Legislature(2005 - 2006)BUTROVICH 205
04/26/2005 08:30 AM Senate JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| SB20 | |
| HB95 | |
| SB12 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 95 | TELECONFERENCED | |
| + | HB 81 | TELECONFERENCED | |
| + | SB 12 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | SB 20 | ||
CSHB 95(RLS)-PUBLIC HEALTH DISASTERS/EMERGENCIES
8:53:39 AM
CHAIR RALPH SEEKINS announced HB 95 to be up for consideration.
He advised the committee they were working off the document SCS
CSHB 95(STA) Version \L.
8:54:08 AM
DR. RICHARD MANDSAGER, director, Division of Public Health
(DPH), introduced HB 95. He presented an overview slide
presentation, which can be found in the bill packet.
8:56:00 AM
Slide 1
Public Health Overview
Slide 2
Public Health is not Health Care.
Slide 3
Division of Public Health Core Services
Slide 4
Preparing for a Public Health Emergency
Slide 5
Preparedness Weaknesses
Slide 6
Old Public Health Enemies
Slide 7
Traditional Disease Control
Slide 8
The Next SARS
Slide 9
Alaska Public Health Law Reform Proposal
9:02:48 AM
Slide 10
Alaska Public Health Law Reform Proposal
Slide 11
SCS CSHB 95(STA): An Act Relating to Public Health
Slide 12
SCS CSHB 95(STA): An Act Relating to Public Health
Slide 13
Sections of SCS CSHB 95(STA)
Slide 14
Intent, Administration, Powers and Authority
Slide 15
Balancing Individual Rights vs. Common Good
Slide 16
Constitutional Constraints and Protections
9:06:30 AM
Slide 17
Limitations
Slide 18
Limitations continued
9:08:23 AM
SENATOR HOLLIS FRENCH asked whether there was a provision in HB
95 for seeking a court order at the same time they would impose
an immediate risk protocol.
MR. DAN BRANCH, attorney, Department of Law (DOL), answered the
question. There is a provision for a court order. Page 14, line
10 states "within 24 hours after implementation of the emergency
administrative order, the department shall notify the superior
court by filing a petition under (d) of this section that also
alleges that the emergency action was necessary to prevent or
limit the transmission of a contagious or possibly contagious
disease to others that would pose an immediate threat to the
public health."
9:09:53 AM
DR. MANDSAGER continued the slide presentation.
Slide 19
Summary of Due Process and Penalties
Slide 20
State Quarantine Authority
DR. MANDSAGER offered an amendment to the committee, which
clarifies when the state could be sued.
9:12:22 AM
A M E N D M E N T 1
Page 2, line 21, following "by":
Insert "negligent"
Page 2, line 22, following "state employee":
Delete "and"
Insert ", or"
Page 2, line 22, following "if":
Delete "the"
Insert "a state"
9:16:08 AM
Amendment one passed unanimously.
9:17:00 AM
SENATOR GRETCHEN GUESS noted Page 2 lines 22-25 discuss gross
negligence and intentional violations. She asked the reason HB
95 does not include actual damages.
DR. MANDSAGER said that was debated vigorously during the House
hearings. The employee of the Department of Health and Social
Services (DHSS) has very limited authorities. The court will be
involved 48 hours into the emergency and will be supervising any
quarantine and isolation authority. There is an incredibly
limited risk of gross negligence happening before the court is
involved.
SENATOR GUESS asked the reason actual damages were not
considered. She said if a traveler were to be mistakenly held in
Alaska due to gross negligence, that person should be able to
recoup all of the extra costs sustained by missing their travel
arrangements.
DR. MANDSAGER could not remember a debate on that question.
9:19:59 AM
CHAIR SEEKINS stated airplanes often get delayed due to
mechanicals. He agreed with the $500 per day limit on expenses.
SENATOR GUESS asserted airlines would at least get the person on
another flight without having to pay extra.
CHAIR SEEKINS suspected the person delayed by quarantine would
be extended the same courtesy by the airlines.
9:21:21 AM
SENATOR GUESS referred to Section 4, paragraph 7 and asked Dr.
Mandsager to explain the word "surveillance."
DR. MANDSAGER stated DPH does not use the word "surveillance" in
the same manner as the DOL does. Surveillance is used in the
context of watching disease incidents in order to identify
health information. Due to privacy protection laws and
departmental policy the DPH does not release detailed
information about the person being diagnosed.
9:23:54 AM
DR. MANDSAGER stated his job is to provide data to policy makers
so that they can debate the issues.
9:24:50 AM
SENATOR GENE THERRIAULT asked whether the committee should
consider changing "surveillance" to "surveillance of clinical
data."
9:25:40 AM
MS. DEBORAH ERICKSON, deputy director, DPH, advised the term
"surveillance" is commonly used in public health practice and it
does refer to monitoring of health conditions in communities.
SENATOR GUESS asked Dr. Mandsager the statute or regulation that
requires them to hold a person's medical information private.
DR. MANDSAGER answered it was in AS 18.15.355-395.
9:27:54 AM
DR. MANDSAGER added the other protection is the federal Health
Information Portability and Accountability Act (HIPAA). He said
there are very rigid rules for those who deal with identifiable
health information and protecting the confidentiality of such.
SENATOR GUESS stated for the record "identifiable health
information" is information that can be tracked back to a
person.
SENATOR FRENCH asked whether radiation would be used in any
stage of a quarantine process to treat an infected individual,
or decontaminate any areas.
DR. MANDSAGER said no. The reason hazardous materials are
included in HB 95 is because there are situations such as
Chernobyl. In a radiation accident people exposed can become a
risk to others.
9:29:47 AM
SENATOR GUESS asked why Section 4 paragraph 11 does not include
the federal government.
DR. MANDSAGER agreed the federal government should be included.
CHAIR SEEKINS commented it is clearly implied.
9:31:30 AM
MARIE DARLIN, AARP testified in support of HB 95.
9:32:47 AM
MICHAEL MACLEOD-BALL, director, Alaska Civil Liberties Union,
(AkCLU) said he does not oppose HB 95 but does have some
concerns about the level of authority granted to the state. He
asked the committee to consider adding a definition for the term
"surveillance." He expressed concern there is no definition of
the term "substantial risk to public health." During dire
circumstances no one will question the government's authority to
act but when the issue is unclear the government should not have
the authority to isolate someone against their consent. Without
a clear definition, the court will not have enough information
to determine whether the authority exists.
9:35:26 AM
MR. MACLEOD-BALL continued the DPH believes the phrase
"substantial risk to public health" defines itself. The AkCLU
believes the legislature should define the phrase in order to
assist the court in their decision about whether a risk to
public health exists.
9:37:59 AM
SENATOR THERRIAULT pointed out Page 13 line 4 and line 21
clarifies the direction for the court. The Senate State Affairs
Standing Committee addressed that concern and set a higher
threshold to prove a person is clear of the disease and are no
longer contagious.
DR. MANDSAGER agreed with Senator Therriault. In order to ask
that someone be quarantined the affidavit has to be very
specific. He said when the DPH considers isolation and
quarantine HB 95 will require that they consider every other
method first. Ordinarily a person will be quarantined in their
home. HB 95 contains much specificity that the DPH must consider
before imposing on a person's individual liberties.
9:41:23 AM
MR. NATHAN JOHNSON, division manager, DPH, testified in support
of HB 95. He asserted most of Alaska's public health statutes
are antiquated. It is imperative that Alaskans be prepared for a
serious public health outbreak. He said the task of defining
"public health risk" is a very difficult task because nearly
every disease first presents with flu-like symptoms. Global
travel and mutations create many different infectious diseases.
Creating too stringent a definition could block the DPH from
action on a future event.
9:44:05 AM
MR. JOHNSON continued two weeks ago when Anchorage set up an
emergency operations center to respond to a bio-terrorism
infectious disease scenario they quickly came up against issues
of emergency powers. It became apparent current statutes are
inadequate and fail to provide guidance. HB 95 will help provide
and protect individual rights.
9:45:12 AM
MS. PATRICIA SENNER, registered nurse and chairperson, Alaska
Nurses Association, testified in support of HB 95. The
Association supports the inclusion of quarantine specifications
and authorization. She expressed unhappiness with the use of the
word "hazardous" on Page 16 line 18 as it is generally used in
Occupational Safety and Health Administration (OSHA) terms and
congers up images of dangling power lines and such. She proposed
to change the wording to "poisonous or radioactive."
9:49:30 AM
CHAIR SEEKINS suggested the term "hazardous material" includes
"radioactive material."
9:51:12 AM
DR. MANDSAGER affirmed the DPH tried to write the language broad
enough to include every possible scenario and also narrow enough
to not intrude into people's lives. He said he believes the
intent is stated clearly.
CHAIR SEEKINS closed public testimony.
SENATOR GUESS noted Page 13 discusses the petition to the
courts. She asked whether the confidentiality clause covers
court records.
DR. MANDSAGER admitted that was a good point.
MR. BRANCH said HB 95 does not cover that but the court system
routinely works with confidential files.
SENATOR GUESS asked whether there is a requirement clearly set
forth for the court to maintain confidentiality of DPH files.
MR. BRANCH directed the committee members to Page 15 line 4,
which lists the hearing rights of individuals. The individual
can elect to have the hearing open to public, which means
otherwise it will be closed and therefore provide
confidentiality.
SENATOR GUESS asked the penalty for violation of confidentiality
in the court system.
9:55:39 AM
MR. BRANCH stated he was not aware of a provision for that.
DR. MANDSAGER asserted quarantine and isolation are rare. The
DPH has sought quarantine and isolation authority twice in the
past ten years.
SENATOR CHARLIE HUGGINS asked whether there were any breaches of
confidentiality within the DPH.
DR. MANDSAGER stated he is not aware of any.
SENATOR THERRIAULT asked the general penalty if confidentiality
is breached by DPH.
9:57:38 AM
DR. MANDSAGER directed the committee to Page 9 subsection (c)
and (d). DPH individuals are subject to the criminal penalties
as listed under AS 18.15.365. Additionally there are federal
penalties for violating the HIPAA statutes.
SENATOR GUESS clarified her question regarded the penalties of
individuals in the court system since HB 95 specifically
references the court's authority to decipher information.
MR. BRANCH detailed Page 16 lines 24-29 provides a general
criminal penalty for anyone who knowingly violates the provision
of the isolation and quarantine statute.
10:00:57 AM
SENATOR FRENCH speculated the case would not be filed like a
sealed record since it would be a matter of public concern.
MR. BRANCH reiterated since the respondent has a right to elect
the court proceedings be open that infers otherwise the
proceedings will be closed. A reporter would not be able to look
at the filings to see whether there was an isolation and
quarantine petition filed.
SENATOR FRENCH commented that opinion was all based on one line.
MR. BRANCH said there is no other way to allow a person to have
that election.
SENATOR FRENCH suggested the committee attempt to make a clear
statement by adding the appropriate language.
10:03:36 AM
DR. MANDSAGER said the model act, which was developed out of a
national consultation looking at states' statutes across the
country, doesn't include a secrecy provision. Confidentiality is
important but the public process is also important. The reason
for ex parte process in HB 95 is to allow for expediency during
an emergency.
SENATOR GUESS expressed concern that a person's entire health
information would be open to the public.
DR. MANDSAGER answered because of HIPAA the DPH would only be
listing in the affidavit the necessary information that pertains
to the public risk factor.
10:07:49 AM
SENATOR GUESS noted Page 12 line 13 says "the department may
isolate and quarantine individuals..." She asked the reason it
is not the commissioner or commissioner's designee.
DR. MANDSAGER explained the last 50 years of experience in DPH
proves they have handled things exceptionally well. Their
regulations list specifically who the individual is that would
be responsible. The statute states the only people who can
request an order are the state medical officer.
10:09:08 AM
SENATOR THERRIAULT referred to Page 9, lines 4-19 and asked
whether the language applies only to individuals in the DPH.
DR. MANDSAGER answered yes. He said HIV data is kept on a
separate computer that is not connected to the Internet. Only
certain people have access to the data files. The DPH collects
data through voluntary means and if confidentiality was ever
breached they would lose their partner relationships and
everything would fall apart.
10:12:00 AM
SENATOR THERRIAULT asked whether the persons referred to on Page
16, line 24 would be exclusively from DPH.
MR. BRANCH inferred it was not the intent to include others,
only those within the department. Subsection (l) requires the
department to adopt regulations to protect as much as possible
the privacy rights of individuals subject to isolation and
quarantine.
SENATOR GUESS asked for clarification to whom the statute is
referring to on Page 16, line 24.
MR. BRANCH explained it is directed towards department personnel
as opposed to persons outside the department.
DR. MANDSAGER added the people who violate confidentiality would
only be court people or those within DPH.
10:15:01 AM
SENATOR GUESS asked whether the DPH collaborates with local
municipalities when carrying out isolation and quarantine
procedures.
DR. MANDSAGER said they do not.
SENATOR GUESS asked whether HIPAA oversees stipulation in
isolation and quarantine status.
DR. MANDSAGER did not know.
10:17:17 AM
SENATOR FRENCH said he sees a real tension between the
definitions of the crime "knowingly disclosing identifiable
health information" on Page 9 and the petition that is filed on
Page 13 and the definition of "identifiable health information."
The public has some right to know when the state is taking
action to quarantine someone. He suggested clarifying by stating
the petition is confidential.
10:18:50 AM
CHAIR SEEKINS said he does not see that conflict.
MR. BRANCH asserted there is an effort in HB 95 to distinguish
between identifiable health information and information in
general terms.
DR. MANDSAGER commented given enough cases, it couldn't be
secret because the concern of the public and employers would be
such. At some level the issue of confidentiality conflicts with
the public good. On a case-by-case basis, the DPH would protect
the individual as much as possible.
10:21:35 AM
SENATOR FRENCH stated he is still not clear where the
responsibility of confidentiality lies. He asked whether the DPH
is under any obligation to tell the public.
DR. MANDAGER informed the committee the DPH recently performed a
bioterrorism exercise for the possible release of Anthrax on a
cruise ship. HB 95 clarifies the DPH would use isolation and
quarantine last. They would communicate public health notices
first. It is a step-by-step progression that would happen within
the community.
10:24:00 AM
SENATOR GUESS asked when a person submits a petition as
discussed on Page 13, how would they not be in violation of the
provisions on Page 9.
DR. MANDSAGER responded first the person has to elect to have
the hearing open. The reason the DPH would acquire the
information would be because it relates to a public health
purpose.
MR. BRANCH said when the court issues an opinion in a child-in-
need-of-aid (CINA) appeal; they use the initials or a pseudonym
name. Senator Guess's concern is that a state employee would get
in trouble for sharing information the court would need about
the individual in the petition. That is covered on Page 8, line
26 where the department is allowed to acquire and use
identifiable health information if it directly relates to a
public health purpose. The proposed AS 18.15.362 is designed to
prevent the department from gathering and using information
unnecessarily but where it serves a valid purpose they are
allowed.
10:28:16 AM
CHAIR SEEKINS closed public testimony.
SENATOR HUGGINS moved SCS CSHB 95(JUD) from committee with
individual recommendations and attached fiscal note(s). There
being no objection, the motion carried.
| Document Name | Date/Time | Subjects |
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