Legislature(2017 - 2018)CAPITOL 106

03/28/2017 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:01:07 PM Start
03:01:46 PM Presentation: the Economic Costs of Alcohol Abuse in Alaska
04:04:29 PM HB54
05:24:39 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: The Economic Cost of Alcohol Abuse TELECONFERENCED
in AK by the AK Mental Health Trust Authority
<Bill Hearing Canceled>
Heard & Held
-- Testimony <Public/Invited> --
+ Bills Previously Heard/Scheduled 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                                                                 
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                                                                                                                   
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                                    
     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                                                                    
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                                                                    
     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                                                                    
     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                                                                
     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                                                                     
     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                                                                          
          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                                                                             
     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                                                                        
          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                                                                            
     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                                                                           
     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                                                                        
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                                                               
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                                                               
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                                                               
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                                                               
4:48:33 PM                                                                                                                    
REPRESENTATIVE  SULLIVAN-LEONARD  asked   about  the  Hippocratic                                                               
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                                                               
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                                                               
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                                                                                                                    
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