Legislature(2021 - 2022)BUTROVICH 205
03/02/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB21 | |
| SB78 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 21 | TELECONFERENCED | |
| *+ | SB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 21-LICENSE MOBILE INTENSIVE CARE PARAMEDICS
2:09:44 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 21 "An Act relating to mobile
intensive care paramedics; relating to duties of the State
Medical Board and the Department of Health and Social Services;
and providing for an effective date." He states his intent to
hear an overview of the bill and take invited testimony. He
asked the staff of bill sponsor Senator Revak to introduce the
bill. He noted a number of people available online to answer
questions.
2:10:43 PM
DIRK CRAFT, Staff, Senator Josh Revak, Alaska State Legislature,
said that SB 21 seeks to consolidate oversight of the Emergency
Medical Services (EMS) system under a single agency to better
provide better peer and professional oversight. This has been
years in the making through a deliberative process that involved
hundreds of stakeholders throughout the EMS community. It has
been unanimously supported by the State Medical Board and has
broad support from paramedics around the state. Currently EMS
oversight is split between the State Medical Board within the
Department of Commerce and the EMS section of the Department of
Health and Social Services (DHSS). This bill will transfer all
paramedic licensure to the Alaska Emergency Medical Services in
DHSS, which currently is responsible for certifying EMTs
(Emergency Medical Technicians), EMT instructors, EMT training,
ground ambulance and medevac services, paramedic instructors,
and paramedic training. The split arose because paramedics did
not exist in Alaska before 1974. After 1974, the term mobile
intensive care paramedic was created for the new scope of
practice in the Anchorage and Fairbanks fire departments. EMS
within DHSS did not exist in Alaska code until 1981 when the
responsibility to license and credential paramedics was placed
under the State Medical Board. In 1984 the EMS section became
fully functional; however, the paramedic licensure still stayed
under the State Medical Board.
MR. CRAFT said that SB 21 will not change the scope of practice,
license requirements, or fee structure for the approximately 600
paramedic licenses in Alaska. Medical direction will be provided
by the existing DHSS chief medical officer and the EMS medical
director's committee comprised of 11 members specializing in
emergency medicine, five of whom are required to have paramedic
experience. The EMS existing data systems are able to
incorporate paramedic licensure, making the move a seamless
transition. Transferring oversight and licensure of mobile
intensive care paramedics from the State Medical Board to DHSS
will fully integrate the EMS system and ensure it is robust,
sustainable, and resilient. Aligning all EMS services under a
single agency better promotes public health and safety while
also providing efficiencies through peer and professional
oversight.
2:13:11 PM
SETH DUGGAN, Staff, Senator Josh Revak, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis:
Sec. 1 amends 08.64.107, State Medical
Board/Regulation of physician assistants and intensive
care paramedics, to remove regulation of paramedic
licensure from the Medical Board. (See also Sec. 8.)
Sec. 2 amends 08.64.170(a), License to practice
medicine, podiatry, or osteopathy, allowing paramedics
to practice medicine to render emergency lifesaving
service under "another law" instead of under the
Medical Board's authority. (See also Sec. 6)
Sec. 3 amends 08.64.360, Penalty for practicing
without a license or in violation of chapter, to
remove paramedics. (See also Sec. 10)
Sec. 4 amends 08.64.369(d), Health care professionals
to report certain injuries, to change paramedics
licensed under the Medical Board to those licensed
under DHSS, for health care providers who must report
certain injuries to the Department of Public Safety.
Sec. 5 amends 12.55.185(11), Sentencing and Probation,
to change paramedics licensed under the Medical Board
to those licensed under DHSS.
Sec. 6 amends 18.08.075, Authority of emergency
medical technician, to allow paramedics to provide
emergency medical care. (See also Sec. 2.)
Sec. 7 amends 18.08.080, Emergency Medical
Services/Regulation, to require DHSS to adopt
regulations establishing standards for paramedic
licenses.
Sec. 8 adds a new subsection 18.08.082(a)(5), Issuance
of certificates; designations, to add regulation of
paramedic licensure to DHSS. (See also Sec. 1.)
2:14:40 PM
Sec. 9 amends 18.08.082(b), Issuance of certificates;
designations, to clarify that DHSS is the central
certifying and licensing agency for all emergency
medical services.
Sec. 10 amends 18.08.084(a), Certificate required, to
prohibit a person from practicing as a paramedic
without a license. (See also Sec. 3.)
Sec. 11 amends 18.08.086(a), Immunity from liability,
adding license because they are certified. This means
it provides immunity in 08.02, which includes
paramedics. They are not liable for civil damages
unless it's gross negligence.
Sec. 12 18.08.089(a) is amended to allow a paramedic
to pronounce someone's death if the paramedic falls
under one of the three categories.
Sec. 13 adds a new paragraph (14) to 18.08.200,
Emergency Medical Services/Definitions, to add the
definition of "mobile intensive care paramedic". (See
also Sec. 14.)
Sec. 14 Amends 29.45.050(r) to include mobile
intensive care paramedics in a municipal property tax
exemption. Emergency Medical Services are already
under this, this section just clarifies Mobile
Intensive Care Paramedics.
MR. DUGGAN noted that Section 14 is only for voluntary EMS
staff.
Sec. 15 amends 37.05.146(c)(77)(F), Definition of
program receipts and non-general fund program
receipts, to add fees for licensure of paramedics to
the list of fees collected by DHSS.
Sec. 16 repeals 08.64.366, Liability for services
rendered by a mobile intensive care paramedic (See
18.08.086, Immunity from liability, under DHSS).
Repeals 08.64.380, Medicine/Definitions to remove (3)
"emergency lifesaving service" and (4) "mobile
intensive care paramedic" (See also Sec. 12).
Sec. 17 amends the uncodified law to provide
transitional authorities: (a) A current paramedic
license issued before January 1, 2021 remains valid
until it expires under the Medical Board, is suspended
or revoked, or is converted to a license under DHSS.
(b) The Department of Commerce, Community and Economic
Development and the Medical Board will transfer to
DHSS on January 1, 2021, files of all pending
paramedic-related records and proceedings,
applications, and disciplinary actions. (c) Authority
for DHSS to adopt regulations which shall include the
conversion of unexpired paramedic licenses issued
under the Medical Board.
Sec. 18 provides an immediate effective date for DHSS
to adopt regulations.
Sec. 19 provides an effective date of January 1, 2022.
2:16:55 PM
SENATOR BEGICH said that anecdotally he has heard that the
process for EMT licensure takes a long time. He asked if this
will this speed up that process. He noted the blank pages in the
fiscal notes and asked if the bill would lead to any cost
savings.
MR. CRAFT replied that speeding up the process was one of the
primary reasons for introducing the legislation, as well to
house all these emergency medical personnel under one
professional licensing statute. The fiscal notes are zero
because the department can absorb any potential change in cost
but he would defer to the department.
2:18:24 PM
CLINT FARR, Deputy Director, Division of Public Health,
Department of Health and Social Services (DHSS), Juneau, Alaska,
said that DHSS can absorb any costs associated with the transfer
of paramedics to his division. The division already has
certification/licensure processes in place and licenses
thousands of EMTs annually, so with the number of paramedics,
the office can absorb that with current staffing and processes.
SENATOR BEGICH asked when jurisdiction transfers from the State
Medical Board, if there is a provision for public comment about
any issues with EMS services.
MR. FARR replied that the public has a way to comment through
the regulatory process. He deferred to Todd McDowell.
2:20:11 PM
TODD MCDOWELL, EMS Program Manager, Division of Public Health,
Department of Health and Social Services (DHSS), Juneau, Alaska,
answered that the medical director's committee has biannual
meetings open to the public for comment.
SENATOR REINBOLD asked if the governor's executive order to
split DHSS into two departments takes effective, which
commissioner would EMS be under.
CHAIR WILSON answered the Division of Public Health. He
clarified with Mr. Farr.
MR. FARR replied that is correct.
SENATOR REINBOLD suggested that if DHSS is bifurcated, the bill
should have conforming language. She shared that the Chugiak
Fire Department is so important to her community and asked that
they be allowed to weigh in. She would love to hear from them
and their views on the bill.
SENATOR HUGHES said that when the classification was first
created, the only place to put it was under the State Medical
Board. She asked why the change has taken so long.
MR. CRAFT replied there is a long history. Brian Webb who was a
paramedic around that time can explain.
2:23:57 PM
BRIAN WEBB, representing self, Anchorage, Alaska, said he was a
former regional EMS training coordinator. He has been involved
with this for many years. One of the issues with his generation
of medics was a feeling if they switched from licensure to
certification that would somehow diminish their stature and them
as a medical practice as a whole. His era has retired or died
off. The newer generation is looking at streamlined and easier
ways of doing things because the paramedic licensure process in
Alaska is a dramatic affair. He has been working on this for the
past 20 years. He started this process with Senator Birch over
three years ago. The paramedics have tried to do this in
different ways over the years and finally the nexus came to be
to do it legislatively.
SENATOR HUGHES said she will try to help them get it across the
finish line. Her husband was in Vietnam as a medic and was an
EMT and then a paramedic. She asked what the difference is
between an EMT and a paramedic. She observed the fiscal note
that moving the paramedics over will create a smoother pathway
for career advancement for EMTs.
MR. WEBB said that the Office of EMS is already staffed by
paramedics who already manage the training and certification as
mentioned. That will streamline process, especially for people
from out of state. It will simplify a lot of things. The subject
matter experts are already at the Office of EMS who know the
process and can streamline it for folks in the future.
SENATOR HUGHES asked him to explain an EMT vs a paramedic.
MR. WEBB said that an EMT I requires 110-160 hours of training
with no clinical experience required before certification. An
EMT I can become an EMT II with another 50-80 hours of training,
plus some additional skills and patient care verification. To
become an EMT III requires 50-80 hours of additional training
and a test. Paramedics are in classrooms for over 1,000 hours
and then after graduating from a paramedic program they spend
about 650 hours in the lower 48 riding along with an advanced
life support ambulance service. Then they take the national
registry test and apply for state licensure. It is a much longer
road with advanced skill sets compared to EMTs.
2:29:03 PM
CHAIR WILSON opened public testimony.
2:29:14 PM
WILMA VINTON, representing self, Fairbanks, Alaska, said that
she is a mobile intensive care paramedic (MICP) since 2007 and
an EMT since 1979. She is an assistant chief of EMS for Steese
Volunteer Fire Department. She is an EMS instructor and past
adjunct faculty for the University of Alaska Fairbanks paramedic
program. She assists EMTs and MICPs with acquiring and
maintaining their certifications and licenses. She has
personally gone through both processes. This move from the
Medical Board to EMS in DHSS is an excellent way to streamline
the licensing process. EMTs and MICPs work side by side, but
when she is assisting members with certifying and recertifying,
she is working with two different agencies and processes. The
state Office of EMS is already providing certification to EMTs
in an efficient and effective manner. EMTs are regularly
certified within a week of testing but definitely within 20
days. She sees no problems with MICPs being licensed in that
same timeline. The licensing under the State Medical Board can
take several months. The board only meets four times a year. The
Office of EMS has staff who work on this on a daily process.
This shortened timeframe is especially important for someone
trying to get job in Alaska as a paramedic. It will be a
seamless move and will align the MICPs with EMS as they are in
many states. This will benefit students, military leaving the
service, and those in the lower 48 seeking jobs in Alaska as
paramedics.
2:32:06 PM
RICHARD ETHERIDGE, Alaska Fire Chiefs Association, Juneau,
Alaska, said the Fire Chiefs Association supports SB 21.
Paramedics often have to be hired from out of state. It often
takes several months to get licensed in Alaska because of
licensure through the Medical Board. The delay places a burden
on a community trying to get paramedics to serve. Sometimes it
takes six to eight months. Transitioning paramedics to EMS will
shorten the timeframe of getting licenses or certificates. There
will be no decrease in quality control. It is beneficial for
fire chiefs to have one state agency to work with for continuing
education and certification. The State Medical Board voted to
support this transition and the Office of EMS is wiling to
accept the program.
2:33:56 PM
MICHAEL LEVY, M.D., EMA Medical Director, Anchorage, Alaska, was
not able to testify because of sound problems.
CHAIR WILSON asked him to submit his testimony to
shss@akleg.gov.
2:35:53 PM
CHAIR WILSON closed public testimony.
SENATOR REINBOLD noted that the next committee of referral is
Labor and Commerce and asked that the chair to get the feedback
of the Chugiak Fire Department.
CHAIR WILSON replied that the bill is not moving out of
committee today. The bill sponsor will try to get in touch with
the fire department before the bill moves out of committee.
SENATOR COSTELLO added that her staff has been in touch with the
fire department and will work to make sure their concerns are
heard.
2:36:49 PM
CHAIR WILSON held SB 21 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HSS_Dave Boswell Board Application_Redacted.pdf |
SHSS 3/2/2021 1:30:00 PM |
SHSS Medical Board Confirmation Hearing |
| HSS_Larry Daugherty Board Application_Redacted.pdf |
SHSS 3/2/2021 1:30:00 PM |
SHSS Medical Board Confirmation Hearing |
| SB 78 v. A.PDF |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 78 Sponsor Statement.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 78 v. A Sectional Analysis.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 78 Fiscal Note DCCED.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 78 |
| SB 21 version B.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sponsor Statement.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sectional Analysis.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sectional Analysis 3.2.21.pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DHSS.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DCCED.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Point Paper.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 State Medical Board Letter of Support (3.2.21).pdf |
SHSS 3/2/2021 1:30:00 PM |
SB 21 |