Legislature(2005 - 2006)CAPITOL 120
03/04/2005 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HB107 | |
| HB175 | |
| HB95 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 175 | TELECONFERENCED | |
| + | HB 95 | TELECONFERENCED | |
| = | HB 107 | ||
HB 95 - PUBLIC HEALTH DISASTERS/EMERGENCIES 2:23:49 PM CHAIR McGUIRE announced that the final order of business would be HOUSE BILL NO. 95, "An Act relating to public health and public health emergencies and disasters; relating to duties of the public defender and office of public advocacy regarding public health matters; relating to certain claims for public health matters; making conforming amendments; and providing for an effective date." [Before the committee was CSHB 95(HES).] RICHARD MANDSAGER, M.D., Director, Central Office, Division of Public Health, Department of Health and Social Services (DHSS), presented HB 95 to the committee. He directed attention to "slides" printed in a handout available in the committee packet, and read the quote from the Institute of Medicine on page 2: "Public Health is what we, as a society, do collectively to assure the conditions in which people can be healthy." He said: What this bill is about is the governmental part of public health; it's not about the private part, it's not about the family part.... If one thinks back over the last 150 years, what contributed to the almost doubling of life expectancy of Americans between 1900 and today is things like sewage and sewage removal ..., safe water, ... protection from vaccine- preventable diseases, ... clean indoor air, mandated removal from the environment of carcinogens, [and] removal of lead from gasoline. All of those things have contributed to improve public health and improve both quality and quantity of life of Americans. DR. MANDSAGER asserted that public health is concerned with populations, not just poor people, and prevention, not just treatment. "Government plays a really unique role in legal obligations to prevent disease, disability, injury, and illness," he noted. Some examples of this: immunization policies in schools, PPDs [purified protein derivatives, a method of testing for tuberculosis, or TB], and injury prevention. If public health personnel do their job right, he said, they're in the background, but when there is an outbreak they need to be prepared to contain it. DR. MANDSAGER turned to slide 4 and said that another important aspect of public health falls under the purview of the Department of Environmental Conservation (DEC), which looks at the food, water, and air safety, and at the reasons animals die. "Public health law really underpins all of our work, and the reason that we're introducing this bill is to update that underpinning," he added. DR. MANDSAGER explained that slide 5 speaks to the public health emergency side. He commented that prior to [the terrorist attacks of September 11, 2001] "nobody had really thought about the fact that biological or chemical agents could really be terrorist tools; so preparedness is a big part of what we are." He shared an anecdote in which a lab in Fairbanks was able to determine within a 24-hour period that a young Juneau girl had measles, and a possible outbreak was contained. "That's what we do in the background to try and contain outbreaks," he said. DR. MANDSAGER pointed out that avian flu has been in the news lately. He explained that this flu has now been transmitted on numerous occasions in the last couple of years from birds to humans, and recently there have been indications of possible human-to-human transmission. He pointed out that avian flu has a 70 percent mortality rate, and if it mutates and becomes transmissible human to human, "containment and the ability to quarantine and isolate is going to be really important." He continued: We learned with SARS [Severe Acute Respiratory Syndrome] a couple of years ago that we could contain a viral outbreak. Toronto proved that ... they were able to contain it - same thing in Hong Kong. ... We've learned that we can, if we have appropriate quarantine and isolation tools, contain an outbreak, because in many of these diseases, ... drugs aren't going to be very useful. We're going to have to limit exposure.... Today we don't have that authority in our state. If I got a call from CDC [Centers for Disease Control and Prevention] that somebody was coming from Hanoi on an airplane into Anchorage tonight, and they thought this person has avian flu, we would have to try and convince a judge that our general governmental authorities were enough to quarantine that individual. And it's very unclear with current statutes whether a judge would agree. DR. MANDSAGER pointed out some weaknesses in the current statutes, including inadequate legal authorities, and problems with the virology laboratory in Fairbanks. He then turned to slide 7 and quickly reviewed past outbreaks: polio and tuberculosis in the 1940s. 2:31:18 PM DR. MANDSAGER explained that slide 8 showed pictures of quarantine and isolation, which he said aren't used very often, but are tools that are important to have in the background. Slide 9 focused on concerns regarding avian flu, on which he commented: "We need to be prepared around the world. There's a lot of work going on in Southeast Asia right now to try and contain this disease, but it appears it is now endemic in birds across Southeast Asia." DR. MANDSAGER reminded the committee that current statutes date back to territory days in the 1940s and have been updated twice: once to address tuberculosis and once for SARS. The bill would provide statutory framework to support public health missions, services, and roles, he said, it would give clear authority for control of conditions of public health importance, and would create modern due process, rights, and rules in statute. He noted: If we tried to serve you with a quarantine or isolation order and you thought government had overreached, it's very unclear in current statutes what your rights are, what your appeal rights are, and it would be pretty much up to the judge you were dealing with as to how this would turn out for you as an individual. DR. MANDSAGER clarified that HB 95 defines the essential public health service and the state's role. He continued: The bill is the result of several years' worth of work. At the time of [the terrorist attacks of September 11, 2001] there was already some work going on nationally about what should be the emergency powers in a state after that; that work was rapidly accelerated, and part of that work was incorporated a couple of years ago when the legislature updated the Emergency Powers Act here in our state. The Robert Wood Johnson Foundation then, in the last several years, funded something called a [Turning Point Model State Public Health Act] process. ... It developed a model act for states to use to look at their current statutes. ... Last summer ... we started a process of reviewing our current Alaska statutes against the model Act, and this proposal is a result of that work over the course of the summer and fall. ... This proposal also takes into context [the Alaska State Constitution] ... and other laws. DR. MANDSAGER noted that slide 13 is an outline of HB 95, and that slide 14 explains the various authorities in the act. Slide 15 focuses on balancing the protection of the public's health against the individual's rights to due process, he said, and slide 16 addresses some of the constitutional constraints. 2:36:46 PM DR. MANDSAGER raised the issue of Acquired Immune Deficiency Syndrome (AIDS) and the question of why individuals that have it aren't quarantined or isolated. He explained that people who are quarantined have a contagious disease that is transmissible to somebody through no act of the individual, such as via breathing or eating, whereas to contract AIDS, one ordinarily would have to engage in an unsafe practice. He said, "We in our country have decided that it wouldn't meet the test to quarantine or isolate somebody for a behavior in which there's an individual behavior that contributes to ... [contagion]." DR. MANDSAGER pointed out that HB 95 would not add new powers, but would only put a statutory basis behind the state's current practices. He turned to slide 17, dealing with the balance between individual rights and the common good, and pointed out: The model Act includes the fact that it's suggested that states have the ability to impose treatment. [House Bill 95] ... does not have that authority to impose treatment. ... Our thinking is that at the point treatment is a possibility, the individual has a choice: they can choose to be treated and be no longer contagious or possibly contagious, or they can go into quarantine or isolation, and the public's health is protected. The individual has an individual choice to make for themselves, and so the proposal before you does not include a mandated treatment. Another thing that has come up in previous hearings has been the suggestion that for religious reasons, a person should be able to exempt themselves from screening or testing. ... We don't think that's a good idea ... [because] in an emergency situation where you have an epidemic that's short-lived, if one or two people were to exempt themselves for religious reasons, it probably doesn't matter. There will be enough other people who will voluntarily agree to testing and we could figure out what's going on, and very shortly the individual's either going to be better, get cured, or, unfortunately, [die]. In a chronic situation, which is much more [of the] Alaska experience with tuberculosis [TB], if somebody's exposed to TB and chooses not to get tested, we then are left with somebody that may or may not have TB, and it seems to me that we would then have the administrative burden of monitoring that person forever and putting that person into quarantine whenever they cough. And that doesn't seem to me to be a reasonable thing to do. DR. MANDSAGER explained that slide 18 spoke to limitations, and slide 19 again addressed the balance that must be found between individual rights and the common good. He noted that the American Civil Liberties Union (ACLU) had proposed that there shouldn't be any ex parte process in any of the authorities, and he said, "If we give somebody a treatment order and they were to refuse, and we think that this person is a risk to somebody, we want to be able to have somebody else besides a state medical officer ... say to a judge, 'This person needs to be ... isolated or quarantined in order to protect the public health.'" DR. MANDSAGER explained that if this were to occur on a Thursday or Friday afternoon, this process could be completed quickly via a district judge through an ex parte process; the department can get an order that same day and "the public can be protected that weekend." The person is entitled to a hearing, and yet the public's health is protected over the weekend, he said. If there was no ex parte process, he noted, there would need to be a hearing before there could be a court order, and then the department's only "tool" would be to obtain an emergency order, which isn't as quick a process. DR. MANDSAGER turned attention to slides 20 and 21, which addressed the proposed amendments. He explained that one of the proposed amendments would add some new standards to the department's ability to acquire and use identifiable health information. He said: Obviously a concern of the public is: when does government have the right to get to identifiable health information. Last summer, in July, people started coming off cruise ships in Whittier with what looked like gastroenteritis. It looked like it was probably going to be a norovirus (ph) outbreak, which we've had every summer for the last several summers, but by talking to individuals, getting samples and so on, and getting a history, it quickly became apparent that this was an "oyster story". And it turned out that what we had was an organism called Vibrio parahaemolyticus both in Prince William Sound and in Kachemak Bay, [that] had never been cultured north of 61 degrees North latitude before anywhere in the world, and it wasn't thought that you had to have a process in place before oysters went to market to assure their safety. A lot of people got sick. We would [have] never ... known it if we hadn't been able to, one, do an outbreak investigation and, two, be able to go into identifiable health information. Now the report that comes out the other side, that is used for policy that DEC is implementing for this coming summer's oyster season, has no identifiable health information; people's ... identifiers are stripped off of it and we have a report that has numbers of people who got sick and where they got sick and what farms were involved and that kind of thing. But that's an example of the kind of work and the balance that's important in public health that we be able to do. DR. MANDSAGER shared another anecdote: [There are] several villages up on one river in the Interior that all construction was stopped last summer because asbestos was found in the gravel. So there are no standards to know how much of a risk is asbestos in gravel for outdoor construction - what kind of protection is necessary, can you use that gravel. So we've been working with ... those villages over the last six months to try and figure out a plan so [the Department of Transportation (DOT)] and others can resume construction this coming summer. ... [We] have looked at x-rays of everybody over age 50 who's been willing to give us their x-rays, and have sent those x-rays to an outside expert that's an expert in asbestosis. And it's not reported yet, but unofficially I can tell you about 5 percent of the people over age 50 have signs of asbestosis in those villages. So now we need to go back to those individuals, get a work history, ... and try and figure out a protection plan for those villages as to how they're going to do construction. DR. MANDSAGER pointed out that the DHSS and the DEC have been working in partnership with Native organizations and people in the coastal villages to look at mercury levels in people and in fish. He noted that the departments have issued policy statements to say that from the data they have, it is safe to eat fish in Alaska because the mercury levels are very low. He said, "If we ... aren't able to do that kind of work, we can't contribute to that kind of policy discussion." He then related a story from last fall in which the citizens of Kivalina had their blood tested for possible lead contamination. He concluded: "Those are examples of ... where we work in the background to contribute to community discussion. ... My hope is, by the time the legislature goes home in May, Alaska isn't the only state in the country ... without quarantine and isolation authority." 2:48:05 PM REPRESENTATIVE DAHLSTROM asked Dr. Mandsager to address the issue of monitoring water standards, and the fact that the state only has one medical examiner. She commented that she is concerned about the rights and responsibilities of an employer while someone is in isolation, as well as the potential liability that a person would face if he/she chose not to go into isolation. She also asked for clarification regarding who would take responsibility for children if both parents were in isolation. She commented that it would be fine to address these concerns [at the bill's next hearing]. REPRESENTATIVE GARA relayed his concern that the statute will "allow the state to quarantine people we don't intend to quarantine", such as people with AIDS. He said that he was not comfortable with the argument that the committee shouldn't worry about the language because the courts wouldn't enforce it that far; he stated that he wanted the language to exclude those diseases that [the committee] doesn't want the law to apply to. He pointed out that the bill says that the department may quarantine people in their own home; he said that if people were willing to be quarantined in their own home, that should be their absolute right and the state shouldn't have the discretion to quarantine them somewhere else. 2:51:21 PM PATRICIA SENNER, Chair, Legislative Committee, Alaska Nurses Association (AaNA), relayed that since [the terrorist attacks of September 11, 2001] and the SARS outbreak in Asia, the Association has been involved in advocating for better disaster- disease outbreak planning. She commented: We were very pleased the Department of Health and Social Services has taken steps in strengthening their legal authority to respond to these types of public health emergencies. It is imperative that the state's health authorities have in place a mechanism to respond quickly to an infectious disease outbreak. We have read this bill from two perspectives: that of the health care provider and that of the affected individuals. We feel that this bill adequately addresses the needs of both these [perspectives], with a few concerns. Our first concern has to do with [proposed AS 18.15.387 on page 15, line 19], which refers to being able to quarantine and isolate only due to disease outbreaks. There's also a mention in there ... of decontamination efforts. We have suggested to the department that they expand this section to refer to situations where individuals are exposed to highly toxic substances that might be transmitted from one individual to another. In this latter case, such as an incident where individuals are exposed to radioactive materials, the department may want to quarantine or isolate individuals, just as they would in the case of a disease outbreak. Now, the department has come back to us and said, "Well that's under DEC," but I think in a crisis situation, the local officials are going to grab on [to] whoever's there, and if the health department is the one that's there, I'd rather have duplicate lines of authority and not just [rely] on one agency for that. MS. SENNER continued: [Proposed AS 18.15.360 on page 8, line 23] states, "The department may request information from and inspect health care records maintained by health care providers that identify individuals or characteristics of individuals with reportable diseases or other conditions of public health importance". ... This section probably concerns us the most because of experiences of health care providers in other states where public health officials have been asking and requesting large numbers of private health care records on individuals, and it seems to be mostly to advance their own personal political status and not really for public health purposes. We don't have questions about the current people in place in the health department, but certainly because there's a lot of concern in the health care community as a whole about what's going on in other states, we would like ... the criteria for this to be spelled out as much as possible. REPRESENTATIVE GRUENBERG asked Ms. Senner if she had read the packet of proposed amendments. MS. SENNER replied that she had seen an earlier amendment. REPRESENTATIVE GRUENBERG asked Ms. Senner if she supported the amendment labeled [24-GH1002\G.1, Mischel, 3/3/05], which read: Page 8, line 29, following "information": Insert "under this section" Page 8, following line 31: Insert a new section to read: "Sec. 18.15.362. Acquisition and use of identifiable health information; public health purpose. The department may acquire and use identifiable health information collected under AS 18.15.355 - 18.15.390 only if the (1) acquisition and use of the information relates directly to a public health purpose; (2) acquisition and use of the information is reasonably likely to contribute to the achievement of a public health purpose; and (3) public health purpose cannot otherwise be achieved at least as well with nonidentifiable health information." Page 20, following line 24: Insert a new paragraph to read: "(18) "public health purpose" means the prevention, control, or amelioration of a condition of public health importance, including an analysis or evaluation of a condition of public health importance and an evaluation of a public health program;" Renumber the following paragraphs accordingly. REPRESENTATIVE GRUENBERG also asked if Ms. Senner would draft an amendment for [proposed AS 18.15.387]. MS. SENNER, in referring to the amendment labeled G.1, pointed out the phrase "public health purpose" [page 1, line 9] and said that she would add a few more adjectives to it. CHAIR McGUIRE requested that Ms. Senner submit her preferred changes in writing. MS. SENNER commented: There is also a proposed amendment for [proposed AS 18.15.385, page 11, line 16] about the right of the individual to refuse treatment. ... As nurses, we deal a lot with individuals that don't want to take responsibilities for their personal acts. ... So we had recommended to the department ... that they add a qualifier, and I think that's one of your amendments to this section, that if an individual does refuse treatment, then they also need to take on the responsibility of taking those measures to prevent the transmission of whatever infectious disease they are exposed to. And the department has added in there that they should go into quarantine or isolation at their own expense. So we would support that amendment. REPRESENTATIVE GRUENBERG commented that there were two amendments that refer to page 11 of HB 95; he asked Ms. Senner if she was referring to both of those amendments. MS. SENNER replied that she was referring to the amendment labeled [24-GH1002\G.5, Mischel, 3/3/05], which read: Page 11, line 20, following "treatment.": Insert "However, an individual who exercises the right to refuse treatment under this subsection is responsible for paying all costs incurred by the state in seeking and implementing a quarantine or isolation order made necessary by a refusal of treatment by the individual. The department shall notify an individual who refuses treatment under this subsection that the refusal may result in an indefinite period of quarantine or isolation and that the individual will be responsible for payment of the costs of the quarantine or isolation." REPRESENTATIVE GRUENBERG asked for further clarification. MS. SENNER commented that she would look over the amendments and get back to the committee later. CHAIR McGUIRE indicated that HB 95 would be held over.
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