02/21/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB312 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 312 | TELECONFERENCED | |
| *+ | HB 442 | TELECONFERENCED | |
| += | HB 271 | TELECONFERENCED | |
| + | HCR 5 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 21, 2006
3:44 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Carl Gatto
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
Representative Vic Kohring
Representative Sharon Cissna
COMMITTEE CALENDAR
CS FOR HOUSE BILL NO. 312(HES)
"An Act relating to pregnant women; relating to training in
fetal alcohol spectrum disorders for and to requiring certain
documentation by licensed physicians, physician assistants, and
nurses; requiring the Department of Health and Social Services
to prepare information for distribution by hospitals, schools,
service providers, and alcohol licensees and permittees about
fetal alcohol spectrum disorders; clarifying that fetal alcohol
spectrum disorders is a condition of public health importance;
and establishing a diagnosis and treatment program, including
contraceptives, for persons with a fetal alcohol spectrum
disorder or alcohol dependency."
- MOVED CSHB 312(HES) OUT OF COMMITTEE
HOUSE BILL NO. 442
"An Act relating to the validity of advance health care
directives, individual health care instructions, and do not
resuscitate orders; relating to the revocation of advance health
care directives; relating to do not resuscitate orders; relating
to resuscitative measures; relating to the liability of health
care providers and institutions; relating to an individual's
capacity for making health care decisions; and providing for an
effective date."
- SCHEDULED BUT NOT HEARD
CS FOR HOUSE BILL NO. 271(HES)
"An Act relating to limitations on overtime for registered
nurses and licensed practical nurses in health care facilities;
and providing for an effective date."
- SCHEDULED BUT NOT HEARD
HOUSE CONCURRENT RESOLUTION NO. 5
Relating to support of community water fluoridation.
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 312
SHORT TITLE: FETAL ALCOHOL SYNDROME/EFFECTS PREVENTION
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH
01/09/06 (H) PREFILE RELEASED 12/30/05
01/09/06 (H) READ THE FIRST TIME - REFERRALS
01/09/06 (H) HES, JUD, FIN
01/31/06 (H) HES AT 3:00 PM CAPITOL 106
01/31/06 (H) Heard & Held
01/31/06 (H) MINUTE(HES)
02/21/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JACQUELINE TUPOU, Staff
to Representative Bruce Weyhrauch
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented CSHB 312, Version L, on behalf of
Representative Weyhrauch, sponsor.
DIANE CASTO, Section Manager
Prevention and Early Intervention Section
Division of Behavioral Health (DBH)
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 312.
CHERYL SCOTT, Manager
Parent Support Grant
Division of Behavioral Health (DBH)
Stone Soup Group
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 312.
MICHAEL BALDWIN, Mental Health Clinician
Fetal Alcohol Spectrum Disorders (FASD)
MatSu Diagnostic Team
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 312.
DIANNE MACCRAE
Kasilof, Alaska
POSITION STATEMENT: Testified in support of HB 312.
RICK IANNLINO, Coordinator
Fetal Alcohol Spectrum Disorders (FASD)
Juneau Diagnostic Clinic
Central Council Tlingit Indian Tribe
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 312.
LAURA ROREM, Parent Navigator
Fetal Alcohol Spectrum Disorders (FASD)
Juneau Diagnostic Team
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 312.
LARRY ROREM, Pastor
Shepard of the Valley Lutheran Church
Juneau, Alaska
POSITION STATEMENT: Testified on HB 312.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:44:38 PM.
Representatives Seaton, Gato, Gardner, and Wilson were present
at the call to order.
HB 312-FETAL ALCOHOL SYNDROME/EFFECTS PREVENTION
3:45:13 PM
CHAIR WILSON announced that the only order of business would be
HOUSE BILL NO. 312, "An Act relating to pregnant women;
requiring hospitals, schools, and alcohol licensees and
permittees to distribute information about fetal alcohol effects
and fetal alcohol syndrome; relating to the consumption of
alcoholic beverages by and the sale or service of alcoholic
beverages to a pregnant woman; requiring involuntary commitment
of a pregnant woman who has consumed alcohol; creating a fund
for the prevention and treatment of fetal alcohol syndrome and
fetal alcohol effects; relating to fines and to the taking of
permanent fund dividends for selling or serving alcoholic
beverages to pregnant women; and increasing taxes on sales of
alcoholic beverages to fund treatment and education related to
fetal alcohol syndrome and fetal alcohol effects."
3:45:37 PM
JACQUELINE TUPOU, Staff to Representative Bruce Weyhrauch,
Alaska State Legislature, introduced the committee substitute
(CS) to HB 312, on behalf of Representative Weyhrauch. She
pointed out that the CS includes: an education requirement for
doctors and nurses and provides for their training; direction to
the Department of Health and Social Services (DHSS) to
disseminate Fetal Alcohol Spectrum Disorder (FASD) educational
information to schools and hospitals; and establishes an FASD
diagnostic program.
3:46:58 PM
REPRESENTATIVE SEATON moved to adopt CSHB 312, Version 24-
LS0241\L, Mischel, 2/21/06, as the working document. There
being no objection, Version L was before the committee.
MS. TUPOU explained that Version L incorporates the specific
requests and suggestions received from the committee [January
31, 2006 meeting] for the bill to include: continued education
for doctors and nurses; prenatal notations from a mother's chart
to be attached to an infant's record; and the creation of an
FASD program.
3:48:31 PM
CHAIR WILSON requested that Ms. Tupou navigate the committee
through the individual changes, for clarification and questions.
MS. TUPOU directed the committee to the first change located on,
page 2, lines 13-17, which requires the "board" to establish
standards for the training of physicians and physician
assistants in the areas of substance abuse during pregnancy,
FASD, and highlights the importance of record keeping and
history taking for these conditions. Page 2, lines 19-22
provides similar language, but it pertains to nurse
practitioners. In response to a question, she explained that
these requirements are to be established through the appropriate
governing boards for each medical professional to receive
his/her licensure or as a continuing education requirement. She
stressed that the respective medical board is to adopt
appropriate regulation and provide for implementation.
3:50:58 PM
REPRESENTATIVE GATTO asked how HB 312 was condensed from being
twelve-pages to four pages. He pointed out the title change.
MS. TUPOU replied that this bill has been reworked multiple
times. She specified that the items removed from the original
bill were the provisions for: involuntary commitment of
pregnant women; penalties to the alcohol/hospitality industry
for sales/service to pregnant women; and FASD testing/screening
of newborn infants. In regard to Table 18 provided, in the
committee packet, she explained that the bottom line figure of
$47 million dollars represents the cost to the state for the 15
FASD births identified in 2003. She explained that this recent
McDowell Group study determined the lifetime costs of supporting
an individual born with FASD. Assuming each will receive
appropriate medical and residential services, the cost per
individual is estimated to be $3.1 million.
3:53:24 PM
MS. TUPOU continued on to the changes for page 3, lines 5-12,
which direct DHSS to distribute FASD educational material to
schools and hospitals for disbursement to their clientele.
Continuing with page 3, lines 14-19 define "service providers,"
and lines 21-25 provide for the registration and documentation
of children with prenatal exposure to alcohol.
3:54:06 PM
CHAIR WILSON reminded the committee that previous discussion [at
the January 31, 2006 meeting] indicated the importance for
having the mother's prenatal records to be attached to the
infant's birth record. She opined that the language in the bill
does not specifically reflect a requirement for the marriage of
these records.
REPRESENTATIVE GARDNER interjected that a mother may have
confidential information not integral to the health of the child
and such records should not be subject to disclosure that may
later be discovered by that child.
MS. TUPOU agreed that it could present problems particularly
with the Health Insurance Portability and Accountability Act
(HIPAA) compliance.
CHAIR WILSON requested clarification of the language on page 3,
line 24, regarding "documentation in a medical record of a
diagnosis," and inquired as to how this could be effectively
executed.
MS. TUPOU conceded that the language may need revising and
suggested that a conceptual amendment would be efficacious.
3:56:55 PM
REPRESENTATIVE GARDNER offered that perhaps this issue could be
addressed by adding language in the training section of the bill
to encourage birth attendants to make a professional note in the
child's chart if they have any suspicion that the infant has
been subject to prenatal alcohol exposure or other illegal
substances.
MS. TUPOU pointed out that language is already included to that
effect on page 2, line 15.
REPRESENTATIVE GARDNER maintained that directive language could
be included to be more specific to the need and she offered
Conceptual Amendment 1 to Section 1 [to insert the following
language]:
The training program should include a provision that
medical professionals be required to note on the
child's records any information they may have about
the mother's substance use during pregnancy.
3:58:29 PM
REPRESENTATIVE SEATON objected, pointing out that being trained
how to take information and making a judgment call whether to
record and document information are two different scenarios. He
emphasized that if the notation is not a specific requirement,
the medical provider may be hesitant to record one person's
information onto another person's chart.
3:59:48 PM
REPRESENTATIVE GARDNER asked whether all birth attendants would
have access to the appropriate records.
CHAIR WILSON, drawing from her nursing experience, explained
that, standard chart information is a routine requirement for
both the mother and the child.
4:00:35 PM
MS. TUPOU pointed out that Section 7 addresses documentation to
DHSS for data base analysis, and may not be the appropriate
place for Conceptual Amendment 1 to be added.
REPRESENTATIVE GARDNER expressed a concern for the need to
streamline accessibility to a child's health and educational
information, not to add additional layers of difficulty for the
retrieval of such data.
4:01:26 PM
REPRESENTATIVE SEATON removed his objection to Conceptual
Amendment 1.
REPRESENTATIVE GARDNER restated Conceptual Amendment 1 as
follows:
The mother's substance use or any knowledge of the
mother's substance use is recorded on the child's
record.
CHAIR WILSON, upon hearing no further objection, announced that
the Conceptual Amendment 1 was adopted.
4:02:32 PM
MS. TUPOU explained the revisions on page 4, lines 2-5,
regarding the distribution of FASD information by hospitals; and
lines 9-25, requiring DHSS to establish a program for the
diagnosis and treatment of FASD and providing specifications to
that end.
REPRESENTATIVE GARDNER questioned whether Section 7 should be
retained or deleted from the bill.
4:03:35 PM
DIANE CASTO, Section Manager, Prevention and Early Intervention
Section, Division of Behavioral Health (DBH), Department of
Health and Social Services (DHSS), clarified that Section 7
refers to the current Alaska birth defects and fetal alcohol
syndrome (FAS) registry. She pointed out that current statute
requires health care providers to report, via an established
code system, any prenatal exposure to alcohol; the data is then
entered into the registry. This is required for defects
identified at birth through six years of age, and it includes
the documentation of a child's potential prenatal exposure to
alcohol. She explained the importance of this data and how it
is used, stating that Alaska leads in FAS prevalence data. This
data is critical when analyzing the effectiveness of the
department's relevant programs. Regarding the committee's
stated concern for confidentiality, she stressed that this data
cannot be linked to an individual. Additionally, she assured
the committee that all children who are reported to the birth
defects registry also receive a notation in their record whether
the mother used alcohol during pregnancy.
REPRESENTATIVE GARDNER asked whether a newborn, who otherwise
isn't identified for the birth defects registry, would be
reported to DHSS if the mother is known to have consumed alcohol
during pregnancy.
MS. CASTO responded that if a notation has been made in the
child's record the information will be provided to the
department. She then explained the effectiveness of the
program. In response to a question, she described how the
reporting code becomes apparent through the billing process,
which is often when a referral is made to the birth defects
registry. She explained that the standard of care established
by the American College of Obstetricians and Gynecologists
(ACOG) is to screen for alcohol use in all mothers, and to make
notations on both the mother's and the baby's record. She
expected that by including language in the bill to incorporate
these standards, as part of the ongoing training and licensure
requirements, they will be upheld. Also, many mothers who have
an alcohol issue are transient and often their birth records are
lost in the shuffle. However, she suspected that by making this
a stronger requirement, the importance of documentation will be
emphasized making it "the standard of care that is followed by
everyone."
4:11:12 PM
MS. CASTO explained how this bill builds on the department's
eight years of work to create a foundation for education,
information, and services related to FASD. She directed the
committee's attention to Section 10, which relates to programs
and obtaining an early diagnosis. She stressed that a diagnosis
is necessary for a child to receive appropriate services, and
stated that there are many undiagnosed adolescents and adults in
Alaska's correctional facilities. The FASD training measures
provided in Section 10 allow for a "fairly concise and doable
process," she opined.
4:14:27 PM
REPRESENTATIVE GARDNER reported a constituent proposal to
establish a statewide FAS/FASD council, with seated members
representing a variety of disciplines that would hold regional
meetings and regular public forums.
MS. CASTO said that a council has been discussed, but the
department has determined that the current statewide committees
for suicide prevention, alcohol/drug abuse, and mental health
issues can elevate the importance of the FASD issue and
incorporate its focus as part of their duties. She pointed out
that a one-time federal grant did provide funding for an FASD
steering committee, which was a benefit.
4:16:43 PM
REPRESENTATIVE SEATON moved to adopt Conceptual Amendment 2,
which read [original punctuation provided and handwritten
changes incorporated]:
Page 4, following line 22, add [a] new section:
(6) provision of long duration contraception on a
voluntary basis to clients of Community medical
clinics, [identified by] community metal health
clinics and public health nurses who are diagnosed
with FASD.
CHAIR WILSON objected for discussion.
REPRESENTATIVE SEATON expressed his concern that HB 312 has an
"after the fact" focus, and this amendment provides preventative
measures for individuals who otherwise would have difficulty in
managing/planning a healthy pregnancy.
REPRESENTATIVE SEATON stressed that contraception would be on a
voluntary basis, and be a "long-term" approach to birth control
versus daily administration methods.
REPRESENTATIVE GARDNER asked for clarification on exactly who
would benefit from this amendment, pointing out that if an FASD
diagnosis is required, a portion of the target group may be
missed. She suggested that perhaps other voluntary substance
abusers should be qualified for the benefit.
CHAIR WILSON, realizing that this amendment would have a fiscal
note attached, asked if the sponsor wished to make a comment.
4:21:19 PM
MS. TUPOU agreed with the amendment, but conceded that it would
be difficult to estimate the cost of including it in the bill;
and thus she opined that it's difficult to provide an
appropriate comment.
REPRESENTATIVE GATTO suggested that it be called the $3.1
million fiscal note [as per the Table 18 statistics].
4:21:56 PM
REPRESENTATIVE GARDNER pointed out that anyone who has obtained
an FASD diagnosis would be considered developmentally disabled,
thus eligible for birth control measures through Medicaid,
Medicare, and the Alaska Native Medical Center (ANMC). She
again questioned whom this amendment would benefit.
4:22:39 PM
MS. TUPOU offered that there is an indeterminate fiscal note
being prepared, which will attach to the bill for subsequent
committee review.
MS. CASTO conceded that the area of prevention does need
attention, and agreed that birth control measures are available
through the various public health centers mentioned. However,
the women who may need it most may not be utilizing the
services. She described a federal grant project which partnered
the Anchorage Neighborhood Health Center with the Highland
Mountain Correctional Center, and related the success of that
type of project in providing birth control to at-risk women.
She related her support of Conceptual Amendment 2 as a clear
statement of focus towards prevention of FASD births, but
expressed the need to ensure that the appropriate populace will
be reached. Further, she suggested the partnering of state
health agencies with state treatment facilities to facilitate
appropriate contraception.
4:26:49 PM
REPRESENTATIVE GATTO inquired about the role a father's alcohol
consumption plays in contributing to FASD.
MS. CASTO explained that research indicates how male drinking
contributes to other prenatal and postnatal difficulties but not
FASD. However, studies do indicate the critical need for a
pregnant woman to have a non-drinking partner to support her in
not drinking during pregnancy.
4:28:42 PM
CHAIR WILSON withdrew her objection to the amendment.
4:28:50 PM
REPRESENTATIVE SEATON proposed Amendment 1 to Conceptual
Amendment 2 [which would insert the following text after FASD]
to add:
"or are associated with alcohol abuse."
REPRESENTATIVE GARDNER suggested that funding problems could
arise if free birth control measures were made available to any
woman who proclaims that she is a substance abuser.
REPRESENTATIVE SEATON maintained that high-risk behavior could
be targeted with this language.
MS. TUPOU said that it would be a good approach to include
language for a proactive program policy of referring women to
the appropriate services for birth control. She opined that
including such a measure would not be implicit on the state
providing free birth control.
4:31:35 PM
REPRESENTATIVE SEATON maintained that without the fiscal note,
the purpose will not be served nor will the number of FASD
births be curbed. He pointed out the $3.1 dollar savings per
birth will offset the fiscal note for the cost of proactively
providing birth control.
REPRESENTATIVE SEATON moved to adopt Amendment 1 to Conceptual
Amendment 2 [text provided previously].
4:32:53 PM
REPRESENTATIVE GATTO asked for clarification as to what type of
birth control is covered.
CHAIR WILSON explained that it would cover any type of birth
control that did not require daily administration.
4:33:37 PM
CHAIR WILSON announced that hearing no objection, Amendment 1 to
Conceptual Amendment 2 was adopted. Further she announced that
hearing no objection, Conceptual Amendment 2 as amended was
adopted.
4:34:51 PM
CHERYL SCOTT, Manager, Parent Support Grant, Division of
Behavioral Health (DBH), Stone Soup Group, stated support for HB
312. She pointed out that non-Native mothers are not served in
the Anchorage area due to the lack of programs, which skews the
statistics inaccurately to demonstrate FASD as a Native issue.
She stressed the need for services to be established to aid
every ethnic group. Responding to a question, she explained
that Providence Health Care Foundation (Providence) received
funding to train a diagnostic team for the Anchorage area that
could evaluate non-Native children; however, after performing
three diagnosis, the Providence administration decided not to
continue this program and the team was terminated. Further, she
stressed the difficulty in capturing accurate information on
ethnic backgrounds outside of Alaskan Natives. She reported
that this is not the situation in Fairbanks, where the team is
able to diagnose across the full spectrum of the population.
Furthermore, the Fairbanks teams are expecting to expand and
also provide diagnostic services for specific age groups.
4:42:01 PM
MICHAEL BALDWIN, Mental Health Clinician, Fetal Alcohol Spectrum
Disorders (FASD), MatSu Diagnostic Team, stated support for HB
312 and the changes that have been provided in Version L.
4:45:05 PM
DIANNE MACCRAE stated support for HB 312, stressing the need to
attach the mother's birth records to the child's. She related
her experiences as an adoptive mother of an FASD child and the
benefits she realized by having the prenatal exposure
information and receiving an early diagnosis.
4:46:22 PM
RICK IANNLINO, Coordinator, Fetal Alcohol Spectrum Disorders
(FASD), Juneau Diagnostic Clinic, Central Council Tlingit Indian
Tribe, stated support for HB 312, and commented that the
currently available FAS 101 and 201 training classes are
excellent, but many health care providers are not attending. He
suggested that an attendance incentive might prove helpful, and,
as a follow up to training, technical modeling and coaching
assistance would be beneficial. Responding to a question, he
said that anyone providing health care who has not been
specifically trained in the issues of FASD may relay information
that is skewed and detrimental. He described FASD as an
"invisible" disability, unlike someone who has a visibly evident
disability. No one would ask an armless person to use the arm
that he/she doesn't have, but with FASD people are routinely
asked to utilize a facet of their mind that does not function in
a normal capacity, he said.
4:50:36 PM
LARRY ROREM, Pastor, Shepard of the Valley Lutheran Church,
provided examples of parenting an FASD adult. He also expressed
concerns regarding service providers who are not adept in
dealing with FASD clients, and stressed the need for appropriate
training.
4:53:51 PM
REPRESENTATIVE SEATON moved to report CSHB 312, Version 24-
LS0241\L, Mischel, 2/21/06, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 312(HES) was reported out of the
House Health, Education and Social Services Standing Committee.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:54:46 PM.
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