Legislature(2005 - 2006)BELTZ 211
03/01/2005 03:30 PM Senate STATE AFFAIRS
| Audio | Topic |
|---|---|
| Start | |
| SB101 | |
| SB20 | |
| SB75 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 20 | TELECONFERENCED | |
| = | SB 101 | ||
| = | SB 75 | ||
SB 75-PUBLIC HEALTH DISASTERS/EMERGENCIES
4:16:33 PM
CHAIR GENE THERRIAULT announced SB 75 to be up for consideration
and asked Dr. Mandsager to come forward. He reviewed the
testimony from the previous hearing then noted that the proposed
amendment had been broken into eight separate pieces for
consideration. He highlighted the proposed changes and the
drafter's comments then asked Dr. Mandsager to proceed.
4:18:32 PM
DR. RICHARD MANDSAGER, Director, Division of Public Health,
Department of Health and Social Services (DHSS), said he would
begin where the discussion stopped the previous week. He
acknowledged that some suggestions weren't included in the list
of proposed amendments and he wanted it to be clear why all
suggestions weren't included.
He emphasized that the governmental part of public health only
works if the public trusts the government. If the system is to
work, there must be voluntary agreement between providers,
individuals and governmental staff and if the people lose trust
in government it's very difficult to reclaim. We have decades of
experience in this state of practices that have had almost
complete agreement about voluntary reporting and this bill
codifies rather than expands those current practices, he said.
DR. MANDSAGER said the foregoing explanation is important when
discussing the details of the balance point between protecting
public health and the due process and individual rights. That
being said, he noted that DHSS did not bring an amendment to
expand religious exemptions to include screening and treatment.
The reasoning is that most emergency situations are short-term
and if a few people claim a religious exemption it wouldn't make
a great deal of difference.
However, if someone were to claim a religious exemption from
screening or testing for a chronic condition such as
tuberculosis, the state public health system would be faced with
the dilemma of deciding whether or not to monitor that
individual for the rest of the person's life. That certainly
would entail an administrative and medical burden, which is why
the department doesn't suggest expanding the exemptions.
4:22:11 PM
DR. MANDSAGER noted the committee took action on proposed
Amendment 1 during the previous hearing.
AMENDMENT 1 --- CSSB75 ( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 15, line 13-14
Delete "minor; however, parents or guardians of the minor
do not have party status in the proceedings under this section"
Insert "minor"
DR. MANDSAGER said that with regard to proposed Amendment 2 he
would first comment on striking any reference to the particular
statutes. DHSS suggested that it should be clear that this part
of the bill is talking about the subjects of information,
protection, and identifiable health information. The constraints
the department proposes to follow on when identifiable health
information could be collected applies to this type of activity.
He explained that identifiable health information is collected
when kids are taken into custody at the Office of Children's
Services (OCS) and public assistance and Medicaid also have
identifiable public health information.
The proposal is that the department may acquire identifiable
health information only if it meets the three standards listed
in proposed Amendment 2. It must be clear that the proposed
constraints only apply to this public health activity of the
department and not that someone might later construe that the
department has a limitation on collection of identifiable health
information in other departmental activities. That is why DHSS
suggested that the statutes be clearly identified in the bill.
He suggested that further conversation with legislative legal is
warranted.
Because legislative legal pointed out that public health purpose
isn't defined in the bill, DHSS suggests including a definition
in the definitions section and striking the (a)(1) reference to
public health importance on page 8, line 7 [CSSB 75(HES)].
AMENDMENT 2 --- CSSB75 ( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 8, line 26, following "information":
Insert "under this section"
Page 8, line 29, following "safeguards.":
Insert the following new material:
"(a) The department [under AS 18.15.355 18.15.390,] may acquire and use
identifiable health information only if the
(1) acquisition and use relates directly to a
public health purpose, including analysis and evaluation of
conditions of public health importance and evaluation of
public health programs;
(2) acquisition and use is reasonably likely to
contribute to the achievement of a public health purpose;
and
(3) public health purpose cannot otherwise be
achieved at least as well with nonidentifiable health
information.
(b)"
CHAIR THERRIAULT asked for clarification
DR. MANDSAGER responded lines 9 and 10 could be dropped from
proposed Amendment 2. It would say the conditions under which
the department could collect identifiable health information
would have to satisfy these the following tests: (1) acquisition
and use directly relates to a public health purpose; (2)
acquisition and use is reasonably likely to contribute to the
achievement of a public health purpose; and (3) public health
purpose cannot otherwise be achieved at least as well as non-
identifiable health information.
After many conversations with the ACLU and other parties that
are concerned that the department had an overly broad authority
to collect identifiable health information, DHSS suggests it be
limited by having to meet those three tests.
SENATOR KIM ELTON asked if he should ask questions as they came
up or wait until the presentation was finished.
CHAIR THERRIAULT explained that DHSS asked that the committee
discuss the proposed amendment packet, but take no action. He
noted that the House is working on the same issue and this
committee might address that vehicle. He said he was simply
taking notes on the suggestions that were presented.
4:26:46 PM
SENATOR ELTON recalled that the ACLU and others cautioned that
the definition that governs the access of private health
information is too broad. Considering the definition that was
just distributed, he said he tends to agree with that
assessment. For instance, if obesity were defined in such a way
that it is given public importance, then DHSS would have the
authority to look at obese persons' private records.
DR. MANDSAGER said there is a distinction between dealing with
identifiable health information and looking at records but
keeping no individual identifiers. There are projects or
surveillance systems where DHSS may look at records of some
sort, but unless the three tests are met, the information
couldn't be kept in an identifiable format.
SENATOR ELTON said he doesn't see anything about looking at the
information in an aggregated manner with no personal
identifiers.
4:29:07 PM
DR. MANDSAGER said if that's correct then the wording needs
additional work because they are attempting to say that the
department may acquire and use identifiable health information
only if it meets the three tests. He asked if he is saying that
the three tests are still too broad.
SENATOR ELTON said that's accurate.
DR. MANDSAGER respectfully disagreed and said this would simply
codify present practice. He turned to Ms. Erickson and commented
they have discussed the implications of using the phrase, "a
significant risk to public health " but that caused him some
concern and he would have to think about it further. He asked
Ms. Erickson if the phrase would cause trouble.
DEB ERICKSON, Deputy Director, Division of Public Health, said
she would like to give that consideration.
4:31:07 PM
DR. MANDSAGER introduced Ms. Erickson as the national chair of
the Turning Point Project, which is looking at model public
health acts for the country. He said he frequently looks to her
as the in-house expert.
DR. MANDSAGER asked if determining the standard for collecting
identifiable public health information would help define the
term they suggested.
SENATOR CHARLIE HUGGINS asked for clarification.
DR. MANDSAGER replied the phrase "conditions of public health
importance" is used nationally.
CHAIR THERRIAULT pointed to the definition on page 7, lines 16
through 20 and said that when people talk about public health
they think in terms of a disease like the plague, but in the
medical community today, the conditions of obesity or high blood
pressure would fall under that definition.
4:33:42 PM
DR. MANDSAGER referenced the partnership with the Anchorage
School District to highlight his concern that narrowing the
definition too much would preclude partnering opportunities.
DHSS partnered with that school district to help analyze
individual height and weight data to produce a body mass index
(BMI) to indicate how fat students are. The information was
given to the school district in aggregate with no individually
identifiable data. However, he agreed that if DHSS were to
collect identifiable health information, there should be a
higher standard.
SENATOR THERRIAULT asked whether identifiable means identifiable
to an individual.
DR. MANDSAGER replied it means being able to track data to a
particular individual in a particular community. In the bill,
identifiable health information is defined on page 19, line 11.
4:35:14 PM
SENATOR THERRIAULT said his preference is to add the definition
to the packet as Amendment 9.
He asked Dr. Mandsager to discuss proposed Amendment 3.
DR. MANDSAGER explained that in this instance legislative legal
decided it was acceptable to specifically reference the statute,
but he wasn't clear why it wasn't acceptable to do so on the
previous amendment.
CHAIR THERRIAULT remarked the intent is to have a limiting
effect.
DR. MANDSAGER agreed.
AMENDMENT 3 - CSSB75( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 8, line 30, following "information":
Insert "collected under AS 18.15.355 - 18.15.390"
DR. MANDSAGER referenced proposed Amendment 4 and explained the
ACLU raised the concern that it isn't clear in statute that
identifiable health information is destroyed once the government
is finished using the information and it's necessary to have a
policy and practice for doing so.
CHAIR THERRIAULT clarified that DHSS suggested inserting the
underscored language and Legislative Legal recommended deleting
the bracketed language in proposed Amendment 4.
DR. MANDSAGER acknowledged DHSS was agreeable to the changes. He
then argued that it should be put into regulation that the
public should know when the government is going to collect
identifiable health information. The public should know what is
collected, how long the data would be kept and when it would be
destroyed.
AMENDMENT 4 - CSSB75( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 9, following line 1:
Insert the following new material:
"(c) The department shall expunge, in a confidential
manner, identifiable health information collected under
AS 18.15.355 - 18.15.390 when the use of the information
[whose use] by the department no longer furthers the public
health purpose for which it was acquired. The department
shall establish by regulation a retention schedule for
records containing identifiable health information."
SENATOR ELTON questioned why the peg is "use of the information"
and whether it wouldn't be more straightforward to say "when the
information collected by the department no longer furthers".
4:38:11 PM
DAN BRANCH, Senior Assistant Attorney General, Department Law,
said it was written that way because the federal HIPAA privacy
regulations recognize and make a distinction between the two
stages. The first is the collection of information and the
second is protection of the collected information.
DR. MANDSAGER explained that proposed Amendment 5 came about in
response to a current tuberculosis case in the state. It is to
clarify that there is a stepwise progression to the process.
AMENDMENT 5 --- CSSB75( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 11, following line 12:
Insert the following new material:
"(b) A state medical officer may direct an individual
who has or may have been exposed to a contagious disease
that poses a significant risk or danger to others or to the
public's health to complete an appropriate prescribed
course of treatment for the contagious disease, including
medication and [including through] directly observed
therapy where appropriate, and to follow [infection control
provisions] measures to prevent the spread of disease [for
the disease]."
Page 11, line 13:
Delete "(b)"
Insert "(c)"
Page 11, line 16:
Delete "(c)"
Insert "(d)"
SENATOR ELTON asked for confirmation that there is just one
state medical officer.
DR. MANDSAGER replied a state medical officer is a physician
employed by the Division of Public Health and that would
ordinarily be the state epidemiologist.
SENATOR THERRIAULT noted the department inserted the underlined
language and legislative legal recommended deleting the
bracketed language.
DR. MANDSAGER said the department is in agreement with the
changes legislative legal recommended.
4:41:33 PM
DR. MANDSAGER informed members that proposed Amendment 6 came
from suggestions made during the previous hearing. It is to make
it clear that if someone refuses treatment then they bear the
cost of isolation and quarantine
The only change he recommends in proposed Amendment 6 is to
change "and" to "or" in the phrase "seeking and implementing" so
it is clear that the individual bears the cost and the state
does not.
AMENDMENT 6 --- CSSB75 ( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 11, line 17, following "treatment.":
Insert "However, an individual exercising the right under
this subsection is responsible for paying all costs incurred by
the state in seeking and implementing [imposing any] a
quarantine or isolation order made necessary by the individual's
refusal of treatment. The department shall advise an individual
refusing treatment that that refusal may result in an indefinite
quarantine or isolation and that the individual will be
responsible for payment of all costs of [any] a quarantine or
isolation."
CHAIR THERRIAULT clarified that the right an individual would
exercise is the right to refuse treatment and go into quarantine
instead.
DR. MANDSAGER explained proposed Amendment 7 is an attempt to
raise the bar for when an isolation and quarantine order is
imposed. The department suggested using the phrase "poses a
significant risk to public health" but Legislative Legal
recommends going back to "is a condition of public health
importance." He maintained that the bar should be raised. The
flu is a condition of public health importance, he argued, but
we wouldn't isolate or quarantine for that. However, Avian Flu
has a mortality rate of 70 percent and they probably would try
to isolate and quarantine because of the significant public
health risk that type of flu poses.
AMENDMENT 7 CSSB75( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 11, line 24:
Delete "disease or"
Insert "disease that is a condition of public health
importance"
Page 11, line 25:
Delete "hazardous material"
4:44:06 PM
SENATOR ELTON commented this is the area in which an exception
for religious purposes was considered and this proposal would
make it possible for any individual to refuse treatment and be
placed in quarantine instead. He questioned whether a new fiscal
note would be needed because living in quarantine or isolation
might be costly and not all individuals would be able to pay for
themselves.
DR. MANDSAGER replied instances in which isolation and
quarantine are indicated occur about once in ten years so the
department doesn't anticipate much increased cost.
4:46:26 PM
DR. MANDSAGER said the language change on page 11, line 25
proposed in Amendment 7 also came about after the Department of
Law questioned what "hazardous material" might mean. Because of
the ambiguous meaning, DHSS elected to drop that reference and
keep isolation and quarantine authority limited to contagious
and possibly contagious diseases, which is in line with most
other states.
SENATOR ELTON asked about medical waste that might need to be
controlled.
DR. MANDSAGER thought it would be covered.
CHAIR THERRIAULT asked about proposed Amendment 8.
DR. MANDSAGER explained it is proposed to keep the language
consistent with the rest of the bill and goes back to the phrase
"significant risk to the public health."
AMENDMENT 8 --- CSSB75 ( )
A M E N D M E N T
OFFERED IN THE SENATE STATE BY _____________________
AFFAIRS COMMITTEE
TO: CSSB 75(HES)
Page 14, line 16:
Delete "substantial"
Insert "significant"
Page 14, line 31:
Delete "substantial"
Insert "significant"
4:50:41 PM
CHAIR THERRIAULT reported that the court rule changes were just
received. They are largely technical and would possibly become
proposed Amendment 10. He asked Dr. Mandsager if he had any
additional information.
DR. MANDSAGER replied the aforementioned summarizes the
proposals that came from the committee during the first hearing,
but doesn't go as far as the ACLU suggested. "We think these
suggestions are reasonable limitations and that we can do what
is necessary." He said he was interested in whether the
committee views this as an appropriate balance point.
CHAIR THERRIAULT asked if the House Judiciary would be presented
with the same packet.
DR. MANDSAGER said that's correct.
SENATOR ELTON remarked he doesn't like the notion that the state
could access his medical records in a way that he could be
identified as an individual for the sake of some study. With
suggested Amendment 9 that could happen, and that is an
unacceptable intrusion, he asserted.
DR. MANDSAGER asked Senator Elton whether he is bothered by the
idea of someone looking at his personal records without his
knowledge even if the information isn't linked to his name.
SENATOR ELTON replied his concern stems from the increasing
number of ways that personal information can be stolen and used.
There were no further questions.
CHAIR THERRIAULT announced he would hold SB 75 in committee and
watch what happens in the House Judiciary Committee.
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