03/28/2017 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: the Economic Costs of Alcohol Abuse in Alaska | |
| HB54 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 151 | TELECONFERENCED | |
| *+ | HB 54 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 28, 2017
3:01 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
Representative Matt Claman (alternate)
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
PRESENTATION: THE ECONOMIC COSTS OF ALCOHOL ABUSE IN ALASKA
- HEARD
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 54
"An Act providing an end-of-life option for terminally ill
individuals; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 151
"An Act relating to the duties of the Department of Health and
Social Services; relating to training and workload standards for
employees of the Department of Health and Social Services;
relating to foster care licensing; relating to placement of a
child in need of aid; relating to the rights and
responsibilities of foster parents; relating to subsidies for
adoption or guardianship of a child in need of aid; requiring
the Department of Health and Social Services to provide
information to a child or person released from the department's
custody; and providing for an effective date."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 54
SHORT TITLE: TERMINALLY ILL: ENDING LIFE OPTION
SPONSOR(s): REPRESENTATIVE(s) DRUMMOND
01/18/17 (H) READ THE FIRST TIME - REFERRALS
01/18/17 (H) HSS, JUD
03/14/17 (H) HSS AT 3:00 PM CAPITOL 106
03/14/17 (H) <Bill Hearing Canceled>
03/27/17 (H) SPONSOR SUBSTITUTE INTRODUCED-REFERRALS
03/27/17 (H) READ THE FIRST TIME - REFERRALS
03/27/17 (H) HSS, JUD
03/28/17 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JEFF JESSEE, Program Officer & Legislative Liaison
Alaska Mental Health Trust Authority
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "The Economic
Costs of Alcohol Abuse in Alaska."
DONNA LOGAN, Vice President
Anchorage Operations
McDowell Group
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "The Economic
Costs of Alcohol Abuse in Alaska."
REPRESENTATIVE HARRIET DRUMMOND
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced SSHB 54 as the sponsor of the
bill.
KRISTIN KRANENDONK, Staff
Representative Harriet Drummond
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SSHB 54 on behalf of the bill
sponsor, Representative Harriet Drummond.
KAT WEST
National Director of Policy & Programs
Compassion & Choices
Portland, Oregon
POSITION STATEMENT: Answered questions and testified during
discussion of SSHB 54.
DAVID COMPTON, MD
Bethel, Alaska
POSITION STATEMENT: Testified in support of SSHB 54.
MARGARET DORE
Attorney
State of Washington
POSITION STATEMENT: Testified in opposition of SSHB 54.
DIANA KRISTELLER, Midwife
APRNs, Voluntary Ending of Life
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of SSHB 54.
CAROL EGNER
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of SSHB 54.
MICHAEL HAUKEDALEN
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SSHB 54.
MARY MCDOWELL
Juneau, Alaska
POSITION STATEMENT: Testified in support of SSHB 54.
NANCIANNA CLONAN
Soldotna, Alaska
POSITION STATEMENT: Testified in support of the SSHB 54.
JOHN FORBES, MD
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to SSHB 54.
WILLIAM HARRINGTON
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SSHB 54.
SARAH VANCE
Homer, Alaska
POSITION STATEMENT: Testified in opposition to SSHB 54.
DIANA BARNARD, MD
Hospice Care
University of Vermont Medical Center
Burlington, VT
POSITION STATEMENT: Testified during discussion of SSHB 54.
CHRISTOPHER KURKA, Executive Director
Alaska Right to Life
Palmer, Alaska
POSITION STATEMENT: Testified in opposition to SSHB 54.
MICHAEL PAULEY
Alaska Family Council
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to SSHB 54.
ACTION NARRATIVE
3:01:07 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:01 p.m.
Representatives Spohnholz, Sullivan-Leonard, Johnston, and Kito
were present at the call to order. Representatives Tarr,
Eastman, and Edgmon arrived as the meeting was in progress.
^Presentation: The Economic Costs of Alcohol Abuse in Alaska
Presentation: The Economic Costs of Alcohol Abuse in Alaska
3:01:46 PM
CHAIR SPOHNHOLZ announced that the first order of business would
be a presentation on the Economic Costs of Alcohol Abuse in
Alaska.
3:02:18 PM
JEFF JESSEE, Program Officer & Legislative Liaison, Alaska
Mental Health Trust Authority, Department of Revenue, introduced
the PowerPoint presentation of the study contracted with the
McDowell Group by the Alaska Mental Health Trust Authority to
review the cost of alcohol and drug abuse to the State of
Alaska. He reported that many different components, including
criminal justice costs, health care costs, car accident costs,
lost productivity costs, and child protection costs, were used
to help quantify the seriousness of the issue for policy makers.
He declared that these were "pretty dramatic numbers" which had
been scientifically arrived at using a rigorous methodology. He
stated that alcohol abuse in the State of Alaska annually cost
the state $1.8 billion and that drug abuse cost the state an
additional $1.2 billion each year. He said that he was stunned
by the amount of work by the Alaska State Legislature to reduce
the cost of government programs and departments which were
"arguably trying to contribute something positive to Alaska and
Alaskans and yet we are doing very little in this process to
look at how we can drive down this $3 billion cost of alcohol
and drug abuse."
3:04:46 PM
DONNA LOGAN, Vice President, Anchorage Operations, McDowell
Group, reported that this was the "fourth edition of the work
that we've done for the Trust over the years." She stated that
every addition was better, as there was better access to data,
which included revised national models and national survey data.
She said that there was quite a difference with this current
version and the previous 2012 report on 2011 impacts. She
pointed out that this report largely focused on the tangible
costs, and did not include the intangible costs for pain,
suffering, and decreased quality of life. She addressed slide
2, "Why Understanding the Economic Costs Matters," and stated
that this was a way to build public awareness for public and
private costs, and monitor the relationships between the costs
of alcohol and the preventative strategies. She moved on to
slides 3 - 5, "Methodology," noting some of the limitations for
a lack of timely data, even though the data used was the most
recently reported. The report was dependent on national
modeling and surveys, even though these did not always capture
the Alaska experience of rural health care with a need to bring
people into urban settings, and these associated costs. She
acknowledged those limitations even as they worked with these
models. She said that national statistics for alcohol
consumption were used for state to state comparisons and for
context to where Alaska fit relative to other states. She
pointed to statistics for productivity losses, incarceration,
underage drinking, diminished productivity due to absenteeism,
and hospitalization, as well as FAS and FASD.
3:12:54 PM
MS. LOGAN pointed to the complexity of the details and,
addressing slide 6, "Alcohol Consumption Patterns (2013 - 2014),
shared a context for alcohol consumption, noting that more than
half the population consumed alcohol on a "fairly current basis,
meaning they've had a drink within the last 30 days." She
defined binge drinking as the consumption of five or more drinks
in one sitting by a male, and four or more drinks by a female,
and stated that 3 percent of the population were binge drinkers
in the past year. She explained that alcohol dependence was
defined to include binge drinking with a match to three of nine
criteria, whereas alcohol abuse was not as heavy, as it included
a match to only one of the nine criteria. She reported that
alcohol consumption in Alaska was similar to the rest of the
U.S., slide 7, "Alaskan Alcohol Consumption (2013 - 2014)." She
listed Alaska, relative to other states, as 31st for binge
drinking, 26th for current alcohol use, 21st for alcohol
dependence alone, and 20th for combined alcohol dependence and
abuse. In response to a question from the Chair, she clarified
that of the 39,000 Alaskans who experienced either alcohol
dependence or abuse in the past year, 19,000 only experienced
alcohol dependence.
3:16:21 PM
MS. LOGAN moved on to slide 8, "Current Alcohol Use (age 12+),
by Age Group," which compared Alaska with the U.S., noting that
alcohol use more than doubled from the 12 - 17 years of age
group to the 12 - 20 years of age group. She pointed to the 18
- 25 years of age group, and noted that 6 out of 10 Alaskans
were drinking, similar to the national levels. She addressed
slide 9, "Per Capita (age 14+) Consumption (2013)," and
explained that the alcohol content of beer, wine, and liquor had
been converted into ethanol counts. She noted that the per
capita consumption in Alaska was similar to the U.S., and she
reported that the overall consumption had been steady over the
last 20 years. She summarized slide 10, "Total Economic Costs
of Alcohol Abuse - /$1.84 B."
MS. LOGAN said that the public-sector costs were reflected on
slide 11, "Criminal Justice and Protective Services - $269.8 M,"
and pointed out that there were about 9400 arrests in 2014
associated with alcohol, about 25 percent of all the arrests in
the state. She relayed that there were 7300 victims of these
alcohol related crimes, about 17 percent of all the crime
victims. She listed the cost to the justice system, the cost to
victims, which included medical costs, lost earnings, and
property loss, and the cost for child protective services.
These tangible costs totaled almost $270 million, and, with the
intangible costs to victims, the total was more than $870
million. She noted that theft was the number one crime
associated with alcohol, followed by DUI (Driving under the
Influence) and assaults. She pointed out that the highest cost
per crime to the victims was homicide and assault.
3:22:11 PM
MS. LOGAN continued with slide 12, "Health Care - $181.8 M,"
which measured the hospitalization costs, including inpatient,
emergency room, and outpatient services. It did not capture the
costs of a primary care clinic or a private doctor. She pointed
out that the slide also listed the cost of alcohol and drug
treatment, almost $26 million, of which almost $12.6 million was
associated with Medicaid costs. She noted that it was not
possible to capture all the Medicaid costs associated with
alcohol. She reported that the 5,000 admissions for drug
treatment in 2015 represented 14,500 days of treatment. There
were also 2200 admissions for alcohol abuse with 15,800 alcohol
related emergency room visits each year. She acknowledged that
although nursing homes and long-term care were not a big cost,
its $1.5 million cost had been included. She reported that the
$3 million cost listed for FAS and FASD was underestimated as it
only captured those costs related to diagnosis at birth. She
pointed out that some of these affects were not labelled until
years later. She noted that the costs captured on slide 13,
"Public Assistance and Social Services," intuitively seemed low,
as they were only about 2.9 percent of the total public
assistance and social services paid by the state.
3:27:00 PM
MS. LOGAN continued with slide 14, "Underage Drinking - $350 M,"
which reflected the cost to the Alaska economy due to underage
drinking alone. About 48 percent of the underage drinking
costs, $168 million, was related to youth violence and another
$99 million was related to youth traffic accidents.
MS. LOGAN directed attention to the nine categories listed on
slide 15, "Traffic Collisions - $594.3 million," which related
to impaired events, and, although the statistics did not
differentiate between drug or alcohol related costs, the costs
listed on slide 15 were based on a determination that 60 percent
of the total costs were alcohol related. She reported that
these costs included workplace costs, traffic congestion costs,
and property damage. She estimated that $600 million was
related to traffic collision costs.
3:29:12 PM
REPRESENTATIVE SULLIVAN-LEONARD asked how the data was
collected.
MS. LOGAN replied that it was based on widely used national
models for producing economic impact analysis. She referenced
an earlier study by the Lewin Group. Moving on to slide 16,
"Productivity Losses - $775.1 M," she explained that
absenteeism, hospitalization, and incarceration were some of the
productivity losses, about 42 percent of the $1.8 billion. She
reported that there were 285 alcohol related deaths in 2015,
with liver disease as the number one cause, then suicide and
poisoning as the next leading causes. She reported that 33
percent of the 3300 inmates were incarcerated for alcohol
offenses. She moved on to report that there had been about
46,700 bed days of lost productivity due to alcoholism.
3:33:15 PM
MS. LOGAN referred to slide 17, "State Alcoholic Beverages Tax -
Volume" which indicated that consumption had remained relatively
stable and that slide 18 reflected a change in the law which
resulted in an increase in alcohol beverage tax revenue. She
added that about half of this increased revenue was placed into
an alcohol and drug abuse treatment and prevention fund. She
pointed to slide 19, "Local Government Alcohol Tax Sales, 2015,"
which showed that almost $5 million had been generated at the
local level. She stated that there were almost 2900 jobs
associated with the alcohol industry, slide 20, "Jobs and Wages
- Alcoholic Beverage Sector, 2014," with a payroll of $66.4
million.
3:35:36 PM
MS. LOGAN reviewed slide 21, "In Summary," and stated that there
was a cost of $1.84 billion associated with alcohol abuse,
whereas the alcohol beverage industry payroll was $66.4 million,
the alcohol beverage tax revenue was $37.6 million, and the
local government alcohol sales tax revenue was almost $5
million. She added that during the study on alcohol, they had
conducted a cost on drugs, slides 23 - 24, "Illicit Drug Use,
2013 - 2014." She pointed out it was important to note that
although drug use was similar to that in the rest of the U.S.,
marijuana consumption was higher. She added that as it was now
a controlled substance, the categorization would change. She
reported that 26,000 Alaskans used pain relievers for non-
medical purposes in the past year, with 13,000 people dependent
on these illicit drugs.
3:37:57 PM
MS. LOGAN concluded with slide 25, "Total Economic Costs of Drug
Abuse - $1.22 B" and slide 26, "In Conclusion." She declared
that there was an economic cost of $1.84 billion from alcohol,
and $1.22 billion from drug abuse, with a total cost of $3.1
billion to the economy in Alaska.
3:38:49 PM
REPRESENTATIVE EDGMON offered his belief that the percentage of
inmates in Alaska correctional facilities for alcohol related
crimes was higher than 33 percent.
MS. LOGAN replied that the source for this statistic was the
Department of Corrections.
REPRESENTATIVE EDGMON offered his belief that the number was
much higher.
MS. LOGAN explained that there were different attribution rates
applied for different crimes.
3:40:42 PM
MR. JESSEE added that there were a much higher percentage of
inmates who had alcohol and behavioral health issues. He noted
that there was a difference between the criminal justice
information and a review of the inmates as individuals.
3:41:15 PM
CHAIR SPOHNHOLZ asked to clarify that although there may be a
much higher number of people within the criminal justice system
with an abusive or unhealthy relationship with alcohol, that
statistic was distinct from the individual crime statistic.
MS. LOGAN relayed that the figures she presented reflected how
much of the crime itself was attributable to alcohol.
CHAIR SPOHNHOLZ asked if there was a separate figure for the
number of people incarcerated related to illicit drug use.
MS. LOGAN replied that she did not immediately have that figure.
MR. JESSEE added that the Office of Children's Services (OCS)
was not able to determine the number of parents with alcohol or
behavioral health issues unless it was recorded in the
paperwork. He stated that this was the disparity between crime
statistics and the actual assessment of individuals and their
actions.
MS. LOGAN, in response to Chair Spohnholz, said that drug
related crimes were attributed to 734 inmates.
3:42:55 PM
REPRESENTATIVE SULLIVAN-LEONARD referenced the comparison of
data between Alaska and the U.S., and asked if there was a
breakdown of the Alaska data by region.
MS. LOGAN replied that there was only statewide data.
REPRESENTATIVE SULLIVAN-LEONARD asked how this data could be
taken into the community to educate, inform, and protect
regarding those affected by some of these attributes.
3:43:46 PM
MR. JESSEE stated that this begins today with the information
being presented to the policy makers, in order to deal with the
impacts and make decisions regarding the allocation of resources
to address this.
REPRESENTATIVE SULLIVAN-LEONARD replied that the information
needed to get into the communities, and she expressed concern
for the data on underage drinking. She declared that society
was okay with alcohol in the establishment, offering examples of
events. She suggested that education needed to be started at a
younger age, and that families and schools needed to be involved
to make a comprehensive change for recognition of the choice not
to drink.
MR. JESSEE expressed his agreement. He said that the social
norms around alcohol were very complex, and he offered an
example of the incongruity for non-profit fundraisers which used
alcohol as part of the fund raising to help those devastated by
alcohol. He noted that many parents did not pay attention to
underage drinking and minor consumption, pointing out that this
was a huge impact to the community.
3:47:22 PM
CHAIR SPOHNHOLZ said that this would be an opportunity for a
future hearing as many organizations, departments, and divisions
in the state were working on reducing alcohol use and abuse.
3:48:06 PM
REPRESENTATIVE JOHNSTON offered her belief that the numbers were
low, as well, and she asked about the methodology.
MS. LOGAN said that the adult alcohol consumption was from the
national survey of drug use and health, with Alaska specific.
REPRESENTATIVE JOHNSTON asked if this was a telephonic survey.
MS. LOGAN replied that it was, and that it was the best data
available to make comparisons across the board. She added that
the latest information had been inflation adjusted.
REPRESENTATIVE JOHNSTON asked whether the risk survey was opt-
out or opt-in, and whether it had been used.
MS. LOGAN replied that they had chosen to go with the national
data for the modeling in this report. She added that other
reports from the McDowell Group had used other data as it
related to underage drinking. In response, she said that a
great amount of time had been spent to determine which was the
best source.
3:51:30 PM
REPRESENTATIVE JOHNSTON asked if these two data sets had been
compared regarding FASD.
CHAIR SPOHNHOLZ asked to clarify that FAS and FAE had not been
included.
MS. LOGAN expressed her agreement, as the data point was not
just condition of the infant, but also whether the mother had
admitted to drinking.
3:53:04 PM
REPRESENTATIVE TARR asked whether all the communities with local
government alcohol sales tax were listed.
MS. LOGAN replied that these were all the communities they were
able to gather.
REPRESENTATIVE TARR asked why Anchorage and Matanuska-Susitna
were not on the list. She shared that an approach she supported
to change social norms had highlighted the decrease in teen
drinking and the shift toward responsible alcohol use. She
asked if there had been a comparison to the tipping points for
these problematic behaviors, such as the difference between
responsible and irresponsible alcohol use.
MS. LOGAN replied that she was not aware of any comparison of
the tipping points, except to define the different levels of
abuse and dependency. She reiterated that the national surveys
were connected to clinical diagnosis.
3:55:24 PM
MR. JESSEE added that this was more of a probability analysis
than a tipping point for any individual or circumstance, as "the
more alcohol you have on board, the more likely something bad is
to happen, and the more often you have alcohol on board, the
more likely something bad is to happen."
3:55:53 PM
MS. LOGAN said that the data did track the differences from
middle school to high school.
CHAIR SPOHNHOLZ said that she was "heartened by some of the
positive social norming that we've been seeing that we believe
may be having positive impact on a lot of young people." She
reported that 90 percent of young people did not drink, which
made it much easier for young people who wanted to make a
healthy choice, while also maintaining that "essential part of
belonging that's so a part of our growing up, of belonging with
their peer group, specifically." She noted that this was an
economic report with benchmark data comparing Alaska with other
states and did not address social change.
3:59:10 PM
The committee took an at-ease from 3:59 p.m. to 4:04 p.m.
HB 54-TERMINALLY ILL: ENDING LIFE OPTION
4:04:29 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 54, "An Act providing
an end-of-life option for terminally ill individuals; and
providing for an effective date."
4:04:56 PM
REPRESENTATIVE HARRIET DRUMMOND, Alaska State Legislature,
paraphrased from a prepared statement, which read [original
punctuation provided]:
Thank you chairwoman, Spohnholz. For the record, my
name is Harriet Drummond and I am the Representative
for House District 18. I would like to thank the
committee for hearing this bill today. I know this is
not an easy subject for most people. Death is a
difficult topic, because it is raw and emotional. No
one wants to lose a loved one or think about leaving
their family behind. And because no one likes to talk
about it, we often don't even start the conversation
until someone becomes ill. And by not starting these
conversations sooner, talking about something as
serious as aid-in-dying becomes personal and painful.
We need to change that.
House Bill 54 allows terminally ill patients to ease
their pain and suffering by allowing doctors to
prescribe medication to aid in dying. This bill allows
an Alaskan the right to live, and die, on their own
terms according to their own desires and beliefs.
Death is a natural part of life. This bill allows
people to be in control of their own care. Providing
dignity and peace of mind during a patient's final
days with family and loved ones places a much greater
focus on a person's life than on the often painful and
agonizing process of dying.
My aide will go over the specifics of the bill in just
a minute, but I wanted to talk to you about why I
introduced this legislation.
At the beginning of session, Claire Richardson came to
my office and asked when this bill was going to get a
hearing.
Her husband, Lisle (pronounced LYLE) was battling ALS,
an incurable, progressive nervous system disorder but
he wanted to come in and testify on this bill. Some of
you may know Lisle. He was born and raised in Juneau.
He founded the Gold Town Nickelodeon. He was a social
worker and an avid outdoorsman. Lisle isn't here
today. But his words are. He recorded this video when
he realized he wouldn't be able to make it to this
hearing.
4:07:27 PM
The committee took a brief at-ease.
4:08:03 PM
A short video of Lisle Hebert recorded prior to his death was
shown to the committee.
4:12:40 PM
REPRESENTATIVE DRUMMOND continued to read from the prepared
statement, which read [original punctuation provided]:
I introduced this bill because of people like Lisle.
The people who are no longer here to advocate for
themselves.
This is my second time introducing this legislation.
And I have heard from a lot of people who have very
strong opinions about this bill. During public
testimony you will hear from family members who have
had to deal with things I hope and pray none of you
will ever have to deal with.
I have also been told I am evil for introducing this
bill. I have been told I am going to hell, I have been
called a Nazi, and I have been told I am playing God.
We hook terminally ill patients up to countless
machines that prolong death for weeks. We have
machines that can breathe, eat, and urinate for
people. We administer CPR on sick patients and break
their ribs, burrow large IV lines into burned-out
veins and plunge tubes into swollen, bleeding airways.
God is looking down on us and asking "what are you
thinking?!"
Science is not God. Medicine is here to help sick
people. And when people are too sick to keep living,
medicine should still be able to help people.
We have stopped seeing the person and are only looking
at the patient.
I have been told that by introducing this legislation,
I am promoting suicide. I resent that. My son was a
sensitive, caring, athletic 17-year old the day he
took his own life. Stephen was my oldest child. He
loved biking and snowboarding. He biked to Denali when
he was just an eighth grader. I have spent years going
over every minute detail of the days leading up to his
death. I have agonized over every decision, every word
I said, wondering if there was anything I could have
done to prevent it. There isn't a day that goes by
when I don't think about how old he would be now or
what he might be doing if he was alive today. Suicide
is a tragedy. An irrational, self-destructive act that
should be prevented at all costs. We don't get to pick
and choose which deaths we want to be suicide. Does a
patient who decides to quit chemo, or stop undergoing
lifesaving dialysis after years of slowly
deteriorating count as suicide? Does a Marine who is
under attack and jumps on a bomb to save his fellow
soldiers count as suicide? Does a Jehovah's Witness
who refuses a blood transfusion because of her
religious beliefs count as suicide? Suicide is a
healthy person who could live but wants to die. Aid-
in-dying is about a sick person who wants to live but
is dying.
This bill allows patients to have important end-of-
life discussions with the doctors they already know
and trust. Without this discussion, well-meaning
doctors are faced with prescribing painful procedures
even when the patient does not want them and there is
little hope for success. People in these conditions
have already lost their health and often much, much
more. This bill at least lets them control the last
and most important decision they have left.
I will turn it over to my aide to walk you through the
bill and then we will answer any questions the
committee may have.
4:16:33 PM
KRISTIN KRANENDONK, Staff, Representative Harriet Drummond,
Alaska State Legislature, spoke from a prepared statement, which
read:
For the record my name is Kristin Kranendonk, and I am
staff to Representative Drummond. We modeled this
legislation off what other states have done.
Oregon enacted the first "death with dignity" law in
the U.S in 1994 through a citizen-approved ballot
initiative. Washington followed in 2008. Vermont,
California, Washington DC, and Canada have all
legalized similar legislation as well. What we have
learned in the over 20 years since Oregon first passed
this legislation is that aid-in-dying has resulted in
significant improvements in the care of the terminally
ill.
I will now go over the sections of the bill and then
answer any questions you might have.
4:17:20 PM
MS. KRANENDONK referenced the Sectional Analysis of the proposed
bill [Included in members' packets], and paraphrased from a
prepared statement which read [original punctuation provided]:
Section 1 & 2:
Page 1: Lines 4-10
New subsections are added to AS 11.41.115 (defenses to
murder) and AS 11.41.120 (manslaughter) to allow a
defense for acting under this new chapter, 13.55.
Provides immunity from criminal liability. (Use of
"defense" places the burden on the state to disprove
the existence of the defense.)
Section 3:
Pages 1-11: Lines 11-21
Adds a new chapter AS 13.55, which provides the
process in which terminally ill individuals may
request medication to aid in their peaceful death.
Sec. 13.55.010:
This section lists the criteria an individual
must meet to qualify for medication. A person needs to
be a resident of Alaska, over 18, suffering from a
terminal disease, they must be mentally capable and
must voluntarily express a wish to die. It also
clearly states that age or disability alone is not
sufficient enough to qualify.
Sec. 13.55.020: Authorizes a qualified individual's
attending physician to dispense or write a
prescription for the necessary medication if the
physician complies with the chapter.
This section allows a doctor or pharmacist to
prescribe or fill out a prescription. This section is
not saying a doctor will ADMINISTER the medication. It
is just talking about dispensing medication.
Sec. 13.55.030: Requires a qualified individual to
make an oral request to their attending physician to
receive the necessary medication. Requires the
qualified individual to repeat the oral request at
least 15 days after the initial request. Provides
alternative request methods for qualified individuals
who are not able to speak or not able to sign the
request.
If an individual is unable to speak (as sometimes
happens with ALS/cancer patients for example,
Stephan Hawking) they can use other means to make
their request. (Like an electronic voice box)
Sec. 13.55.040: Directs the attending physician to
offer the opportunity to rescind the initial oral
request when the qualified individual makes the second
oral request. Allows a qualified individual to rescind
a request at any time. Prohibits an attending
physician from dispensing or prescribing medication
unless the physician offers the qualified individual
an opportunity to rescind the request.
When a qualified individual makes their second
oral request at least 15 days after the initial
request for medication, this section directs the
attending physician to offer the opportunity to
rescind their request. This section also explicitly
states an individual can change their mind and rescind
a request at any time. It also prohibits an attending
physician from dispensing or prescribing any
medication unless they offer a qualified individual a
chance to change their mind.
Sec. 13.55.050:
This section lays out the steps a physician needs
to take throughout the process. These include
determining whether the individual has a terminal
disease, is capable, and has made the medication
request voluntarily. Also includes providing
information to the individual about the medical
diagnosis and prognosis, the risks and probable result
of taking the medication, and feasible alternatives.
Requires the physician to refer the individual to a
consulting physician to confirm the diagnosis and to
determine that the individual is capable and acting
voluntarily. Requires the physician to refer the
individual for counseling if appropriate under Sec.
13.55.090. This section requires the attending
physician to counsel an individual about where this
medication can be consumed (not in public, etc) and
talks about the importance of having someone present
(nurse, family, etc) at the time medication is to be
consumed. Allows the attending physician to sign the
death certificate.
Sec. 13.55.060: Before an individual can qualify under
the chapter, it requires a consulting physician to
examine the individual and confirm the attending
physician's diagnosis of a terminal disease, and to
verify that the individual is capable, acting
voluntarily, and has made an informed decision.
Sec. 13.55.070: Requires the attending or consulting
physician to refer the individual for counseling and
prohibits the dispensing or prescribing of the
necessary medicine until the counselor determines that
the individual is not suffering from depression
causing impaired judgment.
Sec. 13.55.80: Prohibits the attending physician from
dispensing or prescribing medication unless the
qualified individual has made an informed decision.
Sec. 13.55.90: Prohibits the attending physician from
denying the medication request because the individual
declines or cannot notify next of kin.
Sec. 13.55.100: Requires certain waiting periods
before medication can be dispensed or prescribed.
Sec. 13.55.110: Requires that the medical record of
the qualified individual contains the items listed in
the section before the individual receives the
medication.
Sec. 13.55.120: Invalidates will or contractual terms
that require, prohibit, impose conditions on, or
otherwise addresses whether an individual may make or
rescind a request under this chapter.
Does not invalidate a will. This simply means you
cannot condition a will/contract. (You get this $$ on
the condition that you agree not to end your life or
to end your life.)
Sec. 13.55.130: Provides a person with immunity from
civil and criminal liability or professional
disciplinary action for participating in good faith
compliance with the chapter. States that a medication
request by an individual or an attending physician
providing medication in good faith compliance with
this chapter may not provide the sole basis for the
appointment of a guardian or conservator.
Sec. 13.55.140: States that a health care provider has
no duty to participate.
Sec. 13.55.150: Under certain conditions allows a
health care provider to prohibit another health care
provider from participating on the premises in this
chapter.
For example, Providence could prohibit a
physician from prescribing medication at the hospital
and can prohibit qualified individuals from
administering medication at the hospital, but they
cannot prohibit a doctor from doing these things
outside of the hospital (if they have their own
private practice for example).
Sec. 13.55.160: Requires a health care provider to
notify a physician in writing if they prohibit the
administration of medication on the premises.
Sec. 13.55.170 If a health care provider violates the
prohibition (for example, if the physician at
Providence ignores their policy on this issue) the
health care provider can terminate a contract or
impose a loss of privileges.
Sec. 13.55.180: Establishes the crime of abuse for
coercion, or action without authorization from the
qualified individual. Makes the crime a class A
felony.
Sec. 13.55.190: States that the chapter does not limit
liability for civil damages resulting from a person's
negligent conduct or intentional misconduct.
Sec. 13.55.200: Allows a governmental entity to file a
claim against an individual's estate to recover
expenses incurred if an individual consumes medication
to end their life in a public place.
Sec. 13.55.210: Directs the Department of Health and
Social Services to review a sample of the records
maintained under the chapter every year. Requires a
health care provider to file a record of dispensing
medication under this chapter with the department.
Directs the department to adopt regulations to
facilitate the collection of information about
compliance with the chapter. Makes the information
confidential but requires the department to provide
the public an annual statistical report about the
information collected.
Sec. 13.55.220: Outlines the qualifications a
physician must meet
Sec. 13.55.230: Prohibits construing the chapter to
authorize or require health care contrary to
applicable generally accepted health care standards.
Prohibits construing the chapter as authorizing the
ending of life by certain methods, including lethal
injection. Establishes that an action allowed by this
chapter is an affirmative defense to certain crimes,
including murder, manslaughter, and euthanasia.
Sec. 13.55.240: Prohibits a person from conditioning
the sale, procurement, issuance, rate, delivery, or
another aspect of a life, health, or accident
insurance or annuity policy, on the making or
rescission of a request for medication under the
chapter.
Sec. 13.55.250: States that a request for medication
under this chapter is not an advance health care
directive under AS 13.52 and that AS 13.52 (Health
Care Decision Act) does not apply to an activity
allowed by the chapter.
Sec. 13.55.900: Defines the terms used in the new
chapter.
4:27:56 PM
MS. KRANENDONK paraphrased from a prepared statement to describe
Section 4, Section 5, Section 6, and Section 7 of the proposed
bill, which read [original punctuation provided]:
Section 4:
Page 11: Lines 22-26
Indicates that the chapter applies to contracts,
wills, and life, health, or accident insurance or
annuity policies delivered or issued for delivery on
or after the effective date.
Section 5:
Pages 11: Lines 27-31
Allows the Department of Health and Social Services to
adopt regulations for the new chapter.
Section 6:
Page 12: Line 1
Makes the regulation authority given under Bill
Section 5 take effect immediately.
Section 7:
Page 12: Line 2
Makes the Act (except Bill Section 5) effective
January 1. 2019.
4:28:38 PM
REPRESENTATIVE TARR asked for clarification about "acting in
good faith compliance" in the immunity section on page 6. She
questioned whether this was referring to an incident if the
medication was used inappropriately by the wrong person.
MS. KRANENDONK replied that the section protected a physician
who had been acting in good faith, although the stealing of
medication was a prosecutable crime.
4:30:08 PM
REPRESENTATIVE KITO asked how this could be equitably
administered in Rural Alaska communities, if the law only
applied to people who lived close to a hospital or attending
physician. He asked how a request for a prescription by mail
was tracked to ensure that it reached the individual. He asked
about the obligation if a person had received the medication and
decided to rescind, even if this was after the second
consultation opportunity to rescind. He asked how this
medication would be returned if it was not used.
MS. KRANENDONK, in response, said that the telemedicine
component of the section was added to accommodate rural members.
Regarding drugs already in the hands of those who had requested,
there were current federal regulations to deal with unused
medications. She expressed an expectation for the Department of
Health and Social Services to cover this in its regulations as
described in Section 13.55.201. She pointed out that other
states had already addressed this.
REPRESENTATIVE KITO corrected the reference to be for Section
13.55.210.
4:32:38 PM
KAT WEST, National Director of Policy & Programs, Compassion &
Choices, explained that in most homes of terminally ill, dying
people, there were large quantities of pain medications, and
that Hospice would dispose of these unused medications. She
reported that Alaska had a drop off disposal program for safe
disposal of medications, as well. She stated that medical aid
in dying medications were normally taken one hour in advance to
be effective, and that two other medications needed to be
administered simultaneously. These two medications allowed for
absorption and prevention of regurgitation. She declared that
it would be very hard to accidentally overdose on medical aid in
dying medications, as they took about two minutes to drink and
were quite bitter. She stated that there had not been any
accidental overdoses and no mis-applications of the medication
in 30 years.
4:35:17 PM
REPRESENTATIVE KITO asked if this would not apply to communities
without access to regular medical facilities.
MS. WEST offered her belief that it would depend on the
telemedicine laws for rural communities. Currently, under
proposed SSHB 54, the person choosing medical aid in dying would
need to be seen either in person or through telemedicine for an
attending physician to make the original eligibility
determination for a terminally ill adult, diagnosed with six
months or less, and mentally capable of making their own health
care decisions. She added that this eligibility had to be
confirmed by a second consulting physician, and availability of
these physicians could be in person or through telemedicine,
dependent upon state law.
REPRESENTATIVE KITO offered a scenario whereby a person in a
rural community without an attending physician either dies prior
to receiving the medication or is too "far gone" to self-
administer. He expressed concern that the medication would not
be clearly tracked, accounted for, or identified for
disposition. He pointed out that there were not any trooper or
police offices in many communities.
MS. WEST pointed out that most dying people had multiple
prescriptions which were "just as lethal as a medical aid in
dying medication and actually much easier to inject." She added
that most often the health care provider disposed of any unused
medication.
4:39:23 PM
MS. KRANENDONK added that hospice in Juneau provided care to
communities outside Juneau, and that there were regulations in
place to collect the medications. She offered to add an
amendment to clarify.
4:40:23 PM
REPRESENTATIVE DRUMMOND pointed out that it was a very small
number of people who requested and obtained the medication. She
reported that in the more than 20 years since passage of the aid
in dying bill, only 700 - 800 people in Oregon had used this.
She pointed out that these drugs would be dealt with in the same
way as drugs to deal with the opioid crisis. She reminded that
hospice care was a service, not a building.
4:41:47 PM
REPRESENTATIVE JOHNSTON asked if there were any issues which
could compromise federal funds for health care.
MS. WEST, in response, explained that a 1997 federal law, passed
immediately following passage of the Oregon law, prohibited the
use of federal funds for medical aid in dying. She pointed out
that many states, including California and Oregon, had
segregated their state Medicaid funding from the federal
Medicaid funding, to make those funds available to people who
are eligible and qualified for medical aid in dying. She shared
that Oregon offered 23 prescriptions and 15 injections each
year.
4:44:38 PM
CHAIR SPOHNHOLZ opened public testimony. She asked to limit
each testimony to two minutes and to maintain respect.
4:45:52 PM
DAVID COMPTON, MD, stated that he was in full support of the
proposed bill both as a physician, a son, and as a human being.
He reported that the system had not allowed many of his patients
to have their end of life choices accepted. He allowed that
although the Hippocratic Oath said that physicians should not
participate, he offered his belief that a 5,000-year-old
document did not pertain today, as there were many more ethical
and moral decision-making tools. He rejected the slippery slope
argument, noting that there was 20 years of experience. He
opined that the objection was religious in nature, that no one
was being forced, and that a physician can choose to
participate.
4:48:33 PM
REPRESENTATIVE SULLIVAN-LEONARD asked about the Hippocratic
Oath.
DR. COMPTON replied that the statement most pertinent in this
situation was "first do no harm."
4:49:00 PM
MARGARET DORE, Attorney, reported that assisted suicide was
legal in the State of Washington. She added that she was also
the President of "Choice is an Illusion," a non-profit
corporation opposed to assisted suicide. She stated that it was
misleading to discuss aid-in-dying, as a terminal disease was
defined as "without treatment." She stated that the bill was
"stacked against the patient," noting that she was an
inheritance and probate lawyer. She said there was a complete
lack of oversight at the death. She opined that there was a
slippery slope in Oregon, and she noted that the proposed bill
allowed for euthanasia, as a patient may self-terminate with the
medication.
4:51:30 PM
REPRESENTATIVE SULLIVAN-LEONARD asked whether there was anything
in the proposed bill for signing prior to follow through with
the assisted process.
MS. DORE stated that this was not in the current version of the
proposed bill.
4:52:24 PM
DIANA KRISTELLER, Midwife, APRN, Voluntary Ending of Life,
stated her support for the proposed bill and asked for inclusion
of advanced practice registered nurses who were licensed
independent providers in Alaska with full prescriptive authority
in the proposed program.
4:53:15 PM
ROL EGNER offered a personal story of the suffering by her
husband after a severe stroke. She declared her support for the
legal availability for medically assisted death for those in
dire medical circumstances if they choose. She stated her
support for the proposed bill.
4:55:48 PM
MICHAEL HAUKEDALEN offered a personal story of the death of his
wife. He said that the legal system did not allow his wife to
terminate her own life. He encouraged passage of the proposed
bill.
5:00:26 PM
MARY MCDOWELL shared that she had spent a lot of time with
people during the end stages of their lives. She offered her
belief that although Alaska valued individual rights and self-
determination, the state denied "mentally competent adults who
are in the midst of a dying process the right to avail
themselves, only if they want to, of a liberty that they have if
they reside within a number of other states," the right to some
control over the timing and the way of death. She noted that
although many people who obtain the prescription have opted not
to use it, they have had peace of mind throughout the dying
process, knowing they had a way to shorten it if things got that
bad, and were not fretting about the loss of dignity or the loss
of bodily function. She pointed out that the proposed bill
required that an individual have a sound mind to make their own
choice. She offered her belief that this was the Alaskan thing
to do.
5:03:01 PM
NANCIANNA CLONAN offered a personal story about her husband's
death. She asked for passage of the proposed bill.
5:06:16 PM
JOHN FORBES, MD, stated that he was a psychiatrist and had spent
six years working for suicide prevention at a national level.
He stated his personal opposition to the proposed bill. He
declared that the proposed bill was a public health problem and
would have unintended effects. He pointed out that there was a
"serious problem with suicide" in Alaska, and that this proposed
bill would affect suicide rates. He suggested that national
studies showed that locales which approved of assisted suicide
had higher rates of suicide, as well as higher rates of approval
and acceptance of suicide. He said that the acceptability of
suicide varied with different groups, and that the World Health
Organization (WHO) had included messaging guidelines "to avoid
language which sensationalizes or normalizes suicide or presents
it as a solution to problems." He declared that physician
assisted suicide was "invariably presented as a solution to the
problem." He opined that passage of the proposed bill would
send a message of the acceptability of suicide as a solution.
5:08:47 PM
WILLIAM HARRINGTON declared that it was a person's right to have
access to a self-determined self-termination, and that this
should be protected by law. He lauded the bill sponsor for
offering the bill in the face of powerful opposition from two
groups, the organized cartel of religions and medical
professionals. He opined that the chemicals designed to stop
the heart and induce death were not medication. He lauded the
fifteen day "cooling off period."
5:11:21 PM
SARAH VANCE asked for clarification regarding how the legality
by other states had greatly improved the care for the terminally
ill. She asked who paid for the medication, and how much was
the medication. She asked to address the cost and the
possibility for pharmaceutical companies to take advantage. She
declared that it was necessary to respect the sanctity of life,
as the end of life was an unsure time. She asked how many
doctors had been wrong in the determination of remaining time to
live. She declared her opposition to the proposed bill.
5:13:44 PM
DIANA BARNARD, MD, Hospice Care, University of Vermont Medical
Center, pointed out that dying was different than it had been in
past generations, as medical advances had allowed for illness
prevention and management of diseases and accidents. She
acknowledged that there was no cure for dying, and that patients
held deeply diverse beliefs about life and death, with very
different priorities and needs when facing a terminal condition.
She shared her experience that priorities during the final days
and weeks became very simple: time with family and a peaceful
death at home. She noted that the modern medical health system
often made these simple desires go unanswered. She offered her
belief that the nearness of death brought patients clarity to
regain control of how they live and how they die. She
emphasized that medical aid-in-dying was an important option,
one tool to meet the needs of some people. She said that her
experience indicated it was possible to offer this as a
voluntary option.
5:16:58 PM
CHRISTOPHER KURKA, Executive Director, Alaska Right to Life,
stated that this was a dangerous bill, and he urged to vote
against it. He said that this was a game of words. He said
that Alaska had the second highest suicide rate in the U.S. He
questioned the accuracy of diagnosis for a terminal patient,
opining that patients would feel pressure to end their lives.
5:19:55 PM
MICHAEL PAULEY, Alaska Family Council, stated opposition to the
proposed bill for three primary reasons: (1) legalizing
physician assisted suicide places the vulnerable in jeopardy, as
it contained no mandatory requirement for individuals to seek
psychiatric consultation for clinical depression or other
treatable mental health issues in order to protect the dignity
of terminally ill people; (2) physician assisted suicide
corrupts the practice of medicine, and he quoted from the
Hippocratic Oath, "I will keep the sick from harm and injustice.
I will neither give a deadly drug to anybody who asks for it,
nor will I make a suggestion to this effect"; and (3) physician
assisted suicide will lead to worse violations of human dignity.
He concluded that SSHB 54 was dangerous public policy for
Alaska, and he urged opposition to the proposed bill.
5:22:47 PM
CHAIR SPOHNHOLZ announced that public testimony would be left
open, and SSHB 54 would be held over.
5:24:39 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:25 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Alcohol and Drug Impacts Presentation to the Legislature.3.24.....pdf |
HHSS 3/28/2017 3:00:00 PM |
Economic Costs of Alcohol Abuse in AK |
| SSHB 54.PDF |
HHSS 3/28/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 54 |
| SSHB 54 Sponsor Statement 3.27.17.pdf |
HHSS 3/28/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 54 |
| SSHB 54 Sectional Analysis ver O 3.27.17.pdf |
HHSS 3/28/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 54 |
| SSHB 54 Supporting Document--Letters 3.27.17.pdf |
HHSS 3/28/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 54 |
| SSHB 54 Supporting Document--Archbishop Tutu Opinion 3.27.17.pdf |
HHSS 3/28/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 54 |
| SSHB 54 Opposing Document--Letters 3.27.17.pdf |
HHSS 3/28/2017 3:00:00 PM HHSS 4/6/2017 3:00:00 PM |
HB 54 |