02/24/2010 01:00 PM House JUDICIARY

        HB 71 - ADVANCE HEALTH CARE DIRECTIVES REGISTRY                                                                     
                                                                                                                                
2:21:02 PM                                                                                                                    
                                                                                                                                
CHAIR RAMRAS announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 71, "An  Act relating  to a registry  for advance                                                               
health  care  directives."    [Before   the  committee  was  CSHB
(HSS).]                                                                                                                       
                                                                                                                                
2:21:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES, speaking as one  of the bill's joint prime                                                               
sponsors, moved  to adopt the proposed  committee substitute (CS)                                                               
for HB 71, Version 26-LS0289\T,  Kurtz/Bannister, 1/21/10, as the                                                               
work draft.   There being no objection, Version T  was before the                                                               
committee.                                                                                                                      
                                                                                                                                
[Chair Ramras turned the gavel over to Representative Herron.]                                                                  
                                                                                                                                
REPRESENTATIVE  HOLMES explained  that  HB  71 addresses  advance                                                               
health  care directives  - commonly  known  as living  wills.   A                                                               
family member  of an acquaintance  of hers experienced  a medical                                                               
emergency  while the  family  was on  a trip  out  of state,  and                                                               
although the person  who took ill did have a  living will, it had                                                               
been left  locked up  at home  and so was  of no  use whatsoever.                                                               
Representative  Holmes   said  that   upon  hearing   about  this                                                               
experience, she realized  that she, too, could  potentially be in                                                               
a  similar situation  someday because  although she  does have  a                                                               
living  will, she  keeps  it  locked up  at  her father's  house.                                                               
House Bill  71 would  establish, under  the Department  of Health                                                               
and  Social Services  (DHSS), a  voluntary  registry for  advance                                                               
health care directives;  those who choose to do  so, could submit                                                               
their living  will information to  the DHSS for inclusion  in the                                                               
registry  -  a secure,  online  database  -  that could  then  be                                                               
accessed by hospitals and healthcare providers across the state.                                                                
                                                                                                                                
2:23:10 PM                                                                                                                    
                                                                                                                                
JAMES WALDO,  Staff, Representative Lindsey Holmes,  Alaska State                                                               
Legislature  - on  behalf of  Representative Holmes,  one of  the                                                               
bill's joint  prime sponsors -  added that once entered  into the                                                               
registry, a person's living will  would also be accessible to the                                                               
person, his/her  agent, guardian,  or surrogate, and  other types                                                               
of healthcare facilities  such as nursing homes.   In response to                                                               
a question, he explained that under  Version T, the DHSS would be                                                               
allowed  to contract  with a  registry organization  to establish                                                               
and maintain the  State registry - such an  organization would be                                                               
able to do so at less cost than the DHSS.                                                                                       
                                                                                                                                
REPRESENTATIVE  GRUENBERG  observed  that  the  DHSS's  decreased                                                               
fiscal note for Version T reflects that change.                                                                                 
                                                                                                                                
MR. WALDO concurred.                                                                                                            
                                                                                                                                
[Representative Herron returned the gavel to Chair Ramras.]                                                                     
                                                                                                                                
2:26:21 PM                                                                                                                    
                                                                                                                                
WARD  B.  HURLBURT, M.D.,  Director  and  Chief Medical  Officer,                                                               
Central Office,  Division of Public Health,  Department of Health                                                               
and Social  Services, explained  that HB  71 creates  a mechanism                                                               
for the storage of advance  health care directives, and that both                                                               
the division  and the DHSS have  worked with the sponsor  and are                                                               
in support of  the intent to have advance  health care directives                                                               
made available  via the proposed  registry.   The administration,                                                               
however, has taken a neutral position  on HB 71 due to the fiscal                                                               
note.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  GRUENBERG, mentioning  that he  strongly supports                                                               
HB 71, expressed a desire  for national uniformity and interstate                                                               
cooperation regarding advance health care directives.                                                                           
                                                                                                                                
DR.  HURLBURT,  in response  to  a  question, surmised  that  the                                                               
Association  of State  and Territorial  Health Officials  (ASTHO)                                                               
could potentially  provide a  forum to address  such issues.   He                                                               
pointed  out  that  any information  submitted  to  the  proposed                                                               
registry  would  be accessible  to  healthcare  providers out  of                                                               
state.  Furthermore, some other  states have adopted similar law,                                                               
and so could serve as models for Alaska's registry.                                                                             
                                                                                                                                
CHAIR RAMRAS  said he opposes HB  71 due to the  fiscal note, and                                                               
questioned why  the State  should pay  someone over  $100,000 per                                                               
year to maintain the proposed registry.                                                                                         
                                                                                                                                
REPRESENTATIVE HOLMES clarified that the  bulk of the fiscal note                                                               
addresses  startup  costs,  and   that  the  amount  required  to                                                               
maintain  the  registry after  startup  would  quickly be  scaled                                                               
back.                                                                                                                           
                                                                                                                                
DR. HURLBURT concurred.                                                                                                         
                                                                                                                                
REPRESENTATIVE GRUENBERG suggested that  the issues raised by the                                                               
fiscal  note  would be  better  addressed  by the  House  Finance                                                               
Committee, the bill's next committee of referral.                                                                               
                                                                                                                                
2:35:01 PM                                                                                                                    
                                                                                                                                
MARIE DARLIN,  Coordinator, AARP  Capital City Task  Force, noted                                                               
that members'  packets contain the  AARP's letter of  support for                                                               
HB 71, and  that her group is among those  that worked very hard,                                                               
for four  years, to statutorily  provide for advance  health care                                                               
directives,  and  so  views  HB   71  as  a  follow-up  piece  of                                                               
legislation that  would allow advance  health care  directives to                                                               
actually  be useful  and  function  as intended.    The AARP  has                                                               
worked very  hard, and will  continue to  work very hard,  to get                                                               
its  members to  complete  their advance  health care  directives                                                               
and,  hopefully,  carry  them  with   them;  most  people  won't,                                                               
however, and so HB 71  would hopefully provide recourse for those                                                               
people.    She indicated  that  although  the  AARP has  not  yet                                                               
calculated  the cost  of maintaining  the proposed  registry, the                                                               
AARP would  like to  see some  consideration given  to low-income                                                               
people, perhaps via providing for  a very low [registration fee].                                                               
With regard to  the issue of needing access to  the registry when                                                               
traveling outside  of Alaska, she offered  her understanding that                                                               
the  bill is  not yet  clear  with regard  to whether  healthcare                                                               
professionals in  the state a  person is traveling in  would have                                                               
access to Alaska's  registry.  Regardless that that  issue is one                                                               
that might  still need to  be clarified, the AARP  still supports                                                               
HB 71 and hopes that it will pass.                                                                                              
                                                                                                                                
REPRESENTATIVE  HOLMES   noted  that  proposed   AS  13.52.310(c)                                                               
outlines  who  could  have  access  to  the  information  in  the                                                               
registry, and  that it specifically  provides that a  hospital in                                                               
another state could obtain information  from Alaska's registry if                                                               
requested to do so by  the individual or his/her agent, guardian,                                                               
or surrogate.                                                                                                                   
                                                                                                                                
MS.  DARLIN  questioned  whether  that  language  is  all  that's                                                               
necessary.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  HOLMES offered  her  belief that  it  is, that  a                                                               
healthcare provider  would be able  to access information  in the                                                               
registry  regardless of  where the  healthcare  provider and  the                                                               
person happen to be.  That is her intent, she concluded.                                                                        
                                                                                                                                
MS. DARLIN,  in response to  a question,  said that she  does not                                                               
know how  many people would  take advantage of the  registry, nor                                                               
how many  people even  have an advance  health care  directive in                                                               
place yet, nor how such could be estimated.                                                                                     
                                                                                                                                
DR. HURLBURT, in  response to a question,  surmised that although                                                               
the details still  need to be worked out, there  would be various                                                               
options  for submitting  advance  health care  directives to  the                                                               
registry; that  they could  be submitted in  person, by  mail, or                                                               
electronically; that there  would be a central  location for such                                                               
submissions;  and  that the  intent  is  for  a private  firm  to                                                               
administer  the   registry  and  provide  training   to  Alaska's                                                               
hospitals and  healthcare providers.   In  response to  a further                                                               
question,  he  explained that  the  DHSS  staff the  fiscal  note                                                               
references would  be responsible  for monitoring  the procurement                                                               
and selection processes,  and help with statewide  logistics.  In                                                               
response  to a  comment,  he said  he is  unable  to address  the                                                               
amount of the salary listed in the fiscal note.                                                                                 
                                                                                                                                
CHAIR RAMRAS questioned how large  of a registration fee would be                                                               
required in order to pay for that staff position.                                                                               
                                                                                                                                
2:44:37 PM                                                                                                                    
                                                                                                                                
DR. HURLBURT  suggested that  a registration  fee, even  a modest                                                               
one, could prove  to be a disincentive for people  who might wish                                                               
to use  the registry.   The intent of  the bill is  to facilitate                                                               
the use of advance health care directives.                                                                                      
                                                                                                                                
CHAIR  RAMRAS remarked  that regardless  of the  public good  the                                                               
bill would  accomplish, it still puts  a burden on the  State and                                                               
creates another job in State government.                                                                                        
                                                                                                                                
REPRESENTATIVE HOLMES, in response  to a question, explained that                                                               
the department  has worked very  hard to reduce the  fiscal note,                                                               
thus illustrating the importance  being placed on establishing an                                                               
advance  health care  directive registry;  under Version  T, only                                                               
one employee  would be needed  for the first year,  with personal                                                               
services  costs  being  scaled  back in  subsequent  years.    In                                                               
response to  a question,  she indicated  that there  is a  lot of                                                               
concern  among those  she's heard  from that  a registration  fee                                                               
would be required.                                                                                                              
                                                                                                                                
CHAIR RAMRAS  said he  is opposed  to creating  another job.   He                                                               
noted  that the  language  of proposed  AS  13.52.310(h) says  in                                                               
part, "The  department may charge  a fee  to file a  directive in                                                               
the registry", and  suggested that the word, "may"  be changed to                                                               
the  word "shall"  in  order to  offset  the estimated  personnel                                                               
costs.                                                                                                                          
                                                                                                                                
DR. HURLBURT remarked  that if such a change were  made, then the                                                               
committee  should  also  consider  having  the  bill  provide  an                                                               
exemption from the fee for those who are indigent.                                                                              
                                                                                                                                
REPRESENTATIVE  LYNN said  he could  envision  even someone  with                                                               
just less income also being  unable to afford a registration fee.                                                               
In  response to  a comment,  he said  that if  having an  advance                                                               
health care directive is a  good thing, then it logically follows                                                               
that a  registry for such directives  would also be a  good thing                                                               
because then people could actually  make use of their directives.                                                               
It would be  nice, therefore, if everyone,  regardless of income,                                                               
could get their directives added to the registry.                                                                               
                                                                                                                                
2:52:47 PM                                                                                                                    
                                                                                                                                
LORILYN SWANSON, Manager,  Fireweed Place, Tlingit-Haida Regional                                                               
Housing Authority (THRHA) - after  mentioning that in addition to                                                               
managing an  independent-living senior  complex, she  also serves                                                               
on the Juneau Commission on Aging  (JCOA) - indicated that she is                                                               
advocating for  the adoption  of HB  71, and is  in favor  of the                                                               
State of  Alaska establishing and  maintaining an  advance health                                                               
care directive  registry, which  would hopefully  be incorporated                                                               
into  a national  advance health  care directive  registry.   She                                                               
went on to say:                                                                                                                 
                                                                                                                                
     I support  this for several  reasons.  Many of  us have                                                                    
     advance  directives, and  they  are filed  away in  our                                                                    
     home files. ... Yes, we know  they are there, but I ask                                                                    
     you, how  many family members  know where it is  or how                                                                    
     to   access  the   information  -   especially  in   an                                                                    
     emergency.   We live  in the age  of world  travel. ...                                                                    
     For those  having an  advance directive,  they probably                                                                    
     do  not carry  it  with them;  I know  I  don't, and  I                                                                    
     imagine that many of you do not as well.                                                                                   
                                                                                                                                
     I also see firsthand the  confusion that can be created                                                                    
     by  medical   emergencies.    I  manage   an  apartment                                                                    
     building for  an aging senior  population.  A  911 call                                                                    
     leads to  the emergency  personnel being called  to the                                                                    
     building,  and one  of the  first questions  that I  am                                                                    
     usually asked,  if it is a  life threatening emergency,                                                                    
     is,  "Do  you  know  if  this  person  has  an  advance                                                                    
     directive  in place?"   I  may know,  but unless  it is                                                                    
     lying on the table or  in plain sight in the apartment,                                                                    
     I  do  not  feel comfortable  answering  that  question                                                                    
     unless the tenant has specifically  instructed me to do                                                                    
     so in  case of an  emergency, and  then I am  still not                                                                    
     comfortable with it.                                                                                                       
                                                                                                                                
     In  both  of  these  cases, should  there  be  a  State                                                                    
     registry,  with coordination  to  a national  registry,                                                                    
     any  emergency  personnel  or  institution  would  have                                                                    
     computer access to this  information immediately.  This                                                                    
     is why  we all have  an advance directive in  place, so                                                                    
     that it can  be acted upon per our  own personal wishes                                                                    
     and instructions.   I would like to  say, however, that                                                                    
     I  do  not  feel  there  should be  a  filing  fee  for                                                                    
     registering.    I  feel  that   this  would  be  a  ...                                                                    
     detriment for the many who  are on low income, and they                                                                    
     would not  file.   We worked hard,  for four  years, to                                                                    
     get  the  advance  directive  here,  in  the  state  of                                                                    
     Alaska,  and  now  it  is  time  to  make  it  work  by                                                                    
     establishing this State registry.  Thank you.                                                                              
                                                                                                                                
REPRESENTATIVE GRUENBERG  asked how  many people in  Alaska would                                                               
be eligible  for inclusion in  the proposed registry if  the bill                                                               
passes.                                                                                                                         
                                                                                                                                
MS. SWANSON  offered her  belief that anyone  who has  an advance                                                               
health  care directive  would be  eligible for  inclusion.   She,                                                               
too,  relayed that  she  doesn't  know how  many  people have  an                                                               
advance health  care directive  in place,  though as  an advocate                                                               
for senior issues, she encourages  everyone, not just seniors, to                                                               
have  one.    In  response  to  a  question,  she  surmised  that                                                               
mandating a registration  fee would probably not  be popular with                                                               
lower-income Alaskans.                                                                                                          
                                                                                                                                
2:57:02 PM                                                                                                                    
                                                                                                                                
EMILY  NENON,  Director,  Alaska Government  Relations,  American                                                               
Cancer Society  Cancer Action  Network (ACS  CAN), said  that the                                                               
ACS CAN supports  HB 71.  She recounted that  in his later years,                                                               
her father  developed severe  dementia, and  spent the  last four                                                               
years of his live in a nursing  home.  During the last six months                                                               
of his  life, his  advance health  care directive  was overlooked                                                               
three separate times.  On one  occasion, when he was still living                                                               
in the nursing home, her mother  was called to meet the ambulance                                                               
staff taking him from the nursing  home to the hospital, and when                                                               
she got there, she found that  the ambulance staff had managed to                                                               
resuscitate him,  and the attending physician  was mortified upon                                                               
learning  that  her  father  had   had  an  advance  health  care                                                               
directive but  the nursing  home had  not sent  it over  with the                                                               
ambulance staff.   In  conclusion, she said  she doesn't  want to                                                               
see  anyone  else go  through  the  same  agony her  family  went                                                               
through.                                                                                                                        
                                                                                                                                
[HB 71, Version T, was held over.]