Legislature(2005 - 2006)BUTROVICH 205
02/09/2005 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB84 | |
| SB51 | |
| SB75 | |
| SB73 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 75 | TELECONFERENCED | |
| *+ | SB 73 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 84 | TELECONFERENCED | |
| += | SB 51 | TELECONFERENCED | |
SB 75-PUBLIC HEALTH DISASTERS/EMERGENCIES
CHAIR FRED DYSON announced SB 75 to be up for consideration.
DR. RICHARD MANDSAGER, Director, Division of Public Health,
Department of Health & Social Services (DHSS), proceeded with a
20-minute slide presentation focusing on the public health
system. He relayed a quote from "The Institute of Medicine,"
which says, "Public health is what we as a society do
collectively to assure that the conditions in which people live
can be healthy."
He said there are many partners in public health and SB 75
focuses on the governmental part of the public health system -
sewage removal and treatment, safe water, clean air, removal of
lead from gasoline.
DR. MANDSAGER emphasized that public health is not health care,
but rather it focuses on populations and prevention, not
treatment. It focuses on testing kids for TB in schools and
injury prevention projects like on how to prevent logging
accidents. He gave another example from last year, when the
department addressed cruise ship sickness, which turned out to
be caused by oysters from Kachemak Bay. Public health work is
involved in places you don't expect it and problems can't be
predicted from year to year.
He said that SB 75 supports the work the Division of Public
Health does and addresses its underpinning statutory weaknesses.
He said the department is very dependent on federal funds for
preparedness work, which started being redirected last summer
and he thought it would probably continue going that way.
2:43:25 PM
DR. MANDSAGER said that tuberculosis still exists in Alaska and
work will always have to be done to minimize outbreaks. The
public health world is now worried about SARS mutating into
human-to-human transmission as three cases have been documented.
It attacks young adults and healthy people. For the last two
years the mortality rate has been 70 percent. Traditional
disease control generally involves isolation and the state would
have to quarantine people if that were to happen in the next few
years.
Bringing current law that is based on 1949 statues containing
the basic public health framework up to date in SB 75 would
allow the division to address current issues like what different
cultures expect in terms of health care and present-day chronic
disease outbreaks. Further he said that current law contains
nothing about due process. He said:
In my view this bill is all about trying to find the
right balance between the mission of protecting public
health and an individual's right to due process in the
case they think government has overreached....
2:46:41 PM
DR. MANDSAGER explained that the definition of "essential public
health services" is based on the nationally accepted definitions
from the U.S. Public Health Functions Task Force and is further
based on two reports published in the last 15 years by the
Institute of Medicine.
He related an example of blood surveys for lead dust the
department did 10 years ago in the communities around the Red
Dog Mine. When the department went back this fall and tested
people again, it found no evidence of lead absorption. He also
noted on-going concerns about asbestos in the gravel at Ambler.
2:49:39 PM
DR. MANDSAGER continued reviewing his slide presentation. The
meat of the bill is in section 8, the quarantine, isolation and
medical treatment section. Only one state in country doesn't
have adequate statutory authority to quarantine in response to a
bio-terrorism attack scenario and that is Alaska. Because the
department has authority for two diseases only, if small pox
showed up, he would have to persuade a judge that their general
governmental authorities are broad enough for them to
immediately isolate that patient.
2:52:39 PM
SENATOR ELTON asked why section 3 deletes annual TB screening in
public schools because he just mentioned that TB is still an
issue in Alaska.
DR. MANDSAGER replied that the cost benefit analysis of
screening rules doesn't justify annual testing of every
schoolteacher and child in the State of Alaska. He said the
department has been working on this issue on a regulatory basis
and this section updates the statute to reflect that.
2:54:28 PM
SENATOR ELTON asked if it reduces the cost to districts.
DR. MANDSAGER replied yes.
CHAIR DYSON asked if he could still do what was necessary by
regulation.
DR. MANDSAGER replied yes.
SENATOR OLSON asked him to describe the interaction between the
Center for Disease Control (CDC) and the Public Health
Department in the case of a disease outbreak.
DR. MANDSAGER replied that the arrangement is complicated, but
works well because Alaska has a small population. The CDC has
authority on cruise ships until they dock. His division takes
over on land. He said the federal government is going to
establish a special quarantine office in Washington, D.C. to
deal with quarantine authority for disease outbreaks. Because
the communications between involved people are good in Alaska,
dealing with the cruise ship industry has worked well so far.
2:56:36 PM
SENATOR OLSON asked if it is possible to quarantine a cruise
ship without it docking.
DR. MANDSAGER replied yes and in that case the CDC has
authority.
SENATOR OLSON asked if the CDC has any problems working within
the Alaskan constitution.
DR. MANDSAGER replied that he didn't see any.
SENATOR OLSON asked if it would be more advantageous for a new
lab to be built in a more central location than Fairbanks since
most aircraft heads toward Anchorage.
DR. MANDSAGER replied that that question gets to the core of the
next bill up for consideration [SB 73] and the debate about
sample processing is important. Some testing for human viruses
can get to Fairbanks fast enough to diagnose quickly. That could
be a problem if there weren't many flights between Anchorage and
Fairbanks daily.
SENATOR OLSON said that time is of the essence in a rabies case
in Dutch Harbor.
DR. MANDSAGER replied that the biggest risk from Dutch Harbor is
getting to Anchorage, not to Fairbanks. The biggest issue is
getting the sample from anywhere in rural Alaska to a hub in the
first place. He said the Governor's office had prepared an
amendment that the Department of Law and the Office of Public
Advocacy had agreeable on.
SENATOR WILKEN moved to adopt Amendment 1 that was prepared by
Dr. Mandsager as follows:
AMENDMENT 1
TO: SB 75
Page 13, line 28: Delete all material following "g"
through page 13, line 31
Page 14, line 1: Delete "the office of public advocacy
to provide a guardian ad litem for the individual."
Page 17, following line 14: Insert: "Sec. 18.15.389.
Representation; guardian ad litem. An individual who
is the respondent in proceedings under AS
18.,15.375(e) or 18.15.385 has the right to be
represented by counsel in the proceedings. If the
individual cannot afford an attorney, the court shall
direct the public defender agency to provide an
attorney. The court may, on its own motion or upon
request of the individual's attorney or a party,
direct the office of public advocacy to provide a
guardian ad litem for the individual."
There were no objections and Amendment 1 was adopted.
3:02:32 PM
SENATOR ELTON moved to adopt Amendment 2.
AMENDMENT 2
TO: SB 75
Page 6, line 17: After (4) the transportation of dead
bodies, insert "except that the commissioner may not
require that a dead body be embalmed unless the body
is known to carry a communicable disease or embalmment
is otherwise required for the protection of the public
health or for compliance with federal law;"
SENATOR GREEN objected for discussion purposes.
SENATOR ELTON explained that Amendment 2 was prepared due to
another bill he co-sponsored with the chairman that provides
that transportation of dead bodies doesn't require a waiver
process. Families of members of some faiths don't believe in
embalming and want bodies buried in the Holy Land or next to
relatives in other states that require embalming before they can
be shipped out. Currently waivers have been issued in these
circumstances, but that is not in statute. The amendment
provides that the bodies can be transferred unembalmed unless
there is a public health risk. Adopting this amendment means
they would not have to take up the separate bill.
3:04:44 PM
DR. MANDSAGER said he had no objection to Senator Elton's
amendment.
CHAIR DYSON said he understood that bodies are sealed and there
are no public health issues by not embalming them.
DR. MANDSAGER added that dry ice is available today in a way
that it wasn't when the statute was written several decades ago.
SENATOR GREEN remarked that a member of the other body ran into
problems in transporting a body across state lines and asked how
transportation could be assured.
DR. MANDSAGER replied that federal law covers jurisdiction
across state lines and this clause would be okay. He had not
done a thorough study of how this would interact with all other
states' statutes, however.
SENATOR GREEN noted that there was no fiscal note.
3:06:55 PM
SENATOR ELTON added that SB 39 on this same issue had no fiscal
note either.
SENATOR OLSON asked if any disease had ever been spread by an
unembalmed body.
DR. MANDSAGER replied that he was not aware of any.
CHAIR DYSON noted there were no further objections and Amendment
2 was adopted.
3:08:29 PM
NATHAN JOHNSON, Division Manager, Anchorage Municipal Department
of Health and Social Services, supported SB 75. He said the
state statutes are antiquated and it is imperative to update
them for bioterrorism, avian flu and the entire scope of
present-day public health concerns.
3:10:34 PM
ROD BEATTY, President, Alaska State Hospital Nursing Home
Association (ASHNHA) supported SB 75 and the fact that it takes
care of public health before anything serious happens. He
especially praised spelling out privacy issues surrounding a
public health emergency.
3:12:00 PM
CHAIR DYSON asked Dr. Mandsager to explain the religious
treatment of tuberculosis that is repealed in section 12.
DR. MANDSAGER deferred to Dan Branch, Senior Assistant Attorney
General Department of Law, who explained that SB 75 upgrades the
chapter that currently deals with tuberculosis and it was not
the intent to implicate religious beliefs with quarantine
isolation testing.
SENATOR GREEN moved to pass CSSB 75(HES) from committee with
individual recommendations and fiscal note. There were no
objections and it was so ordered.
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