Legislature(2001 - 2002)

03/20/2002 01:15 PM JUD

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 197 - HEALTH CARE SERVICES DIRECTIVES                                                                                      
                                                                                                                                
Number 0413                                                                                                                     
                                                                                                                                
CHAIR ROKEBERG  announced that the  last order of  business would                                                               
be  HOUSE  BILL NO.  197,  "An  Act  relating to  directives  for                                                               
personal  health  care  services   and  for  medical  treatment."                                                               
[Before the committee was CSHB 197(HES).]                                                                                       
                                                                                                                                
Number 0430                                                                                                                     
                                                                                                                                
MELANIE LESH,  Staff to Representative Bill  Hudson, Alaska State                                                               
Legislature, sponsor,  speaking on  behalf of the  sponsor, noted                                                               
that [the proposed committee substitute  (CS) for HB 197, version                                                               
22-LS0712\O,  Bannister, 2/26/02,]  is quite  expanded from  CSHB
197(HES).    She mentioned  that  [Version  O] incorporates  [the                                                               
Uniform  Health  Care Decisions  Act],  which  is national  model                                                               
language that other  states have also adopted.   She relayed that                                                               
there  is  also a  proposed  amendment  that speaks  to  concerns                                                               
raised  by the  Department  of Health  &  Social Services  (DHSS)                                                               
regarding  the   emergency  medical  technicians'   protocol  for                                                               
responding to do-not-resuscitate (DNR) orders.                                                                                  
                                                                                                                                
Number 0582                                                                                                                     
                                                                                                                                
REPRESENTATIVE  JAMES  moved  to  adopt  the  proposed  committee                                                               
substitute  (CS)  for  HB 197,  version  22-LS0712\O,  Bannister,                                                               
2/26/02, as  a work draft.   There being no objection,  Version O                                                               
was before the committee.                                                                                                       
                                                                                                                                
Number 0600                                                                                                                     
                                                                                                                                
SIOUX  PLUMMER, President,  Board  of  Directors, Foundation  for                                                               
Hospice and Home  Care of Juneau Alaska, relayed  that during the                                                               
time she'd  worked for Representative Hudson,  she'd also chaired                                                               
the Juneau  End of  Life Task  Force.  She  said that  she, along                                                               
with other  likeminded people, supports  HB 197.  Because  of her                                                               
interest  in issues  related to  death  and dying,  she said,  it                                                               
became evident to her that  "we could improve existing statute in                                                               
Alaska for persons  who wish to die here."   "We could make dying                                                               
better, if you'll forgive the phrase,  but, in fact, dying can be                                                               
improved  if you  would accept  that language,"  she added.   The                                                               
fundamental intent  of HB 197 is  to clear up, improve,  and make                                                               
more readily  available to  Alaskans this  language based  on the                                                               
idea of  the "Five  Wishes," language  which currently  exists in                                                               
the state laws of 35 or more states.                                                                                            
                                                                                                                                
MS. PLUMMER  reiterated her  support of HB  197, and  relayed her                                                               
hope  that  HB 197  would  be  reported  out of  committee  after                                                               
serious consideration.   She mentioned that on  a personal level,                                                               
she hadn't  been very  familiar with death  and dying  until [she                                                               
watched]  the "Bill  Moyers special,"  which  addressed dying  in                                                               
America and which was broadcast  on public television a couple of                                                               
years ago.  As  a result of that program, here  in Juneau as well                                                               
as  across the  nation in  many  cities, local  groups formed  to                                                               
learn more about issues  of death and dying.  She  said it was at                                                               
one  such conference  that  she learned  about  the Five  Wishes,                                                               
about why the notion of  theses wishes is so prevalent throughout                                                               
the United  States, and  about why  there is a  new trend  in the                                                               
country relating to improving issues pertaining death and dying.                                                                
                                                                                                                                
REPRESENTATIVE JAMES asked what the Five Wishes are.                                                                            
                                                                                                                                
MS.  PLUMMER,  noting  that  they  were  listed  in  the  sponsor                                                               
statement, said that  the wishes include:  "The person  I want to                                                               
make care  decisions for me when  I can't"; "The kind  of medical                                                               
treatment I want or don't want";  "How comfortable I want to be";                                                               
"How I want other people to treat  me"; and "What I want my loved                                                               
ones to know."  These are  wishes that persons who are terminally                                                               
ill or who know they are going  to die soon would want to express                                                               
to  their caregiver,  their medical  provider, their  family, and                                                               
their loved ones.   These Five Wishes are the  premise upon which                                                               
HB 197 is based.                                                                                                                
                                                                                                                                
MS. PLUMMER  relayed that within  the last three years,  she lost                                                               
four of  her closest family  members:  her husband,  her brother,                                                               
her mother,  and her father.   Up until that time,  she said, she                                                               
had never  paid attention to  what it must  be like to  die; now,                                                               
because  of  her recent  personal  experiences,  she has  a  real                                                               
strong feeling about the necessity  of having very clear language                                                               
and clear law that enables people  to die the way they would like                                                               
to.                                                                                                                             
                                                                                                                                
Number 0823                                                                                                                     
                                                                                                                                
CHAIR ROKEBERG asked  Ms. Lesh to comment on  the DHSS's concerns                                                               
and the proposed amendment.                                                                                                     
                                                                                                                                
MS. LESH  said that she has  just spoken with almost  everyone in                                                               
the "Comfort  One Do-Not-Resuscitate  (DNR) program"  affected by                                                               
the  proposed  amendment  as  it  relates  to  Version  O.    She                                                               
explained that  [HB 197]  repealed the  statutes for  the Comfort                                                               
One DNR program, the Organ  Donation program, and the Living Will                                                               
program  and   re-enacted  them  in   one  new  chapter.     More                                                               
importantly,  the  legislation  added the  expanded  health  care                                                               
directives  in which  one can  write his/her  health care  wishes                                                               
succinctly.  Ms. Lesh noted  that in repealing and reenacting the                                                               
aforementioned  programs,  the  very important  Comfort  One  DNR                                                               
program  was [inadvertently]  left out.   Under  this program  an                                                               
individual,  with a  physician's consent,  can obtain  a bracelet                                                               
and  documentation  which  specifies   that  the  individual  has                                                               
chosen,  with   a  physician's  concurrence,  to   not  have  CPR                                                               
administered.  Ms. Lesh said that  the intent of [Amendment 1] is                                                               
to [reenact]  the Comfort One  DNR program since the  sponsor did                                                               
not wish to impact the DNR protocol already existing in statute.                                                                
                                                                                                                                
Number 0982                                                                                                                     
                                                                                                                                
RICHARD  BLOCK, Christian  Science Committee  on Publication  for                                                               
the State of  Alaska, testified via teleconference  in support of                                                               
[Version  O].   First, it  places  the four  statutes, which  are                                                               
currently in different  locations and [are] in  conflict with one                                                               
another,  together in  harmony.   He opined  that that  is reason                                                               
enough alone to adopt the bill.   Second, the bill grants a great                                                               
deal of latitude to the  person preparing a health care directive                                                               
document in  regard to how  that person wishes  his/her surrogate                                                               
to make  health care decisions  on his/her behalf.   Furthermore,                                                               
it allows persons with religious  considerations to express those                                                               
and to  have those protected  through the health  care directive.                                                               
Therefore,  Mr. Block  said, he  viewed [Version  O] as  positive                                                               
because it returns to individuals  the ability to make provisions                                                               
for their  own care.   Mr. Block reiterated support  for [Version                                                               
O] and urged its adoption.   Mr. Block mentioned that he couldn't                                                               
comment on the amendment since he hadn't yet seen it.                                                                           
                                                                                                                                
Number 1186                                                                                                                     
                                                                                                                                
MARK  JOHNSON,  Chief,  Community   Health  &  Emergency  Medical                                                               
Services,  Division  of Public  Health,  Department  of Health  &                                                               
Social Services  (DHSS), announced  support of  the intent  of HB
197.   As  mentioned  earlier,  the Comfort  One  DNR program  is                                                               
already  in  place  for  the  EMS  (Emergency  Medical  Services)                                                               
community, and  seems to  be working.   He  noted that  there had                                                               
been a  discussion with the  sponsor [regarding working  out that                                                               
issue].    He  informed  the committee  that  EMS  providers  are                                                               
trained  to  restore life  whenever  possible,  but there  is  no                                                               
desire to prolong suffering at the end of someone's life.                                                                       
                                                                                                                                
CHAIR  ROKEBERG  asked  if Amendment  1  satisfies  [the  DHSS's]                                                               
concerns as relayed in the letter in the committee packet.                                                                      
                                                                                                                                
MR.  JOHNSON answered  that he  believes the  sponsor intends  to                                                               
satisfy those concerns, although it  still needs to be sorted out                                                               
a  bit.   He remarked  that it's  clear to  him that  the sponsor                                                               
shares [the DHSS's] goal.                                                                                                       
                                                                                                                                
Number 1262                                                                                                                     
                                                                                                                                
LYN  FREEMAN, Executive  Director,  Alaska  Commission on  Aging,                                                               
Division  of  Senior   Services,  Department  of  Administration,                                                               
testified  in  support  of  Version  O.   She  relayed  that  the                                                               
commission  feels that  it's very  important and  meaningful that                                                               
this  draft incorporates  the Uniform  Health Care  Decisions Act                                                               
and includes the Five Wishes  form.  Specifically, the commission                                                               
is   pleased    with   the   thoroughness,    completeness,   and                                                               
understanding  of  the  Five Wishes  component  for  the  general                                                               
population.   She relayed the  importance this kind  of direction                                                               
has for  the individual  and their family  members.   Ms. Freeman                                                               
encouraged the committee to support Version O.                                                                                  
                                                                                                                                
Number 1402                                                                                                                     
                                                                                                                                
MARIE  DARLIN,  AARP  Capitol  City   Task  Force,  informed  the                                                               
committee that AARP was one  of the organizations that pushed for                                                               
this legislation  to be  introduced last year.   Ms.  Darlin said                                                               
AARP  wants to  urge the  committee's support.   She  pointed out                                                               
that the committee  should have a letter  from AARP's legislative                                                               
committee, which supports the bill.   The idea of placing all the                                                               
directives in one  location [in statute] is very  important.  She                                                               
explained that the  AARP really likes the Five  Wishes because it                                                               
opens  up  the  opportunity  for  families  to  discuss  what  an                                                               
individual's last  wishes would  be in a  situation in  which the                                                               
individual can't make his/her own  decisions.  Ms. Darlin relayed                                                               
the belief  that discussions regarding amendments  will take care                                                               
of most everything of concern.                                                                                                  
                                                                                                                                
Number 1462                                                                                                                     
                                                                                                                                
REPRESENTATIVE   COGHILL  moved   to  adopt   Amendment  1,   22-                                                               
LS0712\O.1, Bannister, 3/20/02, which read:                                                                                     
                                                                                                                                
     Page 7, line 19:                                                                                                           
          Delete "do not resuscitate protocol"                                                                                  
          Insert "protocol for do not resuscitate orders"                                                                       
                                                                                                                                
     Page 10, line 30:                                                                                                          
          Delete "orders not to resuscitate"                                                                                    
          Insert "do not resuscitate orders"                                                                                    
                                                                                                                                
     Page 18, following line 29:                                                                                                
          Insert new paragraphs to read:                                                                                        
               "(4)  "cardiopulmonary resuscitation" means                                                                      
     cardiopulmonary   resuscitation  or   a  component   of                                                                    
     cardiopulmonary resuscitation;                                                                                             
               (5)  "do not resuscitate order" means a                                                                          
     directive  from  a  licensed physician  that  emergency                                                                    
     cardiopulmonary    resuscitation    should    not    be                                                                    
     administered   to   a   qualified  patient;   in   this                                                                    
     paragraph,                                                                                                                 
               (A)  "qualified patient" means a patient who                                                                     
     has been  determined by the  attending physician  to be                                                                    
     in a terminal condition;                                                                                                   
               (B)       "terminal   condition"    means   a                                                                    
     progressive incurable  or irreversible  condition that,                                                                    
     without    the   administration    of   life-sustaining                                                                    
     procedures,  will, in  the opinion  of two  physicians,                                                                    
     when  available,  who   have  personally  examined  the                                                                    
     patient, one  of whom must be  the attending physician,                                                                    
     result  in death  within a  relatively  short time;  in                                                                    
     this  subparagraph, "life-sustaining  procedures" means                                                                    
     medical   procedures   or  interventions   that,   when                                                                    
     administered to  a qualified  patient, will  serve only                                                                    
     to prolong the dying process; "                                                                                            
                                                                                                                                
     Renumber the following paragraphs accordingly.                                                                             
                                                                                                                                
     Page 19, lines 2 - 3:                                                                                                      
          Delete "do not resuscitate protocol"                                                                                  
          Insert "protocol for do not resuscitate orders                                                                        
     that is"                                                                                                                   
                                                                                                                                
     Page 19, line 12:                                                                                                          
          Delete "orders not to resuscitate"                                                                                    
          Insert "do not resuscitate orders"                                                                                    
                                                                                                                                
CHAIR ROKEBERG, noting that there was no objection, stated that                                                                 
Amendment 1 was adopted.                                                                                                        
                                                                                                                                
CHAIR ROKEBERG announced that public testimony would be held                                                                    
open for HB 197.  [HB 197, Version O, as amended, was held                                                                      
over.]                                                                                                                          

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