibility provide relief to those patients who need this type of medication. I thank you for bringing Bill form, is what we need to do and I hope to revive the critical relief this necessary these patients who really don't have any other avenues open to them but I don't want arbitrary try to come up with some standard that I'm well equipped to so at an appropriate time I will move a favorable report Mr. Chair Senator McKissick thank you seriously before your questions, that's an area as far as raising the level and individuals are different, I would be glad to work with you on that perhaps we can get in discussions with U. N. C neurologists today and by the time it gets to the floor if it's something that we need to do however I did hear from other folks that did not give me the scenario of increased dosage thats required again everyone is different and they wanted this passed like it is, and there maybe some tentative reluctant on their part to try to increase the diagnose because they want to build the move and as miss [xx] stated want to make it better, it may not be everything dosage wise they want, but most of the community is I think Mr. Luis will agree that this is solemn behind what we're doing here, and we can increase the dosage and the amount by weight, that's something we look at we'll get it down on the floor if we can, thank you. Yes sir Members of the committee I have Senator Robinson and Senator Todd and Senator Wayne and Senator Birmingham has been asked to make the motion so moving to and Senator Davis I guess we'll add that to the list as well. We have 30 minutes to session and to other bills to go, I'll remind you that as well. Senator Robinson. Thank you Mr. Chair and I'll make this quick. Senator Tucker I too conquer with the need for making sure that patients who are suffering don't have to go somewhere else we ought to be one of the best medical state. But two questions I ever had you talk about neurologist, one is have we heard from the Medical Association in general what the neurologist association I don't know what the group is, and that may help to resolve some of those questions senated in the case that was asking but have we heard from them at all?  As you know this bill has been around two years and there has been many discussions and studies that have come out that are favourable to this kind of treatment neurologies have a general idea from the ones that I have talked to about what they need to prescribe so I think they have been contacted that this kind of where list as image if you will to be able to prescribe this through association with hospital and being bored shortfied and releases in for many liability from doing so as we approach through this so my to your question is yes they know what's going on with this. One follow up Mr. Chair. And I just know from point of I think the reaction from most studies they have no position. OK. Senator Robinson follow up. I do know the issues about transport and so my concern on my question is when this is enacted how would we what would be transport at this what that be something that the state or medical facility or who would be in charge because it's a control substance and it is currently prohibited by federal law so when we enact this how would we transport this substance to North Carolina Well and again not an expert in distribution of drug legal drugs that is and but again I would say to you that we are removing all the hinderances from a state stand point and then the federal amendment was passed prohibit to federal government and that's the only block standing is the federal government and so would assume that and I don't like be user at [xx] but the federal amendment has been passed once we do this then they will be able to ship it in here under the control of the largest and hospital e and be able to prescribe

it, hope I have answered your question mom. Yes I will be gland to pour that out define read more for you So as move to this may have start limiting discussion on it beside Senator Tucker Thank you Mr. Chair just a point of clarification if you can for my own understanding if I'm interpreting this correctly does this bill doing two primary functions which is to remove the and expand the service area beyond the academic medical centers and there are basis for why we decided to do this at this time well two thing s last year we been added the ability to be able to study with the university, hospitals state and being funded so nobody moved on it. And then they were doing clinicals on the other drug epidirex[sp?] and so this just makes available now through the treatment with the neurologist. And so it just blondes[sp?] us limination parle[sp?] and just move forward in strange line so we can make it happen. Last year when we passed it it didn't make it happen, and this does send away So, Senator Tucker I won't be sure it's good in simple terms, if my child needed the answer and I was able to get the particular drug in North Calorina and not to care learner a problem and I came to use your neurologist and you said that my child needed this drug and they put him on the list registry or something I'm registered as caregiver for this person is that right? I don't know the answer about a registry I think it will go to the normal process of a prescription of the doc, and then you will get a prescription field as the drugs prescribe. it may be that the only available place to get this all would be at a hospital pharmacy, which is what I think is going to happen initially. So, if you are a guardian or a parent and the neurologist diagnoses the fact that you need the CBD or not apparent the neurologist diagnoses that then he can write a script for it and then they can get to the hospital pharmacy and get the ER. My two questions are, so I'm the caregiver I have a drug, they arrest me, I'm I going to be charged or I'm I not going to be charged? And if I'm the neurologist and I tell you is what happens to me okay this bill the way it's set up is in my understanding would have really have build on the largest parents and/or care givers, it removes the State requirements, legal requirements that it's a violation and then the federal amendment has already moved the federal government will not use funds in a free way a state the heaven artist CBO, CBDO registration, so this stage care of what we've not done in the stay the federal government and the additional amendment this being run that keeping all from being control subsatnce freeze it up even furher, so as we work consitent with fund this will eliminate the legal improcations of it  being a masterminder indoor liability from doctor or parent or guardian is my understanding men, did I answer your question? this one a quick thing if they are not on database so that they can learn, and see who is on the treatment so they know if he should have we're trying to give a word of prescription information together on health information exchanges, and others but currently right now right now there is requirement for any prescription or others who would look into that. But they could the doctor dispensed just like any other medication could be.  Senator Davis. Thanks Mr. Chair actually Senator Tarte asked the questions that I had. But I will simply say is a good characterization as we move forward last session what I powerd, the power really didn't yeild much so we're kind of expanding. Did not yield anything. The cost of the clinical trials on other drugs and the fact we did not fund the pilot, and we did not remove rights of liabilities, which we are removing liabilities consist with what the Feds are doing now for C. B. D. O. one follow up.

In weighing this, could we not accomplish the same fundamental and also in the bill we can also study this is a little new to us well again, Senetor [xx] and I will try to retrieve information from the neurology department at U. N. C. To get some technical information on the way. I'm not an expert in that so, but I could see what you're saying. It could help and just one final comment. It's just a thought, if we went down that line the question is, again how about if this is not working the way last session we thought that was going to work, I mean You know maybe there could be some level of mechanism there, you know, there is a reporting mechanism so we understand how well this policy works. Well, OK, I think those records could be available if you wanted to but Senator Davis you know about how reporting and reporting data goes around here, and as the Chairman alluded to we are in the process of setting up a new health information exchange where that data can be fed back into for these anybody else to treat the whole person, so everybody knows they're under that as far as the results of a diagnose this or anyhow like that, we have not put that in the bill. We did that last time and it hindered anybody from moving now, we just wanted to be broad enough to people can receive the CBD or will not be convicted to being a kind of misdemeanor, and that the dots for liability is removed. so that it is available for the public. Thank you members of the committee, Senator Bingham moves for a favourable report on the bill. Unfavourable the original PCS, is that correct? Yes. I'll soon call for a vote. All those in favour of the bill, the PCS of the bill please signify by saying aye? Opposed? The ayes have it. Thank you Tom. Thank you Mr. Chair And you will be writing it on the floor. OK, next up I moderate the House Bill 327 studying EMS Safety, Representative Dobson. There is a PCS for the bill, Senator Wade moves for consideration of the PCS, all those in favour please signify by saying aye? Thank you. Representative Dobson. Thank you Mr. Chairman, appreciate you allowing this bill to be heard today. Member of the committee it's always good to be with you I'll try to make this real brief, I'll start by saying this is a study bill, and it is a technical corrections bill so hopefully we can have consensus on that. What happened some EMS personnel in my district came to me and said Josh we're having more people, we're going in to more risk risky dangerous situations and we just don't have a mechanism to protect ourselves so we would like something in place to give us some kind of defence mechanism, some kind of training to allow us to defend ourselves as we go in more and more dangerous situations. So we weren't sure what the best direction to go whether be pepper spray whether be some other type of defense mechanism so we put it in to a study bill that basically said that Department of Health and Human Services in consultation with others shall study how emergency medical personnel can reduce the threat of bodily harm when performing their duties Can be done through crisis interventions, self defense tactics, other mechanisms so that's the study bill portion of it. The technical corrections, part of it as well is just some changes that needed to be made so that we could comply with the national EMS educational standards credentials levels. I've talked to the health and human services folks here in Riley and I've also talked to my AMF's director back home and he says it is definitely technical corrections. Senator Ross.  Thank you, it's appropriate I favorable consideration. I think they do need be their protection I'm only trying to get at why would you have left out, why only non lethal means to protect. You're going to endanger situatuions, why not let the study include always to protect to see what the consensus really ends up rather than excluding one form of protection.  Thank you Senator

for the question, I appreciate That and I have put some thought in that, it is my preference that we would start with non-lethal, and if that study comes back, and says that, that's the direction we need to go to start with, then I would prefer that we start there and if we need to move further after that to Lethal, I would, that's something may be we could work on at the appropriate time. Follow up. Follow up.  I think making a mistake in your study by not including something and then going back and studying is probably not the best approach but if you want to do it that way I still think it's a good idea to move forward with the bill, but I strongly suggest you include all forms of defence in the beginning so you can eliminate you only do it once, so not to do it twice. Thanks for comment, Senator Bengm.  Thank you Mr. Chairman representative just kind of puzzles me I've never heard this before I'm just wondering where are you from careful mouse. Senator Banghm, I'm offended that you don't know what your neighbour who he is neighbor, it must be areal flaw, but anyway I'm just poscalso I have nver heard it, I have never and I have talked to a lot it and actually have you should have MT satisfaction, but I've never because normally police law enforcement accompany EMT and so I think till has the proper. I mean SOS resolved in a in my real estate, but neighbours seems to be different. Thank you for the comments and in all seriousness there is domestic balance issues sometimes where EMS personnel may arrive first, before a Law enforcement may have arrived. There's also the mental health issues coming toplace sometimes where you mass personnel are first before the law enforcement and this just gives him protective mechanism to release that's the idea of protective mechanisms. Same way the coomment I think SEnator Ruben moved for a favorable report to the PCS unfavorable to the original bill, all those in favor, please signify by saying I, oppose, no. The I's have it. Thank you representative Dobson, and I will run it on the floor Thank you Mr. Chairman, thank you members of the committee for your time. We have about five minutes left. We need to evacuate the room so we will go ahead and make a try I don't know that representative Hurger was able to make it, representative Blackwell is here. He would like to run House Bill 652 Right to Try Act for Terminally Ill Patients And representative Reeves is also here as one of the prime sponsors Mr. Chair. I'm sort of caught between the rock and a hard place in five minutes I don't want to I presume that people might not have concerns about what's in this legislation, I think it's important but I'm going to try to give you a little background very quickly this is mainly about trying to deal with a situation involving terminal patients who've exhausted their conventional treatment options and have nothing left to access potentially life-saving investigation on medications. Only about 3% of patients today are allowed to enroll in clinical trials that FDA is involved with, for everyone else their only hope of obtaining their potentially life-saving medication is to ask the FDA for special permission. Only about 1000 people make it through the FDA's compassionate use application. Process is complicated, time consuming, expensive. FDA itself as could determine that the process requires a doctor to complete an application that they say takes 100 hours. After he submits it to the FDA, the manufacturer also got to submit link the documentation. FDA has a month to review the submission if they don't immediately grant or deny but have a question the one month clock starts over, if they approve the request then a separate committee not affiliated with the FDA called an Institutional Review Board has to approve the patients use that takes up to another month. Sadly, there are a lot of cases where people die waiting on this process. This bill is designed to try to eliminate barriers that would limit doctors in North Carolina from providing care they're trying to give. It would allow terminally ill patients who qualify under this legislation that we think is fairly strictly drawn and requires a lot of provisions to be met in order to be able to have both the access and the protections of the bill

that we are trying to expand this process say so they've got a chance in getting at this. And this legislation would only apply to drugs that have already done phase one with the FDA which is got your basic safety testing involved with it. It will only be done in case of very clear cut consent by the patient, affirmation by the physician that he was in an agreement. 19 states Representative Backle  can we try to get McInnis question in, I know that we got several one to move forward to the bill but he had a question that was coming out. First I want to thank you bringing the Bill on, Secondly I support it to a 100%, now I'm making a motion for payable report, but let me ask you this, somebody goes through and gets one of these medications, is there any provisions within your bill to limit the liability of the manufacturer, because  manufacturer probably has certain standards that they would normally follow and certain things are mandated out of Washington through the Food and Drug Administrations I just want to make sure that once somebody gets one of this medications and they try them, if for some reason they're not happy and they've gone through all this extraordinary process to get the medication and I support that they won't then try to sue the manufacturer. There's under one of the last articles, or sections in the Bill, there's no private right of action against manufactures or against any other person entity involved in the care provided they comply with provisions of this legislation and have exercised reasonable care and you sir. Excellent, thank you. Let me check if there is any question, I may have to pull the bill is this needs to go on so Senator Robinson. I do have a couple, I think it's important but I also think it's to look at all the details. My question is under page two, line 40 F, when we talk here about the provider the third body who already whoever the patient's health provider is not healthcare or insurance or whatevers pay for the treatment, post this particular biological device or treatment I would be concerned that after this device works it doesn't work a treatment works, that this implies to me or I'm I wrong that it imply as it if they have any other insure that ensure one continue to provide treatment. I think maybe two things I would say quickly in response, one is my understanding is that in practice where they manufacturers enter into this agreements with a patient to provide it with frequently, those kinds of aftre cost are covered in the arrangement to the extent that they are not, it is a matter of what the contractor of the insurance with the healthcare provider says. So we wouldn't be changing that one way or the other. Senator Robinson I think with time I'm going displace this bill I do not know that we have another meeting scheduled of health policy for the session, could you follow up with the bill sponsors? Okay. I don't mind moving for a favorable report. Senator Mackisik has moved for a favorable report, I will take the vote on that this time with an objection all those in favor will report to the bill, please signify by saying I, I! Oppose no. The I's have it, doing this schedule on the fourth.