02/10/1995 01:04 PM House JUD

 HJUD - 2/10/95                                                                
 HB 39 - AUTHORITY TO PRONOUNCE DEATH                                        
                                                                               
 Number 020                                                                    
                                                                               
 REPRESENTATIVE GENE THERRIAULT, bill sponsor, introduced CSHB 39.             
 He said the intent was in certain circumstances, to grant the power           
 to those who do not normally have that authority, to declare                  
 someone deceased.  In rural Alaska there are many instances where             
 there is no doctor, so an emergency medical technician (EMT) or               
 medical assistant has responded to an accident.  Once they start              
 cardiopulmonary resuscitation (CPR), they have a legal obligation             
 to continue until somebody relieves them of that duty by either               
 taking over for them, taking the patient to the emergency room, or            
 by declaring death.  He worked closely with Emergency Medical                 
 Services (EMS) providers to craft language that is fairly tight, so           
 this power is only extended to EMTs and physician assistants in               
 certain circumstances.  Another consideration here in Alaska is               
 that there are bodies of water so cold that you have hypothermia              
 conditions, or cold water drowning.  Special care needs to be taken           
 in those instances.  Two proposed amendments were included in the             
 committee packets, which Representative Therriault supported.                 
                                                                               
 REPRESENTATIVE CYNTHIA TOOHEY made a motion to adopt the committee            
 substitute, version F for HB 39.                                              
                                                                               
 Number 095                                                                    
                                                                               
 REPRESENTATIVE DAVID FINKELSTEIN wanted to know the difference                
 between the committee substitute and the original bill.                       
                                                                               
                                                                               
 ANNE CARPENETI, House Judiciary Committee Council, said the only              
 change she found was on page 3, line 13.  This version of the                 
 committee substitute removes the material that was in the original            
 bill, "by emergency medical technician."                                      
                                                                               
 Number 110                                                                    
                                                                               
 REPRESENTATIVE THERRIAULT explained why that was done.  What he               
 wanted the committee to consider, also removes the same language              
 from section (b) on page 3, lines 15 - 21.  He said we are allowing           
 individuals to make a declaration of death, if they have properly             
 administered resuscitation efforts according to these two                     
 requirements.  That power would be extended to EMTs and to                    
 physician assistants.  The bill started out only providing this               
 authority to EMTs.  Now it includes physician assistants, along               
 with other people already allowed by law.  The intent of this                 
 language is to make the law consistent.  Amendment F.2 makes it               
 consistent.                                                                   
                                                                               
 REPRESENTATIVE TOOHEY moved that F.2 dated 2/10/95, be adopted as             
 Amendment Number 1.  This amendment would delete "by an emergency             
 medical technician" on page 3, lines 16 - 17.  Hearing no                     
 objection, it was so ordered.                                                 
                                                                               
 Number 190                                                                    
                                                                               
 REPRESENTATIVE TOOHEY moved that F.1 be adopted as Amendment Number           
 2.  This amendment would delete "cardiac arrest accompanied by"               
 from two places:  Page 2, line 31, after "means"; and page 3, line            
 2.  There was discussion on the amendment.                                    
                                                                               
 REPRESENTATIVE THERRIAULT explained there had been concern                    
 expressed by the Medical Association about the language on page 3,            
 where it talks about acceptable medical standards.  They were                 
 concerned over the presence of rigor mortis being enough, by itself           
 to determine the state of death.  The EMS providers say they would            
 never just look at the postmortem lividity, discoloration; but they           
 would also check for a pulse, so cardiac arrest would also be                 
 present.  Section (a) says that cardiac arrest is part of its                 
 determining factor.  We are trying to make cardiac arrest part of             
 (a), (b), (c), and (d).  So cardiac arrest and lividity would be              
 factors in determining death.  The EMS providers felt comfortable             
 with that.  He added that since the bill passed the Health,                   
 Education and Social Services (HESS) Committee, the Interior Fire             
 Chiefs Association informed Representative Therriault they support            
 this bill.                                                                    
                                                                               
 Number 290                                                                    
                                                                               
 MARK JOHNSON, Chief, Emergency Medical Services Section, Department           
 of Health and Social Services, testified in support of the bill.              
 He said as Representative Therriault explained, sometimes our EMS             
 providers around the state, especially in rural areas, are expected           
 to continue resuscitative efforts long past the time when there is            
 no hope whatsoever of resuscitating the patient.  The attempt here            
 is to give those workers a standard that will allow them to stop              
 efforts when the patient is dead.  There is no case where somebody            
 met only one of the criteria in this bill and actually lived, so              
 this is a very tight standard we would be applying.  The president            
 of the Alaska State Medical Society expressed concern that the                
 presence of postmortem lividity was not sufficient criteria by                
 itself.  After a conference with Dr. Peter Nakamura, Director of              
 Public Health for Alaska and Dr. Michael Probst, Medical Examiner             
 for Alaska, Mr. Johnson concluded that the safe language would be             
 to say that the patient needed to have cardiac arrest accompanied             
 by (a), or (b), or (c), or (d).  This would satisfy the criteria.             
 He felt a situation in which a patient could have lividity and not            
 be dead, was rare.  The Department of Health and Social Services              
 felt comfortable with the language in this bill, after those                  
 concerns were addressed.                                                      
                                                                               
 Number 335                                                                    
                                                                               
 REPRESENTATIVE JOE GREEN asked if there was any potential for                 
 someone coming back against the state for deficient training in the           
 situation where someone, other than a doctor makes this judgement             
 call.                                                                         
                                                                               
 MR. JOHNSON did not believe they could because they would have to             
 show that there was a chance the patient would have survived.  He             
 felt the state training standards were up to national standards.              
                                                                               
 Number 365                                                                    
                                                                               
 REPRESENTATIVE TOOHEY said, having been an EMT for 15 years on the            
 highway, they are very thoroughly trained in knowing death, seeing            
 death, and trying to prevent deaths.  You will not find a better,             
 more aggressive group of people to prevent it, when possible.  She            
 believed the language covered what was necessary, very well.                  
                                                                               
 CHAIRMAN PORTER asked if there was any other discussion on                    
 Amendment Number 2, or objection.  Seeing none, the amendment was             
 adopted.                                                                      
                                                                               
 Number 420                                                                    
                                                                               
 REPRESENTATIVE TOOHEY made a motion to move the bill, with                    
 individual recommendations and fiscal notes.  Hearing no objection,           
 it was so ordered.