Legislature(2005 - 2006)BUTROVICH 205
04/27/2005 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB225 | |
| HB120 | |
| Confirmation Hearings || University of Alaska Board of Regents | |
| Board of Pharmacy | |
| Alaska Mental Health Trust | |
| Board of Education and Early Childhood Development | |
| Board of Pharmacy | |
| Board of Dental Examiners | |
| Board of Professional Counselors | |
| Alaskan Dental Hygienists Association | |
| Alaska Board of Psychologists | |
| State Physical Therapy and Occupational Therapy Board | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 225 | TELECONFERENCED | |
| += | HB 120 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HB 225-MEDICAL EXAMINERS & AUTOPSIES
CHAIR DYSON announced HB 225 to be up for consideration.
REPRESENTATIVE LESIL MCGUIRE, sponsor, explained that the
understaffed condition of the Alaskan Medical Examiners office
causes some unexplained deaths to go unexamined; it also
diminishes the state's ability to acknowledge and react to the
outbreak of communicable diseases. Last year over 1,100 cases
were filed and the office has only one state medical examiner.
His duties are multifaceted. One of the most important is
performing autopsies, but he also has to testify in court in
cases of a suspicious death. This becomes an important public
issue because a lot of autopsies are suspicious and crimes
cannot come to light and because deaths can be caused by
contagious diseases. HB 225 requires the Medical Examiner's
Office to be staffed with at least one medical examiner and one
deputy medical examiner.
CHAIR DYSON asked if staff to this office could be increased
without this legislation.
REPRESENTATIVE MCGUIRE replied that it could.
CHAIR DYSON asked if the additional position mandated in this
bill is reflected in the Governor's budget.
REPRESENTATIVE MCGUIRE replied:
It is reflected in the House version and I believe it
will be reflected in the ultimate version that comes
out of the conference committee. That is why there is
a zero fiscal note. An additional $100,000 was put in
for this position.... I think from conversations...
with members of the your body it may well have been an
oversight.
She did not want to create more government, there are few very
important areas that should be left to the state and this is one
of those areas. She did not want to see this position
contracted out or left unfilled.
CHAIR DYSON asked Dr. Mandsager if the administration has taken
a position on this bill.
DR. RICHARD MANDSAGER, Director, Division of Public Health,
Department of Health and Social Services (DHSS) testified that
he supported the bill; however he clarified that the division's
budget currently does have just enough money in it for minimal
operation by two medical examiners and he has been recruiting
for the other position for about six months now. He explained
the reason for the $100,000 increment in the Governor's budget
was to begin building the capacity of the Medical Examiner's
Office to more fully meet its missions including attempting to
answer questions from the bereaved as to why their loved one
died.
CHAIR DYSON said he understands that the administration supports
the bill and the administration has established funding for the
addition to the examiners office and the Division of Public
Health is currently recruiting the additional staff.
DR. MANDSAGER replied that that is correct.
SENATOR ELTON said this bill not only provides for a deputy, but
it also establishes his general duties and he asked if the
department would establish his duties if it had one at this time
rather than having those duties established in law as they would
be doing under this bill.
DR. MANDSAGER replied that he thought the department would
establish those duties without this bill in that case. The only
other difference this bill would make is that under current
statute the department could recruit for a second person who
might not be totally qualified to be a deputy. This bill
requires recruiting someone who is qualified to serve as a
deputy medical examiner.
1:43:29 PM
SENATOR ELTON asked whether the department has looked at the
possibility of having contract positions throughout the state to
carry out some of the duties of the medical examiner.
1:44:43 PM
DR. FRANK FALLICO, Chief Medical Examiner, Department of Health
and Social Services (DHSS), replied that the department has
considered that option and determined that it is too difficult
to find enough staff who are qualified to perform forensic
autopsies.
CHAIR DYSON said he has heard that the Medical Examiner's Office
misses the cause of some accidental deaths, particularly those
involving carbon monoxide, because it does not have sufficient
manpower to perform autopsies.
DR. FALLICO, replied:
As a matter of fact, we have investigated those deaths
very thoroughly and when an autopsy is required we do
it. I do not believe that we have missed any of those
deaths. However, I will say that they are very
difficult death determinations sometimes and they can
be missed even under the best of circumstances.
We have a problem with the transportation of bodies
and doing this sort of work within our budget.
However, we have special sensitivity to carbon
monoxide deaths. As you know, there have been quite a
few of them here under tragic circumstances and I do
not believe that we have missed any of them. However,
one sometimes does not know what one misses, if you
will, and we certainly would have a better opportunity
to pick up those accidental deaths to which I am now
deferring if indeed we had one more medical examiner
here.
You know this office really can't run with one
examiner because I am stretched to the point where I
have to triage or turn away cases that would, perhaps,
be done in other good jurisdictions. Once again, I do
not believe that we have missed any carbon monoxide
deaths that are of a level of suspicion such that
others would disapprove of us having turned them down.
CHAIR DYSON said that he has heard that the department often
gets requests to examine cases on behalf of family members whose
recently deceased relatives had made suspicious changes to their
will immediately before their deaths.
DR. FALLICO responded:
In forensic cases an autopsy is done if it will help
solve the case; it is not done solely at the request
of family members or even at the request of police or
troopers unless we both agree to do it. I always work
through the proper police or trooper agencies to see
if the investigation really warrants an autopsy. In
cases where autopsies are not warranted, I do not do
them at the request of families because that is not
the purpose of this office and it is certainly out of
the question given our current staff level.
CHAIR DYSON asked if he is correct in believing that the death
of an elderly person does not trigger a police investigation and
all that is required to close a case is a physician's signature
on the death certificate.
DR. FALLICO replied that if the death is a natural death that
occurs in a hospital, it does not trigger an investigation from
his office. If that same death occurs outside of the hospital,
there are two ways in which it can be handled. The first is
that the police will go to the home and investigate to determine
whether or not it was a natural death. If so, that death is
reported to him and he makes a determination of the cause of
death and signs the death certificate. He said that in the
great majority of cases, that does not require an autopsy and if
the family asks him for one, he tells them that he is not able
to do it. He refers them to a private pathologist who is able to
perform the autopsy.
1:52:05 PM
He said the second way involves what is called an expected home
death where paper work is set up in advance. In these cases
there is no real investigation by police and no autopsy is
performed. Sometimes with these expected home deaths, however,
the troopers disagree and they actually investigate the case,
but nothing happens with his office except that the paper work
is filled out.
CHAIR DYSON asked if the police must respond to a death that has
occurred in an assisted living home or a private home where
hospice care was provided.
DR. FALLICO responded that it depends on whether or not the
death is reported and on the individual circumstances. Assisted
living home deaths push a very sensitive button because of
certain recent deaths and issues of elder abuse. The police
certainly show up in some of those cases.
He said that in every case he reviews the paper work and makes
an independent determination about the cause and manner of death
and he will require an autopsy in some of those cases - for
example, if they die in certain nursing homes - because of the
possible political and legal pressure that may arise from the
deaths.
CHAIR DYSON supposed:
Here is a scenario that I have heard of, an 87-year
old man who has been non ambulatory for six years and
who is incompetent, miraculously decides to marry his
29 year-old personal care attendant whose boyfriend is
the supervising physician and two weeks after the
magic marriage, he ups and dies. But in the interim
his will has been changed; but arguably he has died of
natural causes and the supervising physician signs the
death certificate. Is there anything in our process
that looks at recent changes in status such as in
marriages or in wills that may make you and the
troopers decide that a case needs greater
consideration?
DR. FALLICO responded that his office is not a primary
investigation agency and would refer such a case to the primary
investigative agents and offer its assistance.
1:56:13 PM
CHAIR DYSON asked if recent changes in a will or in marital
status automatically trigger an investigation.
DR. FALLICO replied he believes that the police or troopers
would investigate such cases because that is part of their job.
He believes that they would inform him of such changes before he
made any decision regarding the case. He added that he must
ultimately rely on the judgment of the police and troopers and
if they are not willing to go forward on a case, he cannot
perform an independent investigation.
SENATOR WILKEN said he was puzzled about why this bill is
necessary if the issue was already being taken care of.
DR. MANDSAGER replied he thought the reason Representative
McGuire introduced this bill was because she believes the
department hasn't paid enough attention to making sure to has
the two positions filled. Even, if the bill doesn't pass, he
would continue to try and staff the office with two medical
examiners with the current budgetary amount and it is a bit of
an improvement over current practice in that it states very
clearly that the state needs two medical examiners. He stated,
"My personal opinion is that that's a correct statement and this
bill would put it into statute rather than leaving it as an
opinion."
2:00:50 PM
REPRESENTATIVE MCGUIRE commented that it's not uncommon for the
legislature to set out in statute a series of standards in areas
if wants to - even within the departments of the Executive
Branch there is precedent for it. She said further:
And then secondly, I would just say that I do respect
what you have to say and as I have said earlier I
tread lightly in this area, but I do think it's a
matter of such importance that it should be in
statute.
The concern that I have, Senator Wilken is that when
you look back at the history, it's been an interesting
one. There was a point in time where the Medical
Examiner Office had as many as five physicians
throughout the state that were doing autopsies. We
were rated in the top tier of medical examiner offices
in the United States. And over the years we have
simply have eliminated those positions or they have
fallen off and we have not filled them....
2:03:22 PM
SENATOR ELTON asked if the word "or" should be placed between
"Medical Examiner" and "Deputy Medical Examiner" on page 3, line
19, to form the phrase "Medical Examiner or Deputy Medical
Examiner."
REPRESENTATIVE MCGUIRE thanked Senator Elton for pointing out
the drafting error and said that the suggested corrections would
be made.
SENATOR ELTON moved on page 3, line 19, to insert "or" after
"Examiner". There were no objections and Amendment 1 was
adopted.
2:04:46 PM
DR. DON ROGERS, former State Medical Examiner, supported HB 225
saying that autopsies should be performed on all the coroner's
cases because if one solely relies on police departments and
witnesses, one will often be mislead. Accurate determination of
the cause of death is a requirement on the death certificate and
if one does not do the examination and signs the certificate
without looking at the body, one is going to be wrong in a
substantial number of cases. Medical examiners also have a duty
to alleviate the concerns of the families of the deceased.
2:07:11 PM
DR. ROGERS stated that the Medical Examiner's Office lab needs a
toxicology component because it currently is not able to perform
carbon monoxide tests.
SENATOR ELTON asked if the Office of the Medical Examiner
generally provides autopsies on the bodies of people who die in
hospital.
DR. ROGERS replied that the Medical Examiner does not perform
autopsies for natural deaths that occur in the hospital. He
explained that the law requires an autopsy for deaths that occur
under anesthesia or that occur shortly after admission to a
hospital.
SENATOR OLSON asked whether the investigation of those deaths is
a matter of the Medical Examiners discretion or if they
automatically fall under the purview of the Medical Examiner by
law.
2:09:42 PM
DR. ROGERS replied that when he worked for the Medical Examiners
Office, it performed autopsies for all deaths involving
anesthesia or a possible medical error because most of the time
the physicians and the families wanted someone besides the
hospital personnel performing the investigation. He said that
in a state as small as ours with as few deaths as we have, it is
possible to perform most, if not all, autopsies.
2:11:35 PM
SENATOR OLSON asked what level of education and experience is
required to perform the duties of the Medical Examiner and the
Deputy Medical Examiner.
DR. FALLICO replied:
The answer is to be fully qualified as a forensic
pathologist certified in the sub-specialty of forensic
pathology, one must go to medical school, obtain an MD
or a DO degree, followed by at least certification in
anatomic pathology, which is a branch of pathology and
that takes two to three years, followed then by
certification in forensic pathology and that's an
additional year of training.
Now, another way to do it would be to become certified
in anatomic pathology and clinical pathology, like I
am, followed by another year of forensic pathology.
So you know there's a long arduous course for getting
there - many years. And for a variety of reasons that
I won't get into, very very few people go into this
field. There are about 300 fully qualified forensic
pathologists practicing in the country full time.
Those are the numbers. So, with these great shortages
and so forth, we are not talking about top-rated
people. It is possible that people with lesser
training could do this work, but we've all read about
the disasters across the country in medical examiner's
offices where less-than-well-qualified people perform
the work. What we have done is set the highest
standards here no matter what, because we don't want
to go back to the old ways of doing partial autopsies,
of not weighing certain organs and having my reports
reflect that certain things in the past that may have
been acceptable, but today I would be criticized for.
When I get up on the stand - you probably all know me
- you read about what I do. I was just down there in
Juneau earlier this week and I'm under very, very
detailed cross examination with experts that are flown
up here by the defense and others to certify my work
and try and attack defense. So, I feel what we need
are fully qualified people as I've described in those
qualifications.
SENATOR OLSON asked how this bill would apply to foreign
graduates and that, "Obviously, there are pathologists there."
DR. FALLICO answered that he is a foreign medical graduate from
the University of Bologna. As long as the graduate passes the
qualification to practice medicine in the United States, and
specifically holds a valid bona fide state license, he is just
as qualified as anyone else.
SENATOR WILKEN moved to report SCS HB 225(HES) out of committee
with individual recommendations. There were no objections and it
was so ordered.
| Document Name | Date/Time | Subjects |
|---|