Legislature(1993 - 1994)
04/05/1993 09:20 AM Senate STA
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATOR LEMAN introduced SB 145 (POSITION OF STATE MEDICAL EXAMINER) as the next order of business. BETTY HARGRAVE, staff to the Senate Health, Education & Social Services Committee, read into the record a statement by the committee chair, Senator Steve Rieger. Currently, a coroner determines whether post mortem examinations are necessary, physicians conduct the post mortem examinations under a fee for service arrangement, and the Department of Health and Social Services pays for the exams and associated costs. SB 145 creates a new position of state medical examiner in the Department of Health and Social Services. It provides that coroners may request the state medical examiner, under regulations to be adopted by the department, to conduct an external and/or internal examination of the body and to take other appropriate actions to determine the cause of death and to certify it. It is the expectation of the Senate HESS Committee that a state medical examiner will be able to reduce the total number of post mortem exams performed by eliminating unnecessary exams. Number 225 SENATOR LEMAN asked if there was any existing procedure to restrict the number of post mortem exams. MS. HARGRAVE answered that at this time, the court system orders the autopsy and the Department of Health and Social Services has no choice as to whether or not they perform it. Number 245 DR. PETER NAKAMURA, Director, Division of Public Health, Department of Health and Social Services, explained that for any determination of death, perhaps related to a crime or a public health medical issue, the program allows that determination to be made. Without this service, many crimes and many public health issues would go unaddressed and unidentified. He said they have a good system in place for making these determinations. However, the monies made available to support this program have been inadequate for the past eight years. It is projected that without additional resources they could experience a shortfall of $250,000 this year. The department's response to the absence of adequate funding to run the program is to try to control these expenditures. They feel that by having a medical examiner system in place they would have the opportunity to have the fiscal responsibility in the same location as the responsibility for determining who should and who should not have an autopsy performed. Dr. Nakamura related that the State of Alaska ranks the highest in the percentage of death autopsies. Part of this is explained by the higher number of deaths that occur outside of hospitals. However, even with that adjustment, Alaska is still third in the nation in terms of the frequency of examinations. Dr. Nakamura noted that the bill calls for a licensed physician, but he stressed the importance of having a licensed forensic pathologist. Number 355 SENATOR TAYLOR asked if there was a definition to the phrase "cause of death." AL ZANGRI, Bureau of Vital Statistics, Department of Health and Social Services, responded there are two issues when a death occurs. The first is the manner of death and that is a legal determination that addresses the question and the coroner is responsible for answering. The second issue is the cause of death and that is a medical question. The problem that the system has right now is that there is nobody internal to the system that is medically qualified to make cause of death determinations and the department has to contract out for all cause of death. Number 460 SENATOR TAYLOR commented that he is in favor of the bill because he wants a system that works more efficiently than the current system, but he is concerned that there will only be one medical examiner and that medical examiner is going to have to rely heavily upon somebody at another site, otherwise they will have to continue shipping bodies to other locations to determine the cause of death. DR. NAKAMURA said they will still have contractual arrangements with the medical forensic pathologists in the state. By having an individual who is responsible for this program, their hopes are that there will be enough communication and enough control of the program so that those forensic pathologists under contract will be working very closely with the state medical examiner system. Number 485 ART SNOWDEN, Administrative Director, Alaska Court System, stated the court system's support for SB 145. Mr. Snowden said there are a number of magistrates in rural Alaska that are charged under present law with being coroners and that there must be a cause of death stated. So there is someone who is completely untrained in medicine trying to make a determination on the cause of death. Because magistrates are not capable of giving medical diagnosis on unattended deaths, the court system seeks autopsies which creates tremendous problems in rural Alaska. Mr. Snowden pointed out that approximately 35 to 40 states have medical examiner types of organization. He said he believes that Alaska should go to a medical examiner system because the judicial branch of government is not qualified to make those medical determinations. Mr. Snowden said the bill will help save money and that it will still take care of the public safety requirements and the prosecution requirements. Number 535 SENATOR LEMAN questioned if there really would be a savings with this new system. ART SNOWDEN answered that it is projected that there will be over a $100,000 savings a year and that the savings may increase as time goes on. DR. NAKAMURA added that part of the medical examiner system will be the responsibility to train not only those within the present coroner system but physicians in rural areas to better be able to respond to these things in a way that they can short circuit some of these referrals for autopsies. By having a medical examiner in the state system, they would have the ability to liaison and coordinate with the other practitioners and other health care systems in the state. Number 570 DR. DON ROGERS, a forensic pathologist testifying from Anchorage via the teleconference network, related that he has been practicing forensic pathology in the state for the past 26 years and that he is one of three board certified forensic pathologists in the State of Alaska. Dr. Rogers stated his opposition to SB 145, saying he thinks it sets up another layer of bureaucracy and will not help anything. He said the fastest way to get a cause of death now is to do it the way they are doing it now. TAPE 93-25, SIDE B Number 015 Dr. Rogers said he thinks that Alaska's high ranking in the number of autopsies that are performed is good because he thinks Alaska is doing a better job than any other state. Dr. Rogers commented that he thinks that reductions in costs can be made in the present system, and the only savings he can see in this bill is possibly in the transportation costs. Number 080 SENATOR LEMAN asked Dr. Rogers if he had specific suggestions on ways to save money within the present system and if there would be any benefit to having the services of the forensic pathologists to be under the court system rather than under the Department of Health and Social Services. DR. ROGERS answered that a couple of years ago the court system shifted the burden of payment to the Department of Health and Social Services, and he thinks the payment function should be sent back to the court system and then everything would be in the court system. He added that it wouldn't save money, but it would streamline the system. He suggested that perhaps a fee structure could be developed for some kind of a limited autopsy. ART SNOWDEN said he can see no savings under the court system. They are going to order these autopsies anyway because the regulations demand that those regulations are in the executive branch where also the expertise is. Number 175 KEN BISHOFF, Director of Administrative Services, Department of Public Safety, voiced the department's support for SB 145, saying they would support anything that could help control the costs because the department is directly impacted by doing more than 60 percent of those autopsies in their facilities. Mr. Bishoff urged support of the Governor's amendment for the crime lab related to the impact from this work which has never been funded. Because the Department of Public Safety happens to have a crime lab that is fairly well equipped for this purpose it has become the major facility in state government in recent years for this service to be provided. He noted the competition for the crime lab's services is tremendous in that they did 10 autopsies in 1988 and this year they expect to do 600 autopsies. Number 207 DR. ROGERS commented that they used to do the autopsies in the funeral homes, but when the crime lab was built, somebody decided that they needed to justify its existence, so the crime lab set the policy at the beginning. KEN BISHOFF responded that if they were doing a criminal case, the funeral parlors were not exactly the best place to keep control over the evidence so that it would withstand holding up in court. ART SNOWDEN added that he did support the crime lab and during all the testimony on the crime lab it was envisioned that autopsies would be done at the lab. ELMER LINDSTROM, Special Assistant to Commissioner Mala, Department of Health and Social Services, stated the department supports the concerns and the fiscal note of the Department of Public Safety. Number 285 There being no further witnesses wishing to testify on SB 145, SENATOR LEMAN stated it would be held over until the Wednesday meeting. He then adjourned the meeting at 10:30 a.m.
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