Legislature(2019 - 2020)BELTZ 105 (TSBldg)
03/12/2020 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB68 | |
| SB173 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 68 | TELECONFERENCED | |
| + | SB 173 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 173-LICENSE MOBILE INTENSIVE CARE PARAMEDICS
1:43:28 PM
CHAIR BISHOP announced the consideration of SENATE BILL NO. 173,
"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 stated that this is the first hearing on SB 173 and public
testimony has been noticed.
1:43:45 PM
SENATOR REVAK, speaking as sponsor, stated that SB 173 will fix
an inefficiency in the regulation of paramedics. Regulation of
the emergency medical services (EMS) system currently is split
between the State Medical Board and the Department of Health and
Social Services and this has created several problems. He
deferred further introduction to his intern.
1:44:28 PM
DUSTIN ELSBERRY, Intern, Senator Josh Revak, Alaska State
Legislature, Juneau, Alaska, introduced SB 173, paraphrasing the
following sponsor statement:
SB 173 consolidates oversight of the emergency medical
services system under a single agency. Currently,
regulation of the EMS system is split between the
State Medical Board and the Department of Health and
Social Services.
Paramedics are an essential part of a comprehensive
emergency medical services system. This bill will
transfer paramedic licensure to the department's State
Emergency Medical Services Office. The department
already has responsibility for certifying emergency
medical technicians, EMT instructors, EMT training,
ground ambulance, medevac services, and even paramedic
instructors, and paramedic training. However,
paramedics are licensed by the State Medical Board.
This bill does not change the scope of practice,
license requirements, or fee schedule for the
approximately 600 paramedics licensed 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
specialized in emergency medicine.
The bill provides for a smooth transition on January
1, 2021, with an immediate effective date for
regulations, provisions to ensure current biennial
licenses remain in effect until new regulations are in
place, and continuity of license histories with the
transfer of files and pending disciplinary cases.
The State Emergency Medical Services Office is well-
positioned to support this change with a staff of six
full-time positions, five of which are required to
have paramedic experience. Existing data systems are
ready to incorporate paramedic licensure.
Aligning all EMS services under a single agency
promotes public safety while bringing new efficiencies
to the licensure process.
1:47:26 PM
SENATOR REVAK summarized that SB 173 will transfer the housing
of paramedics from the State Medical Board to the Emergency
Medical Services Section (EMS) in the Department of Health and
Social Services (DHSS), which is where all other pre-hospital
medical care providers are housed. There has been formal support
from the State Medical Board to do this.
1:47:54 PM
At ease
1:48:02 PM
CHAIR BISHOP reconvened the meeting.
1:48:06 PM
SENATOR GRAY-JACKSON asked the sponsor if he had conversations
with any EMS employees.
SENATOR REVAK replied some people will testify today about the
negative impacts of the current system.
1:48:43 PM
MR. ELSBERRY delivered the sectional analysis for SB 173:
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, 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, 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.)
1:50:36 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 18.08.089, Authority to pronounce
death, to ensure consistent use of the term "mobile
intensive care" paramedic throughout the law.
Sec. 12 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. 13 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. 14 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. 15 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. 16 provides an immediate effective date for DHSS
to adopt regulations.
Sec. 17 provides an effective date of January 1, 2021.
1:54:04 PM
JILL LEWIS, Deputy Director, Division of Public Health,
Department of Health and Social Services, Juneau, Alaska, stated
that SB 173 will transfer oversight and licensure of the Mobile
Intensive Care Paramedics from the State Medical Board to DHSS
effective on January 1, 2021.
She advised that DHSS's Division of Public Health has broad
scope in its mission to protect and promote the public's health.
This includes preparedness for all hazards, which is the focus
of the division's Rural and Community Health Section. This
section encompasses the State Office of Emergency Medical
Services as well as health emergency response operations, Alaska
Trauma System, and the Office of Healthcare Access. This
section's mission is to ensure high quality healthcare
throughout a patient's interaction with the healthcare system.
Myriad activities ensure that qualified and well-equipped
emergency medical personal are available to respond to the
emergency medical needs of Alaska citizens and visitors. Thus,
DHSS is ideally positioned to take on paramedic licensure.
MS. LEWIS emphasized that SB 173 will make the EMS system better
and more efficient. This has been years in the making through a
deliberative process that involved hundreds of stakeholders
throughout the EMS community, she said.
1:56:27 PM
MS. LEWES began a PowerPoint: SB 173 License Mobile Intensive
Care Paramedics.
MS. LEWIS explained that transferring oversight and licensure of
Mobile Intensive Care Paramedics from the State Medical Board to
the Department of Health & Social Services will fully integrate
the EMS system and ensure it is robust, sustainable, and
resilient so it functions optimally. The State Medical Board
voted in unanimous support of this transfer on February 7, 2020.
1:58:13 PM
MS. LEWIS displayed slide 3, Aligns a fragmented system. She
relayed that the 2014 National Highway Transportation
Administration review of the Alaska EMS system recommended that
oversight of paramedics be transferred to DHSS. It found that
the split in oversight of EMS personnel "represents an
inconsistency in the state's protection of the public served by
EMS." In fact, Alaska is one of just three states that do not
have all pre-hospital providers housed under one state agency.
She said each component of the EMS system is vital to a well-
functioning system. Seamless communication is important so the
protocols and guidelines are well-informed and followed.
Transferring licensure to DHSS will benefit the system by
reducing administrative burden and ensure that paramedics only
have to communicate with one state agency for licensure,
certification, and patient-care data entry. This will make
communication among all EMS providers more efficient and improve
oversight of the entire pre-hospital system. Communication with
providers will also be more efficient when paramedics are able
to use the DHSS data system. Further, paramedics have
representation on the Governor's Alaska Council on Emergency
Medical Services, but they do not have representation on the
Medical Board.
2:00:26 PM
MS. LEWIS reviewed the bulleted points on slide 4, Protects the
public health:
square4 Aligns all emergency medical services under an agency
whose sole purpose is to ensure a comprehensive EMS
system.
square4 Allows for the full integration of paramedics into
quality initiatives such as stroke, cardiac arrest,
trauma, telehealth and community paramedicine.
square4 Medical direction by the Department of Health & Social
Services' Chief Medical officer and an EMS Medical
director's committee.
square4 Direct oversight will not change
2:02:08 PM
MS. LEWIS reviewed the organization chart slide 5 that outlined
the authority for regulation of the pre-hospital system.
Currently, the Department of Health & Social Services is the
certifying body for EMTs, ground ambulances, medevac services,
instructors and training, but not paramedics. In fact, the state
EMS Office has always been the approval body for the initial and
refresher paramedic training courses. The State Medical Board
does not approve the education for paramedics. She directed
attention to the left side of the slide, stating that the Chief
Medical Officer, the Alaska Council on Emergency Medical
Services, the State EMS Medical Director, and the EMS Medical
Directors' Committee comprise the elements of the medical
direction that oversees the pre-hospital medical care system.
Under that are the types of providers, training, instruction,
and services that the department certifies and oversees. She
directed attention to the right side of the slide, which shows
that paramedics are not regulated by DHSS. They fall under the
State Medical Board.
CHAIR BISHOP commented that the issue is not that paramedics are
not regulated, but that they fall under the jurisdiction of the
State Medical Board.
MS. LEWIS confirmed that paramedics are regulated, but not by
the Department of Health & Social Services.
2:04:00 PM
SENATOR STEVENS asked why it took so long to make what appears
to be a commonsense change.
MS. LEWIS replied this transition has been a long time in the
making. She anticipated that the history of paramedics in Alaska
would be provided during public testimony. Responding to a
further question, she said there has been no opposition to the
bill.
SENATOR REVAK posited that some paramedics would say the current
system is broken.
2:05:10 PM
MS. LEWIS displayed slide 6, Continuity during transition. She
assured the committee that DHSS and the Department of Commerce,
Community and Economic Development have been working to make
this transition seamless. Existing paramedic licenses will
transfer to DHSS and remain valid until they expire. All
paramedic files, records, and proceedings will be transferred
from DCCED to DHSS.
2:06:24 PM
MS. LEWIS stated that there will be no change to the current
scope of practice, licensure requirements, or fee structure for
the 600 paramedics in Alaska. Further, DHSS believes that the
increased caseload and associated $20,000 cost can be absorbed by
existing staff and budget so the transition will have no fiscal
impact. The existing data system needs no additional programming
to incorporate paramedics into the system. She assured the
committee that that the State EMS Office is well-positioned to
provide the organization and oversight to support this change. It
has six full-time employees, five of which are required to have
paramedic experience.
2:09:31 PM
MS. LEWIS concluded her comments saying that paramedics are an
essential part of the state's comprehensive pre-hospital system.
Aligning all these services under one agency will promote public
safety while bringing efficiencies to the licensure process.
SENATOR STEVENS asked who employs paramedics.
MS. LEWIS answered that most paramedics are employed by fire
departments and EMS Services, but they work in a variety of
settings, including as industrial paramedics for corporations on
the North Slope.
2:11:15 PM
BRIAN WEBB, representing self, Juneau, Alaska, characterized
himself as one of the old guard paramedics who has institutional
knowledge about the profession. He became an emergency medical
technician (EMT) in Anchorage in 1978. He was certified by the
national registry of EMTs because the Emergency Medical Services
Section, Division of Public Health, Department of Health and
Social Services (DHSS) did not exist at the time. The same was
true for paramedics and they were eventually housed with the
State Medical Board. There were fewer than 50 paramedics
statewide at the time and now there are more than 600. He became
a paramedic in 1980 while he was still serving as a U.S. Navy
Corpsman and returned to Alaska in 1984. He spent time working
as an EMS training coordinator at the EMS office in Anchorage,
dealing primarily with license questions and impediments. He
said that he has been striving for the past 25 years to bring
all EMS pre-hospital care solely under the DHSS with single
regulations.
2:12:32 PM
MR. WEBB stated that paramedics would not receive any pay
increases by transitioning from a licensed paramedic under the
State Medical Board to a certified paramedic under DHSS. He
recalled that some arguments have been made to keep paramedics
under the State Medical Board because they deliver advanced
procedures such as tracheal intubation and administer
intravenous medications like those given during cardiac arrest.
That argument is not valid because the EMS Section manages EMT-2
and EMT-3 certified EMS providers who deliver many of the same
medications. The EMS Section is well equipped to manage any
advanced EMS providers, he said.
MR. WEBB listed some of the benefits of moving the oversight of
paramedics to the EMS Section. First, the EMS section currently
performs research for the source documents in packets for medics
seeking initial licensure, re-licensure, and recommendations to
the Division of Occupational Licensing for licensure. Second,
transferring paramedics will allow the EMS Section to adopt
regulations to meet emerging skills and practices and procedures
that meet nationally recognized standards of care for all levels
of EMS providers. Critically, this would also give the EMS
Section the ability to provide real-time adjustments to the
scope of practice for all pre-hospital providers during declared
emergencies. Fourth, it would streamline the process of EMS
responders regarding the standing mutual aid agreements in their
compacts.
MR. WEBB highlighted that the EMS Section currently provides
some guidance for the paramedics via some EMS oversight
committees. Of the 12 members in the Alaska Council on Emergency
Medical Services (ACEMS), seven are paramedics, 11 of 12 members
of the ACEMS training subcommittee are paramedics, and all 11
are either emergency room physicians or currently EMS system
physicians in charge of paramedics. These physicians manage the
day-to-day oversight of their EMTs and paramedics, not the state
or the State Medical Board. The National Association of State
Emergency Medical Services Officials work on the EMS national
scope of practice and national compact. The EMS Section manager
is a standing member of that national committee. By contrast,
the State Medical Board does not have any councils, committees,
or working groups that examine the practices or skills for
paramedics.
MR. WEBB emphasized that the EMS Section provides a robust
investigative process to answer any allegations against the
certified EMTs. Although paramedics are currently investigated
by the board, the EMS Section is always heavily involved in any
investigations. The current EMS Section process also includes a
providers' self-reporting system that can capture unreported
issues. He offered his view that this is an important tool for
paramedics to be able to access. Most importantly, the EMS
Section is staffed by paramedics who fully understand the
paramedics' role and function. He offered his view that the
transfer will streamline the application process, including
comity for other states' applicants, training, and
recertification. All EMS functions would be housed in one
section. Finally, paramedics do not have representation on the
State Medical Board since they do not hold any seat. He offered
his view that paramedics will never have a seat on the board.
This means the current 600 paramedics practicing in Alaska do
not have any decision-making say on their professional practice.
However, the EMS Section has had a long-standing system that
allows all certified EMS professions to have input on any
regulatory changes that will affect them. He said this is
significant and all the paramedics he has polled support this
bill.
2:17:10 PM
SENATOR REVAK asked him to relay his personal story.
MR. WEBB explained that when he returned to Alaska in 1984 he
was a medic, having served as a U.S. Navy corpsman. He submitted
his application and supporting documents to the State Medical
Board to be certified as a paramedic, but was denied licensure
because the medical director of his paramedic school had died,
so nobody could verify his initial paramedic training. It took
six months to verify his paramedic training, but by then his
license had expired. This meant he had to spend two years
retaking paramedic training. He opined that these types of
problems would not exist if the paramedic function is
transferred to the EMS section. He acknowledged that even after
35 years it is still painful to talk about his licensing issues
and circumstances.
2:19:23 PM
SARA CHAMBERS, Director, Division of Corporations, Business &
Professional Licensing, Department of Commerce, Community and
Economic Development, Juneau, Alaska, spoke in support of SB
173. She said the division believes that the changes in SB 173
provide a good fit for paramedics for all the reasons that Ms.
Lewis and Mr. Webb mentioned. DHSS is structured to provide
education and oversight and the type of programming that the
DCCED is not funded to provide. She offered her view that the
EMS Section in DHSS can add a lot of value to paramedic
licensure.
ALYSIA JONES, Executive Administrator, Alaska State Medical
Board, Division of Corporations, Businesses, and Professional
Licensing, Department of Commerce, Community and Economic
Development, Juneau, Alaska, echoed Ms. Chamber's comments. She
said that as Ms. Lewis explained, it makes more sense to have
EMS services in one place. Further, as previously stated, there
is not any representation on the State Medical Board for
paramedics. She reported that the State Medical Board
unanimously supported this change during its February 2020
meeting.
2:21:09 PM
MS. CHAMBERS added that some of the difficulties that Mr. Webb
went through in 1984 no longer exist, but it is a reminder that
the licensing requirements need to be logical and attainable.
2:21:44 PM
CHAIR BISHOP opened public testimony on SB 173.
2:22:09 PM
ALEX BOYD, Paramedic; Member, Board of Directors, Alaska Fire
Chiefs Association; Assistant Chief of Training, Anchorage Fire
Department, Anchorage, Alaska, stated that he was representing
these two organizations as well as himself since he is a
paramedic. The Alaska Fire Chiefs Association supports SB 173
for many reasons mentioned already. Primarily, it will improve
efficiencies, ease workforce development and provide a
streamlined process within the same agency. He pointed out the
inefficiency of having emergency responders for fire departments
report to two different agencies. Transitioning paramedics to
DHSS oversight will alleviate this problem.
He said that as the Assistant Chief of Training for the
Anchorage Fire Department, he oversees the licensure and
certification of over 300 EMTs and 90 paramedics. All 90
paramedics have multiple certifications in the EMS Section and
the State Medical Board. The efficiencies in SB 173 will allow
the Anchorage Fire Department to reduce redundancies. He
reported that the fire department sometimes has had to wait for
the State Medical Board to act on paramedic licensures for up to
nine months, which is costly. Further, the department has
experienced delays in processing the applications for paramedics
from the last academy held nearly a year ago. By contrast, the
department has enjoyed almost instant response and certification
from the EMS Section of DHSS for the 50 people it has hired in
the last 24 months. He said he looks forward to the improvements
and efficiencies under SB 173.
2:25:25 PM
WILMA VINTON, Executive Director, Interior Region Emergency
Medical Services Council, Inc.; Assistant Chief of Emergency
Medical Services, Steese Volunteer Fire Department, Fairbanks,
Alaska, stated that she has served as a mobile intensive care
paramedic (MICP) since 2007 and an EMT since 1979. She serves as
an EMS instructor and previously as an adjunct faculty for the
University of Alaska Fairbanks paramedic program. In her work
and training roles, she regularly assists EMTs and MICPs in
acquiring and maintaining their certifications and professional
licenses.
She said moving paramedic oversight from the State Medical Board
to the EMS Section in the Division of Public Health, Department
of Health and Social Services is an excellent way to streamline
the licensing process. The move will align with the actions in
many other states. As previously mentioned, the EMS Section
already provides certification to EMTs in an efficient and
effective manner. She offered her view that adding paramedic
oversight and regulation would not stress that smooth process.
Currently, EMTs are processed within 20 days and are typically
certified within a week of testing. She said the State Medical
Board only meets to approve licenses quarterly, whereas staff in
the EMS Section perform that function daily. She said shortening
the paramedic certification time will benefit students, military
medics seeking certification in Alaska, and paramedics from
other states seeking reciprocity. She offered her view that this
move will be the first step in eliminating existing barriers to
becoming a paramedic in Alaska. She urged members to support the
bill.
2:28:03 PM
ANJELA JOHNSTON, Training Coordinator, Southeast Region, Alaska
Emergency Medical Services Council (ACEMS), Division of Public
Health, Department of Health and Social Services, Juneau,
Alaska, said she submitted a letter of support dated February
14, 2020, which read: [Original punctuation provided.]
I am writing in support of SB173 License Mobile
Intensive Care Paramedics. I currently chair the
state's EMS Training Committee, a committee of the
Alaska Council of Emergency Medical Services (ACEMS),
established in 1981 in order to advise ACEMS and the
EMS Office. We are comprised of members from across
Alaska, representing EMS educators in a variety of
rural and urban settings throughout the state.
On hearing of the introduction of SB173, our committee
unanimously and enthusiastically voted to endorse this
bill.
Some reasons for our endorsement of SB173 include:
square4 Increased patient safety in emergency medical
services (EMS) and prehospital care, made
available by having all EMS oversight under one
roof, instead of pieced out as it is currently.
square4 Cost-savings involved with streamlining functions
currently duplicated by both the Office of EMS
and the State Medical Board,
square4 The robust data collection capabilities made
available by consolidating EMS leadership,
oversight, and regulation,
square4 Less cumbersome processes for initial licensure
and license maintenance for Paramedics and
employing agencies in public safety and industry,
and
square4 A narrowing of focus by Alaska's Medical Board,
whose members could focus exclusively on
licensure of physicians and physician assistants,
further increasing patient safety across the
healthcare spectrum in Alaska.
In short, supporting this bill should be the least
controversial, most constituent-friendly non-partisan
win in front of you this session. There is no
downside, and it's the right thing for patients and
Alaska taxpayers. Most of our members, including this
writer, are Alaska-licensed Mobile Intensive Care
Paramedics, and these members offered the most vocal
and enthusiastic support for SB173.
MS. JOHNSTON said she chairs the EMS Training Committee, which
is a subcommittee of the Alaska Council of Emergency Medical
Services (ACEMS) and they voted unanimously to support SB 173.
The ACEMS Training Committee is comprised of members from all
over Alaska, including public safety, industrial EMS, rural
health aides, and private flight medevac services. She offered
her view that it was an accident of history that paramedics were
placed under the State Medical Board and paramedics have limped
along with the arrangement. She urged members to support the
bill not only to help paramedics but to help patients. In
closing, she said that SB 173 will strengthen, add efficiencies
and oversight, and resilience to the integrated system of pre-
hospital medical care statewide. She emphasized that this system
must be strong.
2:29:45 PM
CHAIR BISHOP closed public testimony on SB 173.
He asked for the anticipated timeline to process a new paramedic
license once this change is made.
MS. LEWIS replied paramedic licenses could be processed in the
same timeline that the Division of Public Health, EMS Section
has for EMTs. this ranges from five days to less than a month
once the application is complete with supporting documents.
CHAIR BISHOP asked if the timeline for license renewals is the
same.
MS. LEWIS replied license renewals take less time. She explained
that new license applications require scrutiny of all the
original documentation for education and experience. She
anticipated it would be on the shorter end of the spectrum for
license renewals.
2:31:25 PM
SENATOR STEVENS described the process as a logical transition
from working as a military [paramedic] to becoming a civilian
[paramedic].
MS. LEWIS deferred to Mr. Webb.
2:31:58 PM
MR. WEBB said the transition from a military medic to a civilian
medic is seamless in other states. With this change, if a
paramedic from Montana or California wished to come to Alaska to
work, the licensure process would be simple. He reiterated that
the current EMS automated system for certification and
recertifications is a streamlined process that only takes a few
days to accomplish.
2:33:30 PM
SENATOR REVAK thanked the individuals who spoke in support of
the bill.
2:33:46 PM
CHAIR BISHOP held SB 173 in committee for future consideration.