Legislature(2009 - 2010)CAPITOL 106
04/09/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB188 | |
| HB168 | |
| HB223 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 188 | TELECONFERENCED | |
| *+ | HB 168 | TELECONFERENCED | |
| *+ | HB 223 | TELECONFERENCED | |
HB 168-TRAUMA CARE CENTERS/FUND 3:19:35 PM CO-CHAIR KELLER announced that the next order of business would be HOUSE BILL NO. 168, "An Act relating to state certification and designation of trauma centers; creating the uncompensated trauma care fund to offset uncompensated trauma care provided at certified and designated trauma centers; and providing for an effective date." 3:20:19 PM REPRESENTATIVE COGHILL stressed that it was a high priority for Alaska to have an emergency trauma delivery system. He explained that he would like to incentivize hospitals to attain trauma center designation, and to direct funding for trauma uses. He noted that two central issues were for uninsured patients, and for payment to the hospitals for the new programs. He suggested that hospitals which increased their trauma designation would receive repayment for the expenses. He referred to the "Trauma System Consultation" report from its November 2-5, 2008, meeting in Anchorage, Alaska. [Included in the members' packets] He noted that the report contained suggestions of ways for Alaska to improve its trauma system. He opined that hospitals would be reluctant, but would support this program. He summarized that there was an important need to take care of Alaskans who were hurt, and that there should not be a question of where the payment would come from. 3:27:48 PM DR. FRANK SACCO, Chair, Alaska Trauma Systems Review Committee, said that his report would demonstrate why this was important, what had been done so far, and what was still needed. He quoted the former U.S. Surgeon General, C. Everett Koop, "If a disease were killing our children at the rate unintentional injuries are, the public would be outraged and demand that this killer be stopped." He opined that a public health system approach was the only proven way to make an impact. He stated that the leading cause of death for individuals up to 44 years of age was trauma, and yet it was still not recognized. 3:31:15 PM DR. SACCO referred to slide 5, "Trauma in Alaska," and detailed the annual impact to Alaskans. 3:31:45 PM DR. SACCO directed attention to the comparative deaths by trauma in the U.S. and Alaska on slide 6, "Death from Trauma in Alaska." He pointed out the high rate for Alaskans and the much higher rate for Alaska natives, and he noted that the Alaska trauma death rate was second only to New Mexico. 3:32:21 PM DR. SACCO explained that the leading causes of traumatic death in Alaska were motor vehicles and firearms, slide 7, "Trauma in Alaska." He disclosed that 25 percent of the $73 million cost for trauma care in Alaska was not compensated. 3:32:53 PM DR. SACCO compared the time from injury to death on slide 8, "Death from Trauma." He pointed out that intervention during the golden hours would improve survival. 3:33:27 PM DR. SACCO indicated slide 9, "Trauma Systems," and read "A trauma system consists of hospitals, personnel, and public service agencies with a preplanned response to caring for the injured patient." 3:33:51 PM DR. SACCO considered slide 10, "Trauma Systems," and described the facilities, the personnel training, the patient transport, the triage. He said "a trauma system was getting the right patient to the right place in the right amount of time." 3:34:20 PM DR. SACCO looked at slide 11, "Facilities-Trauma Centers," and reviewed the definitions for Levels I-IV of trauma centers. 3:35:28 PM DR. SACCO spoke about the various trauma related courses, which included ATLC, TNCC, RTTDC, and ETT, on slide 12, "Personnel." 3:36:07 PM DR. SACCO directed attention to slide 13, "Transport and triage," and spoke about the guidelines that take into account local resources and capabilities. 3:36:35 PM DR. SACCO referred to "Trauma Systems" on slide 14, and declared that trauma systems improved survival of the seriously injured by 15 -25 percent, increased the productive working years, and enhanced the statewide disaster preparedness. 3:37:25 PM DR. SACCO spoke to slide 15 "Preventable Deaths: the impact of trauma systems," and he compared the decrease to percentages of preventable deaths for three major metropolitan areas. 3:37:47 PM DR. SACCO continued on to slide 16, "Trauma Systems & crash mortality," which depicted a state to state comparison for crash mortality before and after the introduction of trauma systems. 3:37:59 PM DR. SACCO explained that slide 17, "Trauma systems & crash mortality" revealed the impact on mortality rates with trauma systems, seat belt restraint laws, lower allowable blood level alcohol, and increases to the speed limit. 3:38:21 PM DR. SACCO spoke about slide 18, "Anchorage Mortality Rate 2005- 2007" which depicted the lower mortality rate for designated, as opposed to non-designated, trauma centers in Anchorage. He explained that the next slide reflected the significant differences for age group mortality rates between the designated and non-designated trauma centers. He reviewed the next slide, "Trauma Center and Disaster Preparedness," and noted that a trauma center maintained its readiness, was staffed for all types of injuries, had a broad communications network, and had the resources to facilitate the patient's recovery. 3:39:21 PM DR. SACCO stated that slide 21 "Trauma Systems and the Public," showed that 83 percent of the people wanted a trauma system in their area. 3:39:47 PM DR. SACCO said that slide 22, also titled "Trauma Systems and the Public," affirmed that 75 percent of people interviewed thought there was a trauma center system in their state, but in actuality only 15 percent of the people lived in a state with a comprehensive system. 3:40:17 PM DR. SACCO explained slide 23, "Alaska Trauma System," and noted that a 1993 Alaska statute created the EMS authority for designating trauma centers, set national standards for trauma centers, and made hospital participation in the trauma system voluntary. He said that in the 15 years since, there was only one Level II trauma center and four Level IV centers in Alaska, which were all listed on slide 25, "Current Status." 3:41:54 PM DR. SACCO introduced the Site Visit Team on slide 26, and he described the "Objective," slide 27, which was "To help promote a sustainable effort in the graduated development of an inclusive trauma system for Alaska." 3:42:20 PM DR. SACCO continued on to slide 28, "Advantages & Assets," and emphasized that Alaska had very committed individuals who served Alaska, that there was an extensive transport network, that there were three large medical centers with extensive expertise in the state, and that there was a very good relationship with Harborview Medical Center in Seattle for sending trauma patients. He also listed the Level II facility, with other small hospitals working toward verification of Level IV. He said the Alaska Trauma Registry received data from all 24 acute care hospitals. 3:43:27 PM DR. SACCO moved on to slide 30, "Challenges and Vulnerabilities." He declared that Alaska did not have a trauma system plan, there were no trauma standards, there were limited human resources, there were few incentives for hospital participation, and there was not a statewide performance evaluation. 3:44:24 PM DR. SACCO directed attention to slide 31, "Trauma Care in Alaska 2009," and concluded: "There are two healthcare systems for injured patients. One for Alaska natives that adheres to national standards and another for the majority of the population." [original punctuation provided] 3:44:32 PM DR. SACCO referred to the recommendations on slide 32, "Definitive Care Facilities," and said that a second Level II Trauma Center had to be established in Anchorage, and that participation by all acute care hospitals should be mandated within two years for trauma center designation appropriate to their capabilities. He continued with slide 33, and declared that there was a need for pediatric trauma care capability. He concluded that it was necessary to determine a method of financial support to trauma centers for uncompensated care. 3:45:30 PM DR. SACCO noted that slide 36, "Alaska Trauma Systems Review Committee," reflected that the committee met twice a year and that its role was to review the Level IV hospitals and the interfacility transfer guidelines, and make suggestions for trauma system improvement. 3:45:57 PM DR. SACCO explained that "Head Injury Guidelines for Rural and Remote Alaska," were implemented primarily by the tribal health system and it decreased unnecessary medevacs by 75 percent, with no adverse consequences. 3:47:10 PM DR. SACCO commented on slide 38, "Current Activity US," and compared that both Georgia and Arkansas put millions of dollars into the trauma system, whereas Alaska was the only state without a designated Level 1 or Level 2 trauma center, other than the Native Health Service facility. He added that federal legislation was currently being considered for help to trauma centers. 3:48:24 PM DR. SACCO concluded with slide 39, "Alaska Trauma System: "Where do we go now?" and said that it was necessary to increase facility participation for development of an inclusive system. 3:49:08 PM REPRESENTATIVE CISSNA asked about community emergency response training. DR. SACCO, in response to Representative Cissna, explained that the difference between designated and non-designated hospitals was determined by the ability to maintain a minimum care level. He endorsed the need to organize providers and facilities to ensure that this care level was always available. DR. SACCO, in response to Representative Cissna, explained that the mortality rates were adjusted per 100,000 people, and that Alaskans had the second highest rate. 3:52:30 PM REPRESENTATIVE CISSNA referred to the need for funding, and asked what could be done that was not funding related. DR. SACCO said that there were over 70 recommendations in the American College of Surgeons report [Included in the members' packets], many of which did not require any funding. He gave two examples: mal-practice caps on damages at a designated trauma center and Medicare and Medicaid allowable billing by designated trauma centers for the Emergency Room activation of a trauma team. 3:55:37 PM CO-CHAIR KELLER opened public testimony. 3:55:55 PM DR. REGINA CHENNAULT, Chair, Alaska Committee on Trauma, American College of Surgeons, Alaska Native Medical Center, said that she agreed with Dr. Sacco, and that a trauma system was also the best design for handling any disaster. She stated that appropriate trauma care did reduce mortality. 3:58:26 PM DR. DANNY ROBINETTE, Northern Alaska Medical Surgical, observed that there was an increasing manpower shortage for general surgery. He noted that trauma patients were often under insured and he suggested that there be incentives for doctors. He said that it became necessary to medevac a patient to Seattle when the Anchorage medical system did not have the availability. 4:01:45 PM GERAD GODFREY, Chair, Alaska Violent Crimes Compensation Board, related a personal story which reflected the flaws in the trauma response time. He said that the ad hoc committee had realized that there was not a standardized procedure for all the potential variables. He opined that there was unwillingness from the hospitals to go along with the training, the protocols, and the start up cost. He supported the pro active approach of the American College of Surgeons. 4:08:00 PM DAVID HULL, Chairman, Alaska Council on Emergency Medical Services, said that trauma care needed to be addressed. He offered examples of emergency medical systems that had treated trauma patients, and he advocated for an entire trauma care system. 4:12:30 PM ROD BETIT, President & CEO, Alaska State Hospital and Nursing Home Association (ASHNHA), said that ASHNHA agreed that work needed to be done on the trauma care system, and that there should be incentives for initiating the system. He opined that DHSS needed to agree on its importance before any talks would be effective. He observed that that there was a significant cost to guarantee the availability of physicians and nurses for the required time response. He remarked that it was different for staff model hospitals, as the physicians worked for that hospital, than for private hospitals, where the physicians did not work for the hospital. He agreed that HB 168 was a good idea. 4:16:45 PM MR. BETIT, in response to Representative Coghill, said that the Medicaid disproportionate share funds were available, as these were often left unused. 4:17:22 PM REPRESENTATIVE COGHILL agreed that having an already existing funding stream was optimal. 4:17:27 PM MARK JOHNSON, Chief (ret.), Community Health and Emergency Medical Services, referred to the initial legislation passed in 1993, which had set up the aforementioned voluntary system. He explained that DHSS had co-sponsored the American College of Surgeons review of eight different hospitals in Alaska. He said that he participated in the reviews, and that many facilities were close to designation. He opined that incentives were necessary for enthusiasm for the designation process. He stressed that the trauma system would save lives. 4:19:38 PM DR. JAY BUTLER, Chief Medical Officer, Office of the Commissioner, Department of Health and Social Services (DHSS), said that injury deaths could not be controlled like a disease. He reported that a systematic approach to improve trauma care had become a DHSS priority. He shared that an American College of Surgeons recommendation was for each acute care hospital to seek trauma center designation, appropriate to its capacity, within the next two years. He affirmed that the goal was to improve the quality of care for trauma victims. He stated that HB 168 provided an incentive to become a trauma center. He cited potential funding sources for reimbursement to hospitals for underinsured trauma patients. He noted that DHSS recognized the importance of trauma care, but that there was uncertainty for fiscal support. He observed that the administration had taken a neutral stance. 4:22:37 PM REPRESENTATIVE SEATON asked how many trauma deaths were alcohol related, and if it was necessary to address the larger problem of alcoholism. DR. BUTLER, in response to Representative Seaton, agreed that alcohol was a component and that the reduction to the legal limit for blood alcohol was a part of the larger solution. REPRESENTATIVE COGHILL, in response to Representative Seaton, said that he was open to the inclusion of other aspects for prevention, as these also had an impact on the system. 4:25:53 PM DR. BUTLER spoke about teachable moments, and he shared that non-fatal incidences of trauma, specifically alcohol related events, were excellent teachable moments. 4:26:42 PM DR. SACCO agreed with the use of teachable moments, and he gave examples to the success with alcohol intervention and education. He suggested that a requirement for trauma centers was to teach injury prevention to high risk populations. 4:29:17 PM REPRESENTATIVE COGHILL, in reference to the bill, reflected that it was important to "be quick but don't get in a hurry." He agreed that there were complexities to the issues, but that people's lives were involved. 4:30:34 PM CO-CHAIR KELLER closed public testimony. [HB 168 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| CSHB 188 Sponsor Summary version N.doc |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |
| CSHB 188 Version N.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |
| HSS188pkt.PDF |
HHSS 3/26/2009 3:00:00 PM HHSS 4/9/2009 3:00:00 PM |
|
| HB223pkt.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 223 |
| HB168pkt.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 168 |
| HB 188 Sectional Version N.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |