Legislature(1997 - 1998)
02/25/1998 03:21 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 383 - EXPECTED DEATHS Number 0044 CHAIRMAN ROKEBERG announced the committee's first item of business would be HB 383, "An Act relating to expected deaths that occur at home or in a health care facility." He invited the bill sponsor to come forward. Number 0059 REPRESENTATIVE GARY DAVIS came forward to present HB 383. He stated HB 383 addresses a concern that was brought to his attention over the interim. He gave the situation of a person who is dying and whose death is considered imminent, who is known to be in a physical state where survival is not expected, and who is being cared for by an agency such as a hospice, home health care service, or some existing organization providing a bereaving service. He noted these services assist not only the patient, but also the family members. Representative Davis stated that current statutes require the police department be notified when that person passes, and the police then come and investigate the cause of death. He said it seems this process is often invasive, noting different peace officers react differently. He said it takes a tactful person to enter that situation, and he wondered why there is even the statute requiring the person at the scene to call the police officer in the case of an expected death where that is agreed and signed by the patient and a physician. Representative Davis indicated he thought, with all the duties and work peace officer groups are involved in nowadays, they would welcome a reduction in workload. Number 0258 REPRESENTATIVE DAVIS stated HB 383 actually clarifies the statute because they have found this situation is currently treated differently in different parts of the state. In some areas the policeman will automatically come to the house, with sirens going, and do his investigation. Representative Davis noted he was not sure, but he thought then the policeman pronounced death and the body could then be moved. He said it is currently a bit vague in statute, noting there is a "may" which some treat as a "shall." At this time, some police departments respond and others don't. He stated HB 383 would also clarify that and that was the legislation's intent. Representative Davis referred to the sectional analysis of Section 1 of HB 383. That part of the sectional analysis reads: "Amends AS 08.68.395 "Determination of death by registered nurse," subsection (a) to specify that required documentation for anticipated death include the physician's agreement to sign the death certificate if the death occurs as anticipated." Representative Davis indicated, because of the cost factors involved in the care of a dying person, they are currently offering as many opportunities as they can for that person to pass as peacefully as possible at home with family members, rather than in a more expensive hospital setting. He stated there is an "expected death form" currently utilized which is signed by the patient and a physician. Representative Davis said when that form is in place, and there is an imminent and expected death, then this "no duty to call the police officer" would come into play. He noted this is the essence of HB 383. Number 0451 CHAIRMAN ROKEBERG noted, for purposes of clarity, he appreciated the inclusion of copies of the relevant statutes in the bill packet. He asked where the reporting requirement was located, questioning whether it was in Chapter 65. Number 0485 REPRESENTATIVE DAVIS replied he thought the reference was in AS 12.65.005 which reads: "Sec. 12.65.005. Duty to notify state medical examiner. (a) Unless the person has reasonable grounds to believe that notice has already been given, a person who attends a death or has knowledge of a death, in addition to notifying a peace officer, shall immediately notify the state medical examiner when the death appears to have" [continues with subsections (1) through (10), and subsection (b)]. Number 0516 REPRESENTATIVE BILL HUDSON indicated this was a topic not many people thought about unless they were personally affected, and he appreciated Representative Davis bringing it to his attention. He referred to the copies of the statutes in the bill packet, Sec. 12.65.010, subsection (c), which read: "The body of a person whose death has been or should be reported to the state medical examiner under this section may not be moved or otherwise disturbed without the permission of the state medical examiner." Representative Hudson stated there was no change in that language, asking Representative Davis if that was correct. REPRESENTATIVE DAVIS stated Representative Hudson was correct. Number 0570 REPRESENTATIVE HUDSON noted that was kind of important as they looked at this. Number 0578 CHAIRMAN ROKEBERG asked Representative Davis how it worked if the police officer was not going to be notified, but the body was not going to be moved. Number 0591 REPRESENTATIVE DAVIS replied it was his understanding that the body could be moved after death had been pronounced. He asked his staff to come forward. Number 0631 DEB DAVIDSON, Legislative Administrative Assistant to Representative Gary Davis, came forward. She asked Chairman Rokeberg to restate the question. Number 0638 CHAIRMAN ROKEBERG restated his question, referring to Representative Hudson's question about not being able to move the body until the medical examiner was notified. Number 0668 MS. DAVIDSON responded that, according to the copy of the procedures she received from the state medical examiner's office, there is an "800" phone number which she thinks is 1 (888) DECEASE. She said it appears this is a 24-hour number rotated among the staff or going directly to the medical examiner, which can be called at any time of the day when death occurs. Ms. Davidson stated, "You tell them that the death occurred, certain information that's already required: name, address, that type of thing." She said at that point the medical examiner gives permission for the body to be moved, and then the funeral director or whoever may be called. Ms. Davidson indicated the state medical examiner might be able to answer that question better. Number 0734 REPRESENTATIVE JOE RYAN stated, for the record, his wife is a registered nurse. He noted he thought Representative Davis's wife was also a nurse. REPRESENTATIVE DAVIS replied in the affirmative. Number 0750 REPRESENTATIVE RYAN asked if this was going to incur an added liability on registered nurses' licenses, noting only a physician previously has had the power to sign the death certificate. Number 0766 REPRESENTATIVE DAVIS stated he would answer and then refer to his staff who has done more research. He said currently registered nurses are authorized to pronounce death, so he doesn't think that would be impacted. Number 0790 REPRESENTATIVE JOHN COWDERY stated he has had members of his family expire in his home on more than one occasion, noting the police showed up without sirens and, in fact, he said the police had been comforting. Representative Cowdery said it was a crazy world, indicating somebody might sign something like an expected death form and then miraculously live ten more years. He asked what would happen if foul play entered this and how was that situation addressed, noting he thought police involvement was for the assurance that no foul play is involved. Number 0864 REPRESENTATIVE DAVIS replied he thought there were two obvious questions which came to everyone's mind in this. He noted the notice of imminent death is valid for 120 days - it is not unlimited, so he said there is a limit there. Representative Davis commented that number is adjustable, but he thinks it is what is used in the current paperwork. Representative Davis said bring up the possibility of foul play is a very good point, and something many people are concerned with these days. He stated the professionals involved are licensed and their reputations are on the line, noting he referred to home health care and hospice personnel but there may be others. Representative Davis stated he would expect these professionals to call the police if they had any suspicion themselves, indicating he thought just the implication of foul play getting to the press or the community would ruin an organization and possibly that individual professional. He said he didn't know whether that is enough rationale to relieve the suspicion on any individual's part, but stated that is how he has rationalized the situation. Number 0967 REPRESENTATIVE COWDERY commented he would like address questions to representatives of the Alaska State Troopers. Number 0978 CHAIRMAN ROKEBERG noted the presence of Representative Sanders, Representative Brice and Representative Kubina. Chairman Rokeberg stated he had some questions, but would like to proceed first to the other witnesses. Number 1074 DR. MICHAEL PROPST, State Medical Examiner, Division of Public Health, Department of Health and Social Services, testified via teleconference from Anchorage. He stated he was speaking in opposition to the portion of HB 383 regarding notification of police officers. Dr. Propst said he is also familiar with death at home, noting his mother died at home not many years ago in Oregon from pancreatic cancer. He said neither he nor his father were upset or alarmed by the deputy sheriff who stopped by shortly after his mother died; he said the officer's presence was comforting. Dr. Propst stated that, as the state medical examiner, he practices forensic pathology. His duties under the statutes are to investigate deaths including deaths in suspicious or unusual circumstances, and he said, in general, that includes deaths which occur at home. Dr. Propst stated one of the basic principles of forensic pathology is that the easiest person to murder is a person who is expected to die, such as those registered in an expected death program. He said the ability to have a brief police visit at the time of death provides a final check and balance in the system for expected home deaths. The officer responds without a blaring siren or flashing red lights, evaluates the scene, confirms the identity of the deceased, briefly views the remains for obvious evidence of injury or violence and reviews the medications of the deceased. Dr. Propst noted the officer's interchange with those present allows the officer to assess the demeanor of those present and (indisc.) the appropriateness of that demeanor. If all is okay, the officer's visit is relatively brief and, in Dr. Propst's words, "But a short intrusion." He indicated the checks and balances provided by the officer's visit includes: 1) confirming the identity of the deceased, and 2) confirming the lack of evidence of injury or violence, whether self-inflicted or inflicted by another. Dr. Propst stated the officer's presence at the scene allows allegations of a variety of bad actions to be addressed: elder abuse; covert, "Kevorkian-like" assisted suicide; and maltreatment by the home health care provider. Dr. Propst stated he opposes the section of HB 383 dealing with AS 12.65 for those reasons. He said he thinks the passage of this has the potential to take away information gathering about the now-deceased patient. Dr. Propst said he relies, as state medical examiner, on the information gathered by the police on a death at home. It allows him to determine that the death was a natural one and did not involve any kind of malfeasance. Number 1250 REPRESENTATIVE RYAN stated being autopsied was a personal phobia of his, and he asked Dr. Propst what someone had to do when he or she died to avoid one. Number 1269 DR. PROPST said dying under a situation which was a natural disease process under the care of a physician in a hospital would pretty much guarantee that. Unless the family wanted some sort of post- mortem examination, he indicated an autopsy would not be necessary in that situation. Number 1290 REPRESENTATIVE DAVIS asked Dr. Propst if he knew of any strange circumstances to date in any Alaskan expected home deaths. Number 1302 DR. PROPST replied that he had investigated at least one case where elder abuse was alleged within the last two years, and said he was able to prove that allegation was unfounded. Number 1314 REPRESENTATIVE HUDSON indicated it sounded like Dr. Propst's concern was Section 3 of the bill, "No duty to notify peace officer of an expected home death." Representative Hudson asked about the bill's other provisions. DR. PROPST responded he had no objections to those other provisions, stating his objections were to Section 3. Number 1331 REPRESENTATIVE HUDSON said he understood Dr. Propst had no objection to the other provisions, but he asked if Dr. Propst could speak to the validity of the need for the other changes. DR. PROPST stated he believed that those changes are satisfactory. Number 1351 REPRESENTATIVE DAVIS noted Alaska is a large place and some areas lack police, but there may be a hospice, home health care, or a registered nurse attending an expected death. He asked Dr. Propst how those deaths were currently handled. Number 1373 DR. PROPST answered there were two points. He said that, for the most part, the police agency responsible for the area responds to every scene of death. In areas covered by the Alaska State Troopers, he believes the troopers respond to each death. Dr. Propst said other police agencies in other areas, including village public safety officers (VPSOs), also respond to death scenes. Number 1401 REPRESENTATIVE DAVIS asked if the statutes requiring the body not to be moved until a police officer has arrived and an investigation has taken place still applied. DR. PROPST answered that is correct, and he said that is the way the current medical examiner statute is structured. Number 1419 REPRESENTATIVE RYAN noted the change in Section 3, stating, "It also doesn't have to be notified in case of expected home deaths where a person authorized to pronounce deaths was in attendance or has knowledge of the death. Isn't that a physician or a licensed registered nurse, and if they are in attendance, or has knowledge and been treating this person, anticipate the death, are they not better trained to do this than a police officer?" Number 1442 DR. PROPST replied that police officers are trained in death investigation. The doctors and nurses present are trained in treating living people and not necessarily in dealing with the investigation of death. Number 1458 REPRESENTATIVE COWDERY related the story of an old-timer who died, he said, out in Western Alaska near Haines Lake. He said a Talkeetna bush pilot happened to land to check on the old guy, and the old-timer was dead in bed. The last mark on the calendar was on September 18, 1991 and the bush pilot flew in on September 21. The pilot notified the Alaska State Troopers who then came out. Representative Cowdery said he wasn't sure how the body was removed, but said it went to Fairbanks. Representative Cowdery indicated he was commenting on what he understands to be the current requirements, noting that guy was 96 years old and it was determined that he died a natural death. Number 1540 CHAIRMAN ROKEBERG noted Dr. Propst had indicated there was one incident in his experience, where, because of the investigating police officers he had been able track down some criminal activity. The chairman commented that he was receiving some head-shaking from the committee. Number 1558 DR. PROPST clarified that there was one instance in the last two years where elder abuse had been alleged but his further examination of that case found no evidence of abuse. Number 1570 CHAIRMAN ROKEBERG asked for rough statistics on the number of deaths reported to the state medical examiner in the last two years. DR. PROPST replied 900 to 950 deaths per year. CHAIRMAN ROKEBERG clarified that the Dr. Propst's testimony was that one alleged incident may have occurred out of approximately 1,900 deaths in two years. DR. PROPST replied that was what had come to mind. Number 1596 CHAIRMAN ROKEBERG asked if there was a requirement that a police officer confiscate all the medications the deceased had been taking when an officer came into the home after a death. Number 1610 DR. PROPST responded he did not know. He said he imagined it had to do with the police agency and the police agency's specific requirements for its death investigation protocol. Dr. Propst noted he did not make the rules for the police. Number 1622 CHAIRMAN ROKEBERG asked, in term of the reportage in the state of Alaska, did Dr. Propst notice a difference in the time frame and the quality of the investigative work for reports between urban areas such as the Municipality of Anchorage, where the Anchorage Police Department (APD) makes the reports, and bush areas where the Alaska State Troopers are making reports. Number 1635 DR. PROPST stated that each of those police agencies are very well- trained, and he has come to rely on both Anchorage Police Department officers and Alaska State Troopers, in terms of being an extension and giving reliable information about their findings at the death scene. Number 1648 CHAIRMAN ROKEBERG indicated there was clear evidence before the committee that a number of hospice groups and medical providers, for example, hospitals and assisted living facilities, were examining ways to facilitate the concept of "expected death." He also added the review the state has done (indisc.) Comfort One Program [the Alaska DNR (Do Not Resuscitate) Program, also known as the Alaska Comfort One Program]. Chairman Rokeberg stated, "I guess the issue that you wish to raise here is whether there is -- the police officer investigation is necessary. You claim it is necessary when there has been a - a procedure created by this legislation to allow for not reporting, is that correct?" Number 1685 DR. PROPST replied that was correct. He stated he feels the police officer's visit at the time of death provides a final check and balance on the system. Number 1691 REPRESENTATIVE GENE KUBINA referred to the case of alleged elder abuse being discussed and he asked if it had been the police officer who had given Dr. Propst a report of abuse. DR. PROPST answered in the affirmative. Number 1701 REPRESENTATIVE KUBINA stated then that the police officer had seen something when the officer went out there that made him or her think that there was some abuse. DR. PROPST answered in the affirmative. REPRESENTATIVE KUBINA said then that was found to be not the case. Number 1715 REPRESENTATIVE DAVIS asked Dr. Propst if he knew of differences in the way police departments currently handle the situation. Number 1721 DR. PROPST answered in the affirmative, stating there are differences depending on the area of the state. To the best of his knowledge, the Alaska State Troopers go to the scene of a death in the areas they cover. In the Anchorage area, he said the Anchorage Police Department goes to the scene of one of these deaths. Dr. Propst said Juneau is the only area he is aware of where officers are not routinely sent to the scene of death. He said the Juneau Police Department is notified, and may or may not send an officer. Number 1750 REPRESENTATIVE DAVIS clarified for the committee that he thinks "no code," meaning no siren and no lights, is standard in most places, indicating he used the "flashing lights" analogy to indicate the differences in the ways different departments handled this situation and that he was not personally aware of anybody using flashing lights or sirens as a standard practice in this situation. Number 1772 CHAIRMAN ROKEBERG asked Dr. Propst to differentiate for the committee what type of institutional settings are allowed to be exempted from a law enforcement officer investigation of a death, noting a hospital would probably be exempt from that requirement. Number 1787 DR. PROPST added that he expected an extended care facility would be exempt from that requirement. Dr. Propst stated (indisc.) area he was concerned about is death at home or in a residence, as opposed to a place where medical care is routinely given. CHAIRMAN ROKEBERG clarified that it was death at home, and any institution would be exempt from the requirement basically. DR. PROPST replied basically yes. Number 1808 CHAIRMAN ROKEBERG gave the example of a small, assisted living facility "with just a few that are licensed in the state of Alaska," commenting that these facilities would not be required to have a law enforcement officer investigate. DR. PROPST replied that, quite frankly, he had not thought that through. CHAIRMAN ROKEBERG noted that there are a number of those facilities, particularly in urban areas of the state. Number 1826 REPRESENTATIVE RYAN asked Dr. Propst what the cost was for the state medical examiner's to perform an autopsy. DR. PROPST replied it was approximately $1,000 dollars involved in transporting the body to Anchorage, preparing it after the autopsy and transporting it back to the place of death. Number 1839 REPRESENTATIVE HUDSON noted Dr. Propst had indicated approximately 900 deaths occurred at home annually, asking if he had heard correctly. Number 1850 DR. PROPST replied that the question to which he had responded was how many deaths were reported to the state medical examiner in the last couple of years, and his answer to that question had been around 900 to 950 [per year, see Dr. Propst's previous testimony]. Number 1856 REPRESENTATIVE HUDSON noted HB 383 was speaking about those who want to die at home and who complete the expected home death registration form, which is signed by the attending physician and a copy is provided to the state medical examiner. Representative Hudson said under these and only these circumstances, he presumed at any rate, the "no duty to notify police officer" kicked in. Representative Hudson asked Dr. Propst how many of circumstances he was notified of were dealing with normally anticipated or pre- anticipated terminal life cases. He asked Dr. Propst, when he was notified, if most of the cases he was notified of were people who simply expired because of old age or illness, and how that fit within the context of HB 383. Number 1906 DR. PROPST replied that the 900 to 950 did not include the roughly 200 to 250 deaths the state medical examiner's office is notified of that are expected deaths. He said that of the 900 to 950, about a third are people who have died suddenly and unexpectedly "from apparent causes that investigation has no suspicion whatsoever and no reason to further examine." Number 1926 REPRESENTATIVE HUDSON commented that HB 383 would not exempt police officer notification in these cases; it would be only those people who wanted to die at home, who had a limited life expectancy and literally signed a form and filed a copy with the state medical examiner's office. Representative Hudson asked Dr. Propst if he still felt notification of a police officer was still necessary under those circumstances. Number 1950 DR. PROPST replied he did. Number 1958 CHAIRMAN ROKEBERG asked if the state medical examiner's office already had a procedure in place of for expected deaths, and what form did that take. Number 1965 DR. PROPST answered that an expected home death program has basically been in operation since the Office of the State Medical Examiner was created by the legislature in 1993. He said the program has varied somewhat by geographic area. Dr. Propst noted the Alaska Comfort One Program passed by the legislature a couple of years ago has now been implemented and the state medical examiner's office is utilizing the paperwork generated in that program as the expected home death registration material. Number 1993 CHAIRMAN ROKEBERG asked what the purpose and value of the medical examiner's office's expected death program was if it was not to warn the medical examiner's office about these circumstances. Number 2002 DR. PROPST replied that was exactly the purpose of the expected home death program. If there is no suspicion of foul play when the person dies and the police officer does his brief investigation, that means the medical examiner's office does not have to investigate further, saving the state money. Number 2019 CHAIRMAN ROKEBERG stated, "Therefore, Dr. Propst, you would prefer to see a police officer in the loop so that you don't have to be in the loop, is that right?" Number 2025 DR. PROPST commented that the number of police officers statewide was probably in the "tens" and his entire office staff was ten people covering the entire state. He stated he would like to (indisc.) that not everybody who is reported to the medical examiner's office receives an autopsy. Dr. Propst stated each death is investigated, but some deaths are sufficiently investigated either by the police officer or by his office's medical examiner investigators. Number 2050 CHAIRMAN ROKEBERG stated Dr. Propst was welcome to stand by if there were further questions when the committee considered HB 383. Number 2059 DEL SMITH, Deputy Commissioner, Department of Public Safety (DPS), came forward to testify. Mr. Smith said that to echo most of what Dr. Propst had said, DPS does have some concerns about this because of the checks and the balances. Mr. Smith said, noting he thought Representative Cowdery had referred to this, when he was at the Anchorage Police Department in the late 1980s the department established what was called the no-code death response for the very reasons that have been brought up that day. He said a family who has just suffered an expected death is still having problems with that, and he stated, "To have a squad car come skidding the last half a block with red lights on and people leap out with guns is not an appropriate response." Mr. Smith said the Anchorage Police Department still has that response today; they do respond to every one of those deaths, but they are aware that this is going to happen so they do the cursory check Dr. Propst referred to. The Alaska State Troopers do the same. He noted he spoke to Captain DeCapua of the Juneau Police Department, they do, they don't necessarily go out to the hospice on all of these situations, but certainly if it was an unexpected death they would respond, but he noted the Juneau Police Department is the one agency he found that doesn't respond to necessarily every one. If they've been notified by the hospice and they're comfortable with the circumstances, Captain DeCapua said they don't respond to every one. Mr. Smith said Captain DeCapua did tell him they felt they ought to be notified that it was going to occur in all situations, indicating this was so they could prevent inappropriate responses. Mr. Smith said he is certainly sensitive from his experience over the years to responding to these kinds of situations, having his officers at APD and the Alaska State Troopers respond. He said he guesses, "If you're going to change that, I just want you to be aware that that is a check and balance that occurs, and although they may be rare, there may be a circumstance where somebody's expedited on the way out that would not necessarily have occurred so quickly." He said maybe it was his suspicious mind from his business, but he thinks it is helpful to have the officer respond. Number 2150 REPRESENTATIVE COWDERY said then Mr. Smith would basically oppose this legislation. MR. SMITH said he thought yes, in the legislation's current form. REPRESENTATIVE COWDERY asked Mr. Smith if the deletion of some areas in the bill would satisfy him. Number 2165 MR. SMITH stated the only area he has discussed is Section 3 of the bill, noting he had discussed it the previous day with the bill sponsor and staff. Mr. Smith said he realized there were some situations where police officers have not appropriately responded, noting he was not exactly sure how to deal with that. He said he thought there were seven or so different forms around the state: the Comfort One Program form, the DNR form, commenting it took him a while to figure out it meant do not resuscitate, not the Department of Natural Resources. Mr. Smith indicated this meant there are things that could be done, but said he is ultimately concerned, as a police officer, that there might be something important at the scene that would tip the police officer off that this person did not go as easily as he or she might have. He noted Dr. Propst's people based in Anchorage do not get a look. Number 2211 CHAIRMAN ROKEBERG related he had the unfortunate circumstance of witnessing his father expire at his father's home in Anchorage a few years previously, after Mr. Smith had left the APD. Chairman Rokeberg stated the mortuary showed up and they had to wait approximately 1 1/2 hours for the police department because the death watch was busy that morning. He said the officers did not show up with sirens or lights, apologized for the delay, but indicated their presence was intrusive. He said they interviewed everyone in the household and confiscated his father's medications and related supplies. Chairman Rokeberg indicated his father had been suffering from cancer for several years so his death was expected situation; he said it clearly did not warrant any kind of overview by law enforcement. He stated (indisc.) totally unwarranted, and he thought that is what this bill calls for. To Representative Davis, Chairman Rokeberg noted HB 383 probably did not even belong in the House Labor and Commerce Standing Committee, but said he had some concerns about some of the language in even Sections 1 and 2 of the bill. He stated was not sure he quite understood those and asked the sponsor what he would like the committee to do. Number 2298 REPRESENTATIVE DAVIS stated he had been surprised to see HB 383 referred to Labor and Commerce as well. Representative Davis said he was a proponent of law enforcement and did not want to interfere to a degree law enforcement was reasonably uncomfortable with. Representative Davis noted HB 383's next committee of referral was the House Judiciary Standing Committee and stated he would like to see the bill moved. Representative Davis said he wanted to work with the Department of Public Safety, addressing the reasonable concerns the department might have. He indicated he thought moving the bill might help bring about a reasonable solution. Number 2357 CHAIRMAN ROKEBERG noted he was not sure he understood Section 2. In response to a note delivered by the teleconference moderator, Chairman Rokeberg announced that there were seven people who wished to testify on HB 383 via teleconference and the committee had been unaware of these witnesses until that moment. Chairman Rokeberg referred back to his question about Section 2, stating it seemed like the ability of a registered nurse to sign a death certificate was being taken away, and he asked if that was the sponsor's intention. Number 2381 REPRESENTATIVE DAVIS answered in the negative. He noted they were changing the existing statute from wording that says, "The nurse shall sign the death certificate," to, "The nurse shall provide the necessary information to the person signing the death certificate," which would be a physician. Section 2 of the bill reads: AS 08.68.395(b) is amended to read: (b) A registered nurse who has determined and pronounced death under this section shall document the clinical criteria for the determination and pronouncement in the person's medical or clinical record and notify the physician who determined that the prognosis for the patient was for an anticipated death. The registered nurse shall provide to the person who will sign the death certificate [, WHICH MUCH INCLUDE] the (1) name of the deceased; (2) presence of a contagious disease, if known; and (3) date and time of death. Number 2390 CHAIRMAN ROKEBERG asked if that wouldn't take the ability of a registered nurse to sign a death certificate away. Number 2434 MS. DAVIDSON stated wording was changed because the "expected home death case report" forms currently used by the state medical examiner, which may be provided in the background information, have a statement that the doctor signs. This statement says the doctor agrees to sign the death certificate in the event that this home death occurs as expected. Ms. Davidson noted the statute said that if the nurse in this situation pronounces death she will sign the death certificate, yet the form sent to the medical examiner's office says that the physician signs the death certificate. Ms. Davidson indicated they decided to change the language in the statute to make it consistent with the form. Number 2427 CHAIRMAN ROKEBERG questioned whether the nurse, in the (a) section, still had the right to sign the death certificate in those circumstances. MS. DAVIDSON asked if the Chairman meant in other circumstances. REPRESENTATIVE KUBINA stated, "'In the following circumstances,' is the way I read it." Number 2441 MS. DAVIDSON stated that the physician would sign the death certificate under the expected home death circumstance. In answer to Chairman Rokeberg's question, she said it appears they would be taking away the nurse's right to sign the death certificate. She stated, "We certainly didn't mean to take anything away that they didn't want, it was more to make the requirement consistent with the way the procedure is now." Number 2458 CHAIRMAN ROKEBERG stated, "In many areas, particularly rural areas, they wouldn't be able to ..." MS. DAVIDSON responded, "As it now stands, the doctor has to sign a form authorizing ..." [TESTIMONY INTERRUPTED BY TAPE CHANGE] TAPE 98-18, SIDE B Number 0001 CHAIRMAN ROKEBERG stated, "... So Representative Davis, I - I have some time here real quickly, if you want to take some testimony." REPRESENTATIVE DAVIS answered in the affirmative, suggesting perhaps a time limit so the witnesses could condense any testimony. Number 0018 CHAIRMAN ROKEBERG apologized to the teleconferenced witnesses, indicating the committee had not been notified they were waiting to testify. Due to the next scheduled bill, he requested the witnesses limit their testimony to less than a minute, noting they would not be cut-off. He indicated written testimony could be sent to the committee from the Kenai Legislative Information Office (LIO). Number 0036 CYNTHIA ELLIOT, Staff Registered Nurse; First Choice Home Health Care, Incorporated, testified via teleconference from Kenai in support of HB 383. Ms. Elliot read from her prepared statement: I am a home health nurse. I have over five years experience as a hospice nurse working with people who are dying at home and being cared for by their family members. I also have experienced the deaths of three of my own family members at home in three different states. Nowhere have I encountered the kind of situation we have here in Alaska at an expected home death. It is unusual that law makers and law enforcers in this state feel compelled to involve police in naturally occurring, expected home deaths. Having police present in the home at the time of death is unnecessary and traumatic to family members. Death is a normal life transition. It is not a crime if it occurs naturally. Dying at home of natural causes is not police business, nor is it suspicious or unusual. Here in Alaska on the Kenai Peninsula, it has become a crime to die at home. ... Police are called to what they refer to as the "scene" and conduct a death investigation. They collect evidence by asking questions, confiscating medications and taking photographs of the deceased ... at the home. Death is a sacred life event, a once-in-a-lifetime experience for the family. This precious time should not be intruded upon by officers of the law, or anyone who is not directly involved with assisting the family to take care of the deceased and facilitate the grieving process. To ask a family member who has just witnessed the passage of their beloved to answer questions and stand by while photographs of the deceased are taken by a uniformed officer with a gun and handcuffs on his or her belt is intimidating and upsetting, and only complicates the grief process. Change the law here in Alaska to allow families to care for their loved ones at home without having to report a natural occurrence to the police. Legalize expected home deaths. Number 0113 TOM WILKINSON, Staff Nurse, Central Peninsula General Hospital (CPGH), testified next via teleconference from Kenai in support of HB 383. Mr. Wilkinson stated he was a certified critical care nurse at CPGH. He thanked Representative Davis for sponsoring this bill. He related he has unique experience in that he does pronounce people [dead] at the hospital; he said they notify the medical examiner and there is no investigation by the Alaska State Troopers. However, he related he attended the death of a personal friend at home the previous week who was 87 years old with end- stage leukemia. Mr. Wilkinson said the Alaska State Troopers and EMS (emergency medical service) did have to show up. He said he had pronounced his friend and was with the family. Mr. Wilkinson stated the responding trooper was very sensitive; the trooper basically entered the room and viewed the deceased from a distance without pulling back the covers. Mr. Wilkinson stated, "So if that's an investigation, I - I find it hard to believe that anything could have been found out by that," Mr. Wilkinson said it was more of an observation and anything more would have been an intrusion and inappropriate. The EMS knew Mr. Wilkinson, and said they didn't need to see the body because of his presence. He said the EMS took some information and left, noting they were also very sensitive. Mr. Wilkinson said he personally thinks it would be very difficult to prove murder in the case of his friend, stating, "End-stage leukemia -- short of a knife sticking out of his chest or - or a bullet wound, it would have been to prove anything or question it. I think that ... the people most qualified to pronounce death are also those who are licensed to note life or the existence of life, and I think that registered nurses are trained to note the absence of life -- so I think that they're probably the best. They also have a rapport with the family, whether it be a hospice nurse, home health nurse, or a nurse in a facility. We - we develop a close relationship with the families, and the families bring us into that inner circle, and then bringing somebody in shortly thereafter is fairly intrusive. So I - I'd like to see this changed and allowed to move forward." Number 0218 DEBRA SHUEY testified next via teleconference from Kenai in support of HB 383. She stated her 14-year-old son had died 3 1/2 weeks previously. He had been battling cancer for two years, and she said they were very fortunate they were able to be back home in Alaska because they had traveled all across the United States for her son's medical care. She said he had wanted to be around his friends and at home. Ms. Shuey said the police really were invasive when they responded. She stated, "They asked for all of his prescriptions, and I was standing there, 'You want two years of his prescriptions?' You know, 'What kind of medication do you want of his, his latest or whatever?' And they took several pictures of him, and I just felt it was really unnecessary. Everybody in this community knew my son, was medically involved, in the emergency room once or twice a week. We had the home health nurse there, and it seems to me like if they thought that that there was any problem with his death, that they would have been able to call that. We had the ... Comfort One form there, we thought everything was all prepared, and we tried to make it -- Jared (ph) died very peacefully and with dignity and he accepted his death, and I think it's very important to that, but I also think it is important to have the family members that are left afterwards. And in this particular situation, we had been through a tremendous ordeal in two years, trying to do all that we could, ask all the questions imaginable, and when this trooper showed it was like, 'Well, did I do everything? Should of I done more? What did I do wrong here?' And I don't think I needed to ask those questions an hour after my son died. And I fail now -- when I look back at that, I like to think about him dying peacefully, laying in his bed, and that he's at rest now, but what also comes in, is the trooper standing there taking pictures, asking me for his drugs, and I didn't need that at that point. Everybody knew how ill Jared (ph) was and everybody accepted it, and it was very difficult for me to go through that, and it's a memory I do not like." Number 0315 CHAIRMAN ROKEBERG asked if there were any questions for Ms. Shuey, and stated their hearts went out to her. Number 0321 LIZ SCHUBERT, Executive Director, Hospice of the Central Peninsula, testified next via teleconference from Kenai in support of HB 383. She stated she has been the hospice's executive director since 1991. Ms. Schubert stated, following her prepared statement, "Traditionally hospice care has focused on terminally ill patients and their loved ones. ... We focus on the fact that care and comfort measures will neither hasten nor postpone a death. That pain control, pain management, be it physical, emotional, spiritual or psychosocial, will be treated aggressively. That clients and families can choose where they would like to die and who will be present at the time of their death. That the client's physician consents to hospice care and agrees to sign the client's death certificate, which allows them to remain at home, a choice that most of us would prefer, should we be allowed to choose this. Also, ... families feel that by completing, signing, filling out in-home expected death Comfort One forms, enrolling in Comfort One, being enrolled with either a home health care or hospice program, having the needed support from hospice ... that they'll need to experience an in-home death with dignity with the least amount of trauma to their already bereaved family does not include a police officer arriving at the scene, photographs and an EMS that needs to be called to pronounce the death, when a registered nurse is already able to do that - is already in the home." Number 0381 MS. SCHUBERT said she would like to address a comment Dr. Propst made about people who are terminally ill, people who are expected to die, being the easiest persons to murder. She stated, from her experience with hospice care and hospice involvement with families, that these families are very prepared for the death of their loved ones, that the families would do nothing to hasten their loved one's death. She said the dying person does not want to burden his or her family any further by knowing that pictures will have to be taken of his or her body and that the person's family members will be interrogated by a police officer. Ms. Schubert stated she was in support of all sections of HB 383. Number 0420 CHIEF SHIRLEY WARNER, Soldotna Police Department, testified next via teleconference from Kenai. She stated she would be brief because Dr. Propst and Deputy Commissioner Smith already addressed some of her concerns. Chief Warner stated she is concerned with the "no duty to notify peace officer" portion of HB 383. Chief Warner indicated the reason HB 383 has so much support concerns her. She informed the committee that Ms. Shuey had left the LIO. Chief Warner stated she felt very badly for Ms. Shuey's experience, but said, "The one thing that she will never see, and - and I'm not saying that would happen, but if there was ever an allegation in the community that there was some foul play, the officers are there ... to reassure and confirm that there is not." She thinks that does happen with these cases, and she is concerned about the safeguards, and Chief Warner wondered if that was perhaps in the content of the forms that would be developed. She said, "But if there is abuse, who calls? Who calls if there's a question on foul play? The home care person? ... I don't think so." Besides the previously expressed concern about observation of the area, and noting what drugs were available, Chief Warner commented about providing protection for a person's property. She indicated she was had not been in Soldotna long enough, but said when she was in Anchorage it seemed like she dealt quite a bit with the property of deceased people, and she commented she wasn't sure who stepped in in that respect when the police did not. Number 0509 DAVID CORAY testified next via teleconference from Kenai. He said his brother had passed away in December of pancreatic cancer, noting his recent experience with the issue at hand. Mr. Coray stated that all forms relating to the expected death were filled out, and, at the time the death occurred, the paramedics, according to current procedure, did make a cursory appearance to determine that death had occurred, followed by a city policeman who made the same determination, and who then asked detailed questions of all those present. Mr. Coray said, "And while these particular police officers were tactful and sensitive, my position is that this doesn't always run across the board, and that there might be a variance in the particular police individuals involved in terms of how they approach these delicate family matters, so I'm in favor of freeing up the police from having to make these home visit and vesting these powers with the home health care agencies that are professionally trained to actually determine ... when death has occurred and to look for any evidence of foul play. ... I stated earlier, they are with the families during this transition and have a history of dealing with the transition process ... with the survivors. ... The presence of police is often viewed as a domestic disturbance, which potentially creates a social problem for the survivors in terms of dealing with - with neighbors and that sort of thing; it just ... seems invasive. It seems like we're re-inventing the wheel here by having so many agencies involved, and that a streamlining effect could take place by having just one agency determine that death did occur, and it would lend itself to a ... more stable transition for the survivors, and with that, I'd like to voice my support for HB 383." Number 0586 LORI BROWN, Administrator; First Choice Home Health Care, Incorporated, testified next via teleconference from Kenai in support of HB 383. She stated she understood Dr. Propst's and the police departments' concerns. However, she said she has seen several instances where it has really interfered with the families. She noted although the police try to be comforting, et cetera, she said she personally would feel it very invasive if her loved one died and a stranger came into her home. Ms. Brown stated she supported HB 383 and understood the concern. If any changes were to be made, she suggested the addition of something like the wording "unless there is suspect of abuse" to Section 12.65.007, no duty to notify peace officer in an expected home death. Otherwise, she would like to support the bill as it currently reads. Ms. Brown stated they have highly-trained, state-licensed nurses, and the "Kevorkian" reference really bothered her, noting Dr. Propst had mentioned it, and it had been mentioned to her by one of the local police officers. She said, "I'm sorry, we are highly regulated, the nurses have worked very hard to receive their licenses and I don't think that they would step out on any ... type of a limb to lose their licenses. And as a home health care agency, I don't think any of you have any idea the regulations that we have to go through, both state and federal." Number 0653 REPRESENTATIVE COWDERY asked if the impact of HB 383 on social security or insurance claims had been explored. He stated that if Representative Davis did not know, Representative Cowdery would like to have that information before he voted on the bill. Number 0668 REPRESENTATIVE DAVIS replied he did not have any information. CHAIRMAN ROKEBERG added, "Social security pays $250 ..." REPRESENTATIVE COWDERY replied he knew that, but said a certain criteria was also required. Number 0678 REPRESENTATIVE KUBINA made a motion to move HB 383 out of committee with individual recommendations and the zero fiscal note. Number 0690 CHAIRMAN ROKEBERG objected to comment that he was a little concerned about some of the language, particularly in the second section. He noted perhaps he wasn't reading it right. The Chairman indicated he hoped Representative Davis would work with the DPS to clean this up before it came to the House Judiciary Standing Committee. Number 0705 REPRESENTATIVE DAVIS indicated the make-up of the House Judiciary Standing Committee would ensure the bill would not pass if the DPS objected highly to it. Number 0730 CHAIRMAN ROKEBERG withdrew his objection. He noted again to the teleconference witnesses from the Kenai LIO that the committee had not been aware of them until just after 4:00 p.m., apologizing for "trying to rush them along," noting that was not his intent. Number 0742 CHAIRMAN ROKEBERG stated they needed to add the term of art "with the committee's zero fiscal note attached" to HB 383, asking if the committee was all in order on the motion. Hearing no objections, Chairman Rokeberg stated HB 383 was so moved.
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