03/31/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES

HB 225-MEDICAL EXAMINERS & AUTOPSIES                                                                                          
                                                                                                                                
3:09:17 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE BILL  NO. 225,  "An Act relating  to medical  examiners and                                                               
medical death examinations."                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE,  speaking as  the sponsor,  expressed her                                                               
belief that the duty of the  state medical examiner is of immense                                                               
responsibility and  importance to  the citizens  of Alaska.   She                                                               
explained that autopsies  are performed by the  state coroner for                                                               
various   reasons,  including   suspicious  death   and  possible                                                               
communicable  disease  outbreaks.   There  is  one state  medical                                                               
examiner  in  Alaska,  she related,  manages  over  1,000  cases,                                                               
annually.    She  further  explained   that  Alaska  law  divides                                                               
autopsies   into   two   different  categories,   which   include                                                               
suspicious, unusual or public health  related deaths in the first                                                               
category and leaves other cases  to the discretion of the medical                                                               
examiner.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  MCGUIRE said  that HB  225 would  require that  a                                                               
deputy medical examiner be appointed  to assist the state medical                                                               
examiner  in  Alaska.    She explained  that  the  state  medical                                                               
examiner has been  so overworked in past years,  that some deaths                                                               
have  not  been  properly  investigated,   due  to  the  lack  of                                                               
resources.   She  pointed out  that the  deputy medical  examiner                                                               
would provide  respite for the  state medical examiner  and allow                                                               
for the development  and training of the position.   If the state                                                               
medical examiner became ill, needed  to take time off, or decided                                                               
to leave the  position, there would be someone to  take over, she                                                               
related.                                                                                                                        
                                                                                                                                
REPRESENTATIVE MCGUIRE  stated that there  is a zero  fiscal note                                                               
attached to HB 225 because  the governor's office decided to fund                                                               
the  [deputy commissioner]  position.   She  explained that  this                                                               
position was funded in recognition  that this is a critical state                                                               
responsibility, and a matter of public trust.                                                                                   
                                                                                                                                
3:14:37 PM                                                                                                                    
                                                                                                                                
DR. ROGERS  said that he  was the  state medical examiner  for 27                                                               
years in Alaska.  He explained  that he resigned and retired when                                                               
the policy  in Juneau  shifted requirements  to complete  only 25                                                               
percent of  deaths reported  to the state  medical examiner.   He                                                               
continued:                                                                                                                      
                                                                                                                                
     I couldn't  see doing  that because we  have to  sign a                                                                    
     death  certificate, we  have to  certify that  somebody                                                                    
     died  of  something.   And  the  word certify,  I  take                                                                    
     seriously, ... the word certify  is equivalent to being                                                                    
     under oath.   So, I didn't want to do  what they call a                                                                    
     walk by autopsy  and just make a guess at  the cause of                                                                    
     death and  sign it out  ....   One of the  reasons that                                                                    
     the  present  situation  is unsatisfactory  is  nothing                                                                    
     more   that   death   certificate  statistics.      The                                                                    
     Department  of   Epidemiology  ...  thought   that  our                                                                    
     autopsy records  were the best  in the  country because                                                                    
     we  did  autopsies  on  about 98  percent  of  all  the                                                                    
     coroner's  cases  and   that  includes  the  unattended                                                                    
     natural deaths,  and there are  a lot of things  to die                                                                    
     of besides a  coronary, which is what most  of them get                                                                    
     signed out  as now.   Our death  certificate statistics                                                                    
     have  become relatively  worthless ...  for people  who                                                                    
     die outside of the hospital ....   I was at a meeting a                                                                    
     while  back  where a  group  from  Pittsburgh tried  an                                                                    
     experiment,  they  would  bring  a body  in,  the  duty                                                                    
     pathologist  would  decide  whether  or not  to  do  an                                                                    
     autopsy and  write down what  he would sign it  out as;                                                                    
     ... if  he decided he didn't  need to do one,  then one                                                                    
     of  the other  pathologists in  the group  would do  an                                                                    
     autopsy ....   And they  found that they were  wrong 25                                                                    
     percent  of the  time and  I  think that  a 25  percent                                                                    
     error rate is really not very acceptable.                                                                                  
                                                                                                                                
     I  think it's  a responsibility  of the  state to  know                                                                    
     what its  citizens die of,  and therefore I  think this                                                                    
     bill will at  least provide more people for  them to do                                                                    
     the work.   Right now, one guy just simply  can't do it                                                                    
     all ... my partner and I,  used to do about 1,000 cases                                                                    
     a  year and  it can  be done  if the  time is  utilized                                                                    
     efficiently ....   I really applaud this  bill and hope                                                                    
     that it  will make  a difference  in the  policies that                                                                    
     come out of  the "department"; I assume  that they come                                                                    
     from the  commissioner ....   When they made  us change                                                                    
     it  came   through  Dr.  Nakamura,   I  think   is  Dr.                                                                    
     Mandsager's predecessor,  and it  was his view  that we                                                                    
     should do only  an average job compared to  the rest of                                                                    
     the country.  And I wanted  to do a better job than the                                                                    
     rest of  the country, not  because we're any  better at                                                                    
     it,  but because  there are  few enough  cases that  we                                                                    
     could do  them all.  So,  I think we should  go back to                                                                    
     doing them all, again.                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON  moved to  report HB  225 out  of committee                                                               
with individual recommendations and  the accompanying zero fiscal                                                               
note.   There being no  objection, HB  225 was reported  from the                                                               
House Health, Education and Social Services Standing Committee.