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61st Annual Meeting of the Southern Legislative Conference

July 14-18, 2007 | Williamsburg, Virginia

Chair's Reports

CHAIR'S REPORT
HUMAN SERVICES & PUBLIC SAFETY COMMITEE

TO:      Members of the Executive Committee

FR:      Representative George Flaggs, Jr., Mississippi
Chair, Human Services & Public Safety Committee

RE:      Report of Activities of the Human Services & Public Safety Committee at the 61st Annual Meeting of the Southern Legislative Conference in Williamsburg , Virginia , July 14-18, 2007

            The Human Services & Public Safety Committee convened on Sunday, July 15, for a business session, on Monday, July 16, for a program session, and on Tuesday, July 17, for a technical tour during the 61st SLC Annual Meeting.  The following is a summary of the speaker presentations and Committee activities during this event.

Business Session, July 15, 2007

I.          Pharmaceutical Benefits Management

Barbara Levy, Vice President and General Counsel, Pharmaceutical Care Management Association, Washington , D.C.

Background
            Throughout the last decade, the number of pharmaceutical benefits managers has increased dramatically throughout the nation, providing prescription drug coverage to approximately 100 million Americans. In an effort to control escalating expenditures for outpatient prescription drugs, pharmaceutical benefits managers work with employer groups and insurance organizations to develop volume purchase agreements with pharmaceutical manufacturers.

Ms. Levy’s Presentation

            Ms. Levy began her presentation by describing the unique role pharmaceutical benefit managers (PBM) play in managing healthcare in states.  First of all, according to Ms. Levy, PBMs are the only entities in the drug chain dedicated to lowering cost and increasing quality.  Pharmaceutical benefit managers advise plan sponsors on benefit design options, pool purchasing ability of millions of consumers to negotiate lower drug prices, link networks of pharmacies nationwide, and use cost and quality management tools to make drug benefits more affordable. 

            Pharmaceutical benefits management companies are organized in five different ways:  stand alone for-profit companies; local and regional companies; large insurers or managed care plans; retail chain drug stores; and buying groups of independent pharmacies or pharmacy purchasing cooperatives. 

            Ms. Levy continued by citing some statistics regarding the use of PBMs.  First of all, more than 210 million Americans received pharmacy benefits through PBMs last year.  Pharmaceutical benefit managers are projected to purchase $204 billion in pharmaceuticals in 2008 and save approximately 29 percent in the purchase of pharmaceuticals during that year.  One of the ways PBMs achieve this, Ms. Levy pointed out, is by slowing prescription drug spending.  The Centers for Medicare and Medicaid Services have maintained that prescription drug spending in 2005 was at a 10-year low, attributable in part to the growth of generics and to the increased use of mail-order pharmacies.  PBMs have contributed greatly to moving generics into the marketplace as well as supporting the movement towards mail-order dispensing.  Secondly, Ms. Levy noted, PBMs assist in expanding drug coverage. 

            Ms. Levy continued by detailing the variety of clients served.  First among these are insurers and health plans that often subcontract to PBMs.  Self-insured large employers, particularly those that carve out their drug benefits programs from their general healthcare plans, are increasingly looking to PBMs for supervision and guidance.  Other users include union plans, state employee and retiree health benefit plans, and government plans, which can include Medicare Part D and Medicaid. 

            Ms. Levy described the ways in which PBMs meet their clients’ needs.  First of all, they only act as intermediaries and do not contract directly with their consumers.  Secondly, a PBM’s plan sponsors tend to be large, sophisticated and knowledgeable companies, which often use brokers and other consultants to assist them in advising development and evaluation of bids.  Thirdly, they do not create benefit designs, which instead are developed by the plan sponsors. 

            Ms. Levy continued by suggesting a few details for lawmakers to consider when formulating legislation in their states.  First, PBM activities already are regulated.  Since 2003, more than 200 bills pertaining to the regulation of PBMs have been introduced.  In 2007 alone, 22 states considered and rejected legislation that would impose restrictions on PBMs.  Ms. Levy asserted that no additional regulation is necessary, since PBMs already are regulated directly at the state level in their capacity as licensed, certified, or registered entities, and because PBMs are regulated indirectly through contractual compliance with state and federal requirements imposed on insurers, HMOs, and employer-sponsored plans.

            In conclusion, Ms. Levy emphasized the value of PBMs in offering lower prices on prescription drugs than retail pharmacies and non-PBM owned mail pharmacies, as well as their effectiveness in capitalizing on opportunities to dispense generic medications.  Finally, Ms. Levy reiterated that the incentives of PBMs are closely aligned with their customers.

II.        Legislative Roundtable Discussion

            A legislative roundtable followed the presentation which included the following topics: PBM disclosure legislation; the correlation between closing of mental health hospitals and the crowding of state prisons; cost of housing people in mental hospitals vs. prisons; the cost of corrections, generally, and what states can do to help counties in maintaining jail costs, particularly.

Program Session, July 16

I.          HPV and the Debate Over Mandatory Immunizations

Dr. Daniel Salmon, Associate Director for Policy and Behavioral Research at the Institute for Vaccine Safety, The John Hopkins School of Public Health, Maryland
Karen Mason, Acting Associate Director for Health Policy of the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Georgia

Background
            With recent controversies in various parts of the country over proposed mandatory immunizations for the human papillomavirus (HPV) for school-age girls, the topic of mandatory immunizations for infectious diseases has become one of particular interest to health officials, lawmakers, and parents of young children alike. An understanding of the history, evolution and implications of mandatory vaccination laws in the United States is imperative for state lawmakers as they formulate legislation for the citizens of their state.

Dr. Salmon’s Presentation

Dr. Salmon began his presentation by maintaining that, although there are no federal mandates, all 50 states have laws that require school-age children to be immunized.  Also, many states have daycare and college-entry requirements in addition to elementary or secondary requirements.  However, there is wide variation in how states go about implementing these requisites.  For instance, in 44 states and the District of Columbia , a documentation from a healthcare provider is necessary to demonstrate that a child is fully vaccinated.  In the six other states, the parents are allowed to fully complete the forms. 

In giving a brief history of vaccinations in the United States , Dr. Salmon stated that the first vaccination law was implemented in Massachusetts , a law that applied to the general population for smallpox immunization.  The law was challenged involving a man who was fined for not receiving the vaccine, claiming that it infringed on his personal autonomy.  The challenge eventually was heard by the U.S. Supreme Court, in the case of Jacobson v. Massachusetts (1809).  Ultimately, the Supreme Court upheld the right of the state to require vaccination.  This case, Dr. Salmon stated, has been the foundation for public health law in this country.  In 1922, in the case of Zucht vs. King, the Supreme Court ruled for the first time that school requirements were a constitutionally valid application of compulsory vaccination.

            There was a growth in school laws in the 1960s and 1970s, Dr. Salmon continued, which in many ways represents the modern era of school vaccination requirements and compulsory vaccination.  Growth largely was in response to measles, which was endemic in the United States at that time.  Dr. Salmon cited various studies of measles rates in the 1973 and 1974 that demonstrate that states lacking mandatory school entry requirements had much higher rates of measles than those that adopted them.  For instance, in 1974, the 40 states with such laws saw 33.1 cases for ever 100,000 residents under the age of 18, versus the remaining states without mandatory immunization laws, which saw 55.4 cases per every 100,000 residents under the age of 18. 

            Dr. Salmon continued by stating that enforcement is a very important aspect of immunization policies.  As an illustration, Dr. Salmon cited a 1977 study that showed that the six states with the strictest enforcement laws saw 40.6 cases of measles per every 100,000 residents under 18 years of age.  The rest of the country saw 90.3 cases per every 100,000 residents under the age of 18, more than double the frequency. 

            School immunization laws initially existed in order to prevent outbreaks, according to Dr. Salmon continued.  Since schools often are the site of rapid disease transmission, school-age children typically are disproportionately affected by disease.  However, retrospectively examining these laws shows that they serve other helpful purposes as well.  For instance, these laws provide a safety net for ensuring that nearly all children are fully vaccinated by the time they enter school.  Also, these laws demonstrate a public commitment to immunization, as well as assist the introduction of new vaccines to the public and quickly obtain high coverage rates—this can be very important during times of abrupt outbreak.

            Dr. Salmon explained that just as all states have immunization laws, all states provide some sort of exemption to these laws.  West Virginia and Mississippi , for instance, are the only two states that offer only medical exemptions.  The other 48 states offer medical exemptions, as well as religious exemptions.  Nineteen of these offer philosophical exemptions as well, although the distinction between “religious” and “philosophical” often is one of semantics. 

            Dr. Salmon continued by emphasizing the profound drop in morbidity over the last two centuries for vaccine-preventable diseases.  Smallpox and diphtheria, for instance, have been eradicated.  With the exception of pertussis, the incidence of most vaccine-preventable diseases has been reduced by about 99 percent.  While this saves considerable healthcare money, as well as lives, it also raises various challenges.  First of all, Dr. Salmon admitted, no vaccine is 100 percent safe.  Adverse events play a role in immunization practices.  As a disease begins to be diminished and eradicated by a vaccine, there reaches a point when the rate of adverse affects (whether actually caused by the vaccine or at least perceived to be caused by the vaccine) begins to “catch up” with the rate of disease.  What happens at this point, Dr. Salmon noted, is that attention shifts from fear of the disease to fear of the vaccine, which inadvertently decreases the rate of vaccine coverage and increases the potential for an outbreak. 

            Dr. Salmon addressed one of the most controversial aspects of mandatory exemptions: religion and the law.  He cited a recent case involving the state of Arkansas , which until 2002 maintained a very strict exemption on the grounds of religion.  The law read that a child may be exempt if “immunization conflicts with the religious tenets and practices of a recognized church or religious denomination of which the parent…is an adherent member.”  Also, the parent was required to provide a copy of the church doctrine that prohibited immunization and details of his or her religious organization.  There was a challenge to this law, in which the parents of a child in the state did not want their child to be vaccinated for the Hepatitis B vaccines, on the grounds that the disease is commonly spread through intravenous drug use or sexual activity, since administering the vaccine promotes this behavior.  The state rejected the exemption request for failure to cite church doctrine, among other reasons, and the case eventually made it to a U.S. District Court.  The court applied the Three Prong Lemon Test, which states that: a law must be secular in purpose; the primary effect of a law must not advance nor inhibit religion; and a law must not result in excessive entanglement of the government with religion.  The court ruled that the law failed the second and third prongs, thereby violating the Establishment and Free Exercise Clause of the First Amendment of the U.S. Constitution, as well as the Equal Protection Clause of the Fourteenth Amendment. 

            Following the ruling of this case, the Arkansas Medical Society requested assistance from Dr. Salmon and his program in constructing a new law.  Dr. Salmon concluded by presenting his model legislation for formulating exemptions for state immunization laws.  First of all, the parent seeking an exemption should furnish a signed, personal statement explaining the reasons for the request and provide documentation from a licensed physician or department of health professional stating that the individual is aware of what is being requested for his or her child.  Secondly, the state should weigh the strengths of the parent’s conviction alongside the risks of granting the exemption (vaccination rates, community vulnerability to disease outbreaks, testing and science behind various vaccine-preventing drugs, etc.).  Also, if an exemption is granted, since it is possible that the parent’s convictions as well as the risks may change, an annual renewal of exemption should be required. 

Ms. Mason’s Presentation

            Ms. Mason began her presentation by reiterating Dr. Salmon’s point concerning the overwhelming success of immunizations.  Overall, the impact of vaccination requirements for school-age children on morbidity rates has been profound, and not just for the children receiving them.  The rate of adult death from diseases such as pneumococcus, for instance, has dropped approximately 36 percent from pre-vaccine era until now because the disease was so easily transmitted from children to adults.  The Childhood Immunization Program, which is the largest public/private partnership in the country, is federally funded and implemented by states.  It has 55,000 participating providers and covers children that are uninsured or Medicaid eligible, or underinsured if they are treated in federally qualified health centers.  The program has produced record-high coverage rates, as well as record-low incidences of vaccine-preventable diseases.  Measles, Ms. Mason emphasized, is no longer an epidemic in the Western Hemisphere, and rubella has been eliminated in the United States . 

            Also, Ms. Mason continued, immunization is one of the few clinical preventive services that saves dollars as well as lives.  A study done in 1999 revealed that for each birth cohort vaccinated in a year, society saves approximately $43.3 billion; healthcare costs are reduced by about $9.9 billion; 33,000 lives are saved; and 14 million cases of disease are prevented.  However, Ms. Mason added, as new products arise, new challenges develop as well.  For instance, in 1985 there were only seven diseases for which vaccines existed in the routine childhood and adolescent immunization schedule; in 1995 there were 10; and today there are 16. 

            In addition, new vaccines bring about a difference in price.  In 1985, the cost for vaccinating a child through the age of 18 was $45, according to federal contract prices (not private sector prices).  By 1995, the cost had risen to $155.  As of April, 2007, Ms. Mason stated, the cost for vaccinating a male child was $924 and a female child $1,214.  Also, it is the case that the newer vaccines are more expensive. 

            The human papillomavirus (HPV) vaccine is the first vaccine in the routine immunization schedule that is recommended only for one gender: female.  The vaccine is recommended for the 11- to 12-year age group, with “catch up” for 13 to 26 year olds.  Such a vaccine presents many opportunities for new outreach and partners but, as states have seen in recent months, the vaccine presents new challenges as well. 

            Ms. Mason noted the prevalence of immunization requirements in the United States .  As an illustration, Ms. Mason stated that, for children entering kindergarten, all 50 states require the diphtheria vaccination; 49 states require the tetanus vaccination; and 46 states require the pertussis vaccination.  Also, these vaccines typically are given in one injection, so even if a state does not require some vaccines, most children are receiving them.  Overall, these requirements are successful in ensuring that children are vaccinated.  In the 2005-2006 school year, 95 percent of children entering school had been vaccinated for polio, diphtheria, tetanus, pertussis, and measles. 

            There have been challenges throughout history to these requirements.  The courts have upheld the constitutionality of these requirements, on most occasions.  Almost all school vaccination laws have some type of exemption, which has helped to moderate criticism of them.  Regardless, however, criticism of vaccination laws remain.  There are parents who ardently disagree with the practice of vaccination altogether, for instance.  In addition, public officials throughout the country are concerned about the proper way to implement exemptions.  As illustrated in Dr. Salmon’s presentation, concern for individual rights must be balanced with concern for the well-being of society as a whole.

            Many new controversies, Ms. Mason continued, revolve around the expansion of existing vaccination laws to include new vaccines, such as HPV.  Other controversies have involved philosophical exemptions to vaccines.  In addition, the recent heightened level of involvement of drug companies in the legislative process has been controversial. 

Turning to HPV legislation, 41 states have had some form of HPV bill in the last several years.  Twenty-four of those states had bills that dealt with school requirements.  Seventeen states passed some type of legislation regarding HPV vaccination, including laws that require state insurance companies to pay for the vaccine, and laws that put the vaccine in the state Medicaid program or employee health program.  One state, Virginia , passed legislation requiring school-age girls to receive the vaccine. 

            Ms. Mason explained what state legislators should consider when constructing HPV legislation.  First of all, as with any vaccine, legislators should consider the availability of the vaccine.  Various states passed legislation in recent years requiring the pneumococcal vaccine for childcare centers and schools, but the manufacturer of the drug could not produce it fast enough.  This led to problems in school eligibility for children who were unable to obtain the vaccine. 

            Secondly, lawmakers should consider financing.  One specific aspect of this is ensuring that everyone can be covered.  This can be complicated.  As an illustration, Ms. Mason stated that children of working parents, who have minimal healthcare coverage, are most at risk due to their inability to receive vaccinations than any other group.  This is important to consider whenever contemplating sweeping requirements. 

            Thirdly, gaining community and provider acceptance is very important.  Since enforcement varies from not only state to state, but from county to county and even school to school, community support is imperative for a requirement to be a success.  Also, there must be providers in place to administer the vaccine. 

            Fourthly, safety must be considered.  Approved vaccines have gone through the FDA licensing process, but there have been newly discovered adverse events long after drugs have been approved by the FDA. 

            Finally, feasibility is vital.  A lawmaker should talk to state health department officials about how an immunization requirement would actually be accomplished.  A time frame for developing capacity (if it does not already exist) should be established. 

            There are many nuances to such laws that can cause problems and be counterproductive.  For instance, if a lawmaker is seeking a middle school requirement, rather than a school entry requirement, then there must be a plan (which would include personnel needs) for checking vaccination records.  Such tasks can be daunting and should be considered when formulating legislation.  Some common unintended consequences of immunization requirements, Ms. Mason noted, can be: broadening of exemptions, loss of public support for vaccinations and requirements, erosion of program gains, and lack of enforcement. 

            Ms. Mason concluded by stating that what is most important for lawmakers to consider is what is best for their state.  State lawmakers understand much better than those at the federal level what the needs of their state are, and what the ramifications are for supporting and passing immunization requirements. 

           

II.        Sex Offender Management

Randi Lanzafama, Sex Offender Program Manager, Division of Community Corrections, Department of Corrections, Virginia

Background
Constructing laws that both effectively protect society while successfully meeting the rehabilitation needs of sex offenders is a challenging undertaking. State lawmakers must consider the financial and effectual implications of laws that address housing, monitoring and regulating convicted sex offenders.

Ms. Lanzafama’s Presentation

            Ms. Lanzafama began by describing community corrections in the Commonwealth of Virginia , stating that there are 43 probation and parole districts.  Each district varies in size.  In some portions of the state, probation and parole districts cover five counties.  There are approximately 730 probation and parole officers working in the state, supervising about 56,964 cases, of which almost 4,000 are from other states.  The Department of Corrections conducts more than 81,000 investigations annually, which can consist of anything from a pre-sentence investigation to a record check or a transfer investigation.  In addition to this enormous case load of probation and parole duties, as of July 9, 2007, Virginia supervises more than 2,300 sex offenders in community correction centers across the state.  If distributed evenly, this would amount to 53 sex offenders for each district to manage.  Unfortunately, these probation and parolees are not evenly distributed across the state, leaving sex offender managers in some districts supervising up to 156 offenders at one time.  More than 1,800 of this total population are considered “violent” offenders. 

            Ms. Lanzafama detailed the various levels of sex offender supervision used by her division.  The most intense level of supervision requires the supervisor meet personally with the offender at least four times per month; the supervisor to visit the offender’s home at least twice a month; the supervisor meet with other persons associated with the offender, such a family member or a treatment provider twice a month; and the supervisor conduct four record checks on the offender every month.  About 10 percent of all the offenders in Virginia are supervised in this manner, requiring around 85 contacts per supervisor each month.

            The next level of supervision is slightly less rigid, where the supervisor makes two personal contacts, one home visit, one “other” contact, and four record checks every month.  However, more than half of all offenders in Virginia fall into this category, amounting to approximately 330 contacts per supervisor for this group.

            The least restrictive level requires one personal contact, one home visit, and four record checks per month.  With more than 25 percent of offenders falling into this category, this adds an average of another 100 contacts for each supervisor every month.  With each supervisor making more than 500 contacts in a given month, the need for additional personnel, and correspondingly additional funding, is immense.

            Virginia employs the “containment model of supervision,” which has the purpose of imposing external controls on sex offenders so that the offender might develop the internal controls to “choose not to re-offend.”  There are a variety of ways the Department of Corrections goes about doing this, including: consolidating caseloads so that supervisors can “specialize” in particular areas; employing evidence- and research-based supervision practices; maintaining small caseloads; requires multi-agency collaboration; providing specialized treatment for offenders; and using specialized and investigative tools. 

            With regard to specialized caseloads, Ms. Lanzafama continued, the consensus among supervision offices throughout the country is that this population requires specific attention.  Focused training that equips officers with the ability to offer this attention is imperative.  Ideally, within this program, a senior officer would supervise 20 to 24 high-risk offenders, with intensive probation and parole officers supervising no more than 40 medium- or low-risk offenders.

            Supervision practices should also be evidence- and research-based, Ms. Lanzafama insisted.  Much research suggests, for instance, that the overwhelming majority of victims of sex crimes are assaulted by someone known to them.  Specifically, 90 percent of victims under the age of 12 know their offender.  Also, by way of example, it is widely held that various things assist an offender in not re-offending, such as steady housing, stable employment, and a secure support system.  Lack of stability increases risk.  Therefore, passing laws that endanger an offender’s ability to maintain stable housing, for instance, can lead to inadvertently negative repercussions.  Residency restrictions, as an example, can bring about such results.  Similarly, lawmakers should consider what is accomplished by exclusion zones, and what possible damaging side-effects might arise from an offender’s inability to work or go to church in certain areas. 

            Ms. Lanzafama then turned to the issue of multi-agency collaboration.  It has been shown, she stated, that individual agencies no longer are able to manage this population on their own.  The Department of Corrections in each state must work together with law enforcement, social services, and other agencies to maximize results.  Also, this is a way to make the best use of limited resources for sex-offender management. 

            Many states are moving in the direction of ensuring that personnel who supervise sex offenders have specialized training.  Training for such personnel must go beyond basic counseling curriculum in order to offer offenders adequate analysis and help.  Much of the treatment regimens for offenders diverges greatly from typical counseling or therapy.  For instance, part of the treatment program in Virginia entails mandatory, weekly group sessions for most offenders.  These sessions are aggressive in nature.  Coordinating and facilitating such meetings requires special training of personnel.

            Specialized treatment and tools can include the use of polygraph examinations, which compels offenders to be honest about their past behavior.  Global positioning devices and other electronic curfew checks are becoming increasingly popular in many states.  There are technological, financial and other restrictions to the use of these tools, but they can be very useful to the supervision officer.  In conclusion, Ms. Lanzafama stated that there is no silver bullet.  States must maximize the tools that are available to them, and move forward in implementing practices that are specific to the particular situations in their state.

II.        Election of Officers

            At the recommendation of the Nominating Committee, chaired by Senator Yvonne Miller of Virginia , the Committee elected Representative John Arnold, Jr. of Kentucky as its new chair, and Senator Barbara Horn of Arkansas as its new vice chair.  Also, Representative Arnold presented Chairman Flaggs with a plague acknowledging the Committee’s appreciation of his years of service.

           

Technical Tour, July 16

Tour of Eastern State Hospital :  Mental Health and Corrections

Senator Yvonne Miller, Virginia (presiding)
Dr. Jim Reinhard, Assistant Commissioner for Facilities, Department of Mental Health, Mental Retardation, and Substance Abuse Services, Virginia
Mr. Larry Roberts, Counselor to Governor Tim Kaine, Virginia

Background
            Opened in 1773, Eastern State Hospital was the first public facility in the United States established solely for the care and treatment of mentally ill patients.  The Committee toured the reconstruction of the original 1773 facility, as well as viewed plans for reconstructing the existing hospital to meet 21st century needs.  Also, the Committee heard a panel discussion on the steps Virginia is taking to transform its mental health system, particularly focusing on the intersection of mental health and criminal justice in Virginia today.

Dr. Reinhard’s Presentation

            Dr. Reinhard began by giving a brief history of Eastern State Hospital , located just three miles west of Williamsburg on approximately 400 acres of land.  The Hospital offers treatment to approximately 420 residents of southeastern Virginia , who are housed in various treatment facilities.  Treatment at Eastern State Hospital is provided by a multi-disciplinary team comprising physicians, psychologists, nurses, social workers, occupational and activity therapists, and registered dietitians.  Also, a full support staff ensures efficient day-to-day operation of the facility.

            Further, a full program of activities and therapeutic treatment modalities are available to patients, including expressive therapy, occupational and recreation therapy, as well as patients’ library services.  A gymnasium, game room auditorium, greenhouse, swimming pool and picnic area are located on the grounds as well. 

            In closing, Dr. Reinhard spoke about the balance the facility attempts to seek in facility and community investment.  Also, he emphasized the need for further development of forensic facilities for mentally ill prisoners, as well as jail diversion and jail treatment services.  He also stressed the potential impact progress in these areas can have on state and federal budget reductions. 

Mr. Roberts’ Presentation

Mr. Roberts spoke about what the governor is doing to address mental health and corrections in Virginia , specifically in light of the 2007 shootings at Virginia Polytechnic University .  Mr. Roberts spoke briefly on the emotional difficulties that have accompanied the need to address the causes and repercussions of the Virginia Tech incident.  He spoke on the governor’s efforts to set up a briefing for the congressional delegation, and the ongoing conversation with the attorney general’s office.  Perhaps most importantly, these events led the governor’s office to assemble a panel to review and evaluate the events leading up to the shootings, which met for the first time on May 10, 2007.  The panel soon will produce a report that will be used to further address the mental health affects of corrections in the state. 

            Mr. Roberts concluded by stating that although it is impossible to prevent every potential crime from happening, and although there is no one profile for all people who commit these type crimes, it is possible to learn from the past and move forward to minimize the possibility of these events from happening again.

Southern Legislative Conference Fall Conference
San Antonio Texas , October 26-29, 2007

            The SLC will meet for its 2007 Fall Conference October 26-29 at the Westin Riverwalk, San Antonio , Texas , for discussions on how states are focusing their policies to encourage the development of existing businesses and foster the growth of new industries.  Members will share their experiences and hear from leading experts on how communities and regions succeed or fail, and learn about innovative ways to achieve collaborative success for economic development.  In keeping with the wishes of the SLC presiding officers, please note that meeting notification does not authorize travel.

SLC Staff Contact:   If you have any questions regarding this report or the 2007 SLC Fall Conference, please contact Jeremy Williams in our Atlanta office at (404) 633-1866 or jlwilliams@csg.org.


Attendance List
Southern Legislative Conference 61st Annual Meeting
Human Services & Public Safety Committee
July 14 – 18, 2007
Williamsburg , Virginia

Alabama
Representative Stephanie Flowers
Representative Mac McCutcheon
Representative William E. Thigpen

Arkansas
Senator Barbara Horn
Representative Sharon Dobbins

Canada
Claude Bachaud, Member of Parliament
Brad Trost, Member of Parliament
J. Dewetering , Canada - U.S. Inter-Parliamentary Group

Florida
Representative Mitch Needelman

Georgia
Representative Mickey Channell
Representative Sharon Cooper
Representative Clay Cox
Representative Billy Horne
Karen Mason, Centers for Disease Control and Prevention
Frank Rogers, GlaxoSmithKline
Jeremy Williams, Southern Legislative Conference

Indiana
Jeff Drozda, Golden Rule

Louisiana
Elizabeth Borne, House of
Representatives
Jim Delatte, Takeda Pharmaceuticals
Camille Sebastian Perry, Senate Judiciary and Government Division

Mississippi
Representative George Flaggs, Jr.
Representative Sara Thomas

Kentucky
Senator Perry Clark
Senator Dick Roeding
Representative John Arnold, Jr.
Representative Tom Burch
Representative David Floyd
Representative Jimmie Lee
Representative Tim Moore
Representative Addia Wuchner
Representative Brent Yonts
Stacy Bassett, Office of the Governor
Ray DeBolt, Department of Juvenile Justice
Wanda Fowler, The Council of State Governments
Jon Grate, Legislative Research Commission
Nancy Hublar , Kentucky Association of Health Care Facilities
DeeAnn Mansfield, Legislative Research Commission

Maryland
Senator Lisa Gladen
Delegate Steve DeBoy
Delegate Jim Gilchrist
Delegate Joseph F. Vallario
Daniel Salmon, Johns Hopkins University

Mississippi
Senator Hillman Frazier

Missouri
Kristina Jenkins, House of Representatives

North Carolina
Representative Jeff Barnhart

Oklahoma
Representative Dennis Johnson

Tennessee
Representative Mike Kernell
Gary Blalack, GlaxoSmithKline
Paul D. Miller, Tennessee Alliance for Progress
Marlene Sanders, Eli Lilly & Company

Virginia
Senator Emmett Hanger, Jr.
Senator Janet Howell
Senator Yvonne B. Miller
Senator Toddy Puller
Senator Patsy Ticer
Delegate Kathy Byron
Delegate Kirk Cox
Delegate Melanie Rapp
Delegate Beverly Sherwood
Delegate Jeion Ward
Joy Bechford, Anthem
Erin L. Bumgarner, Virginia Crime Commission
Dick Hickman, Senate
Reggie Jones, Williams & Mullen
Randi Lanzafama, Department of Corrections
John Palya, Wyeth
Mark Pratt, Anthem
Gary L. Riddle, Schering-Plough

Wisconsin
David Moody, Student Government Association

West Virginia
Senator Jon Hunter
Randall Elkins, Department of Employment Security

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