Legislature(1993 - 1994)
04/07/1993 03:00 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
April 7, 1993
3:00 p.m.
MEMBERS PRESENT
Rep. Cynthia Toohey, Co-Chair
Rep. Con Bunde, Co-Chair
Rep. Al Vezey
Rep. Bettye Davis
Rep. Irene Nicholia
Rep. Tom Brice
MEMBERS ABSENT
Rep. Gary Davis, Vice Chair
Rep. Pete Kott
Rep. Harley Olberg
COMMITTEE CALENDAR
HB 30: "An Act amending the definition of `municipality'
for the purposes of the human services community
matching grant program."
PASSED WITH INDIVIDUAL RECOMMENDATIONS
SB 71: "An Act relating to emergency medical service; and
repealing obsolete references to the Statewide
Health Coordinating Council and health systems
agencies."
HEARD AND HELD - NO ACTION TAKEN
WITNESS REGISTER
ANNETTE KREITZER
Legislative Assistant
Sen. Loren Leman
Alaska State Legislature
State Capitol, Room 113
Juneau, Alaska 99801-1182
Phone: (907) 465-2095
Position statement: Testified in support of SB 71
MARK JOHNSON, Chief
Emergency Medical Services Section
Division of Public Health
Department of Health and Social Services
P.O. Box H
Juneau, Alaska 99811-0616
Phone: (907) 465-3027 work
Phone: (907) 463-5807 home
Position statement: Testified in support of SB 71
MATT ANDERSON, Training Coordinator
Emergency Medical Services Section
Division of Public Health
Department of Health and Social Services
P.O. Box 110616
Juneau, Alaska 99811-0616
Phone: (907) 465-3141 work
Phone: (907) 789-1549 home
Position statement: Testified in support of SB 71
LARRY FANNING, Fire Chief
Capitol City Fire & Rescue
Alaska State Fire Chiefs Association
820 Glacier Ave.
Juneau, Alaska 99811-0616
Phone: (907) 586-5322
Position statement: Testified in support of SB 71
ELMER LINDSTROM
Special Assistant to the Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
Phone: (907) 465-3030
Position statement: Answered questions on SB 71
TODD HUTTENLOCHER, M.D.
Co-Medical Director
Emergency Medical Services Section
Division of Public Health
Department of Health and Social Services
P.O. Box 3739
Juneau, Alaska 99801
Phone: (907) 586-8447 work
Phone: (907) 789-4919 home
Position statement: Testified in support of SB 71
PREVIOUS ACTION
BILL: HB 30
SHORT TITLE: HUMAN SERVICES MATCHING GRANTS
BILL VERSION:
SPONSOR(S): REPRESENTATIVE(S) BRICE,Sitton,Therriault,
Davies,James
TITLE: "An Act amending the definition of `municipality' for
purposes of the human services community matching grant
program."
JRN-DATE JRN-PG ACTION
01/04/93 32 (H) PREFILE RELEASED
01/11/93 32 (H) READ THE FIRST TIME/REFERRAL(S)
01/11/93 32 (H) CRA, HES, FINANCE
01/15/93 92 (H) COSPONSOR(S): DAVIES, JAMES
02/09/93 (H) CRA AT 01:00 PM CAPITOL 124
02/09/93 (H) MINUTE(CRA)
02/10/93 284 (H) CRA RPT CS(CRA) 5DP 2NR
02/10/93 284 (H) DP: BUNDE, DAVIES, WILLIS,
TOOHEY, OLBERG
02/10/93 284 (H) NR: SANDERS, WILLIAMS
02/10/93 284 (H) -2 ZERO FNS (DCRA, DHSS) 2/10/93
02/22/93 (H) HES AT 03:00 PM CAPITOL 106
03/15/93 (H) HES AT 03:00 PM CAPITOL 106
03/15/93 (H) MINUTE(HES)
03/16/93 (H) HES AT 03:30 PM CAPITOL 106
03/17/93 (H) HES AT 03:00 PM CAPITOL 106
03/17/93 (H) MINUTE(HES)
04/02/93 (H) HES AT 03:00 PM CAPITOL 106
BILL: SB 71
SHORT TITLE: EMERGENCY MEDICAL SERVICES SYSTEM
BILL VERSION: CSSSSB 71(FIN) AM
SPONSOR(S): SENATOR(S) LEMAN,Ellis,Taylor,Duncan,Donley,
Kerttula,Little,Zharoff,Lincoln
TITLE: "An Act relating to emergency medical services; and
repealing obsolete references to the Statewide Health
Coordinating Council and health systems agencies."
JRN-DATE JRN-PG ACTION
01/27/93 170 (S) READ THE FIRST TIME/REFERRAL(S)
01/27/93 171 (S) HES,LABOR & COMMERCE,FINANCE
02/26/93 503 (S) SPONSOR SUBSTITUTE
INTRODUCED-REFERRALS
02/26/93 503 (S) HES, LABOR & COMMERCE, FINANCE
03/08/93 (S) HES AT 02:15 PM BUTROVICH
ROOM 205
03/09/93 688 (S) HES RPT 3DP 2NR
03/09/93 688 (S) FISCAL NOTE (DHSS)
03/09/93 688 (S) ZERO FISCAL NOTE (DCED)
03/10/93 723 (S) L&C REFERRAL WAIVED
03/15/93 (S) FIN AT 08:30 AM SENATE FIN 518
03/22/93 (S) RLS AT 12:00 PM FAHRENKAMP
ROOM 203
03/22/93 895 (S) FIN RPT CS 7DP SAME TITLE
03/22/93 895 (S) LETTER OF INTENT WITH FIN
REPORT
03/22/93 895 (S) ZERO FISCAL NOTE TO CS
(S.FIN/DHSS)
03/22/93 895 (S) PREVIOUS ZERO FN APPLIES
(DCED)
03/23/93 912 (S) RULES 2 CALENDAR 1NR
3/23/93
03/23/93 913 (S) READ THE SECOND TIME
03/23/93 913 (S) FIN CS ADOPTED UNAN CONSENT
03/23/93 914 (S) ADVANCE TO 3RD RDG FAILED
Y11 N9
03/23/93 914 (S) THIRD READING 3/24/93 CALENDAR
03/23/93 916 (S) COSPONSOR(S): TAYLOR, DUNCAN,
DONLEY,
03/23/93 916 (S) KERTTULA, LITTLE, ZHAROFF
03/24/93 929 (S) READ THE THIRD TIME CSSSSB
71(FIN)
03/24/93 929 (S) RETURN TO SECOND FOR AM 1
UNAN CONSENT
03/24/93 930 (S) AM NO 1 ADOPTED UNAN CONSENT
03/24/93 930 (S) AUTOMATICALLY IN THIRD READING
03/24/93 930 (S) (S) ADOPTED FIN LETTER OF
INTENT
03/24/93 933 (S) COSPONSOR(S): LINCOLN
03/24/93 931 (S) PASSED Y20 N- CSSSSB
71(FIN) AM
03/24/93 934 (S) TRANSMITTED TO (H)
03/26/93 775 (H) READ THE FIRST TIME/REFERRAL(S)
03/26/93 775 (H) HES, FINANCE
04/07/93 (H) HES AT 03:00 PM CAPITOL 106
ACTION NARRATIVE
TAPE 93-60, SIDE A
Number 000
CHAIR TOOHEY called the meeting to order at 3:11 p.m., noted
members present, and announced the calendar. She then
brought HB 30 to the table.
HB 30: HUMAN SERVICES MATCHING GRANTS
Number 023
REP. NICHOLIA MOVED passage of HB 30 from the committee with
individual recommendations.
Number 030
REP. VEZEY OBJECTED.
CHAIR TOOHEY called for a roll call vote. Those voting yes
were Reps. Toohey, Bunde, B. Davis, Nicholia and Brice;
voting no was Rep. Vezey. The motion PASSED 5-1. She
declared that HB 30 WAS PASSED FROM THE COMMITTEE WITH
INDIVIDUAL RECOMMENDATIONS.
SB 71: EMERGENCY MEDICAL SERVICES SYSTEM
CHAIR TOOHEY brought SB 71 to the table.
Number 144
CHAIR TOOHEY announced her intention not to pass SB 71 that
day, but to take it up again on Thursday, April 8, 1993.
Number 146
ANNETTE KREITZER, LEGISLATIVE ASSISTANT TO SEN. LOREN LEMAN,
PRIME SPONSOR OF SB 71, read a sponsor statement. In
summary, the statement said that since trauma was the
state's top killer, a statewide trauma system was essential.
She stated that SB 71 would allow the Department of Health
and Social Services (DHSS) to regulate voluntary compliance
for trauma care centers. It would also establish a patient
care information system and allow paramedic training inside
Alaska instead of elsewhere. She said there was broad
support for the bill. She then proceeded to give a detailed
sectional analysis of the bill.
Section 1-8 eliminates language limiting the bill's
application to physician-trained paramedics, as
paramedics are trained by others as well as by
physicians.
Section 9 allows DHSS to establish criteria to
designate hospitals as voluntary trauma centers.
Section 10 was amended in the Senate Finance Committee
to allow paramedics to collect patient information
data, but not to compel them to do so. Most such data
is already collected voluntarily.
MS. KREITZER explained that the patient information system
involves contracts with emergency room nurses who abstract
data for DHSS, at a cost of about $40,000 per year. She
said Sen. Leman wanted to return the $40,000 to the fiscal
note under contractual services, instead of under grants.
Number 114
MS. KREITZER noted a letter of intent from the Senate
Finance Committee requiring DHSS to streamline its
computerized data collection, a letter the sponsor
supported, she said. She noted that the Finance Committee
had deleted two positions in the bill, and asked that the
two positions, a computer specialist and a clerk typist, be
returned to the bill, as the data they would gather was
valuable and other users could pay for it when the federal
grant expired on September 30, 1993. Ms. Kreitzer continued
the sectional analysis.
Section 11 changes the name of the advisory council on
emergency medical services to reflect its extended
membership and purpose.
Section 12 was amended to require that one member of
the advisory council be from an area not on the state
road system.
MS. KREITZER noted that the bill packets contained
recommendations that no two of the three consumer members of
the advisory council be selected from the same one of the
state's four judicial districts, to ensure representation
from all over the state. She said she had prepared an
amendment to effect that request.
Section 13 expands the authority of the DHSS to adopt
regulations to charge fees for certification and
licensing of organizations such as trauma care centers.
Section 14 allows for certification of emergency
medical dispatchers (EMDs), and allows the department
to set standards for paramedic training programs, and
prevents people without such training from claiming to
be certified.
Section 16 prevents trauma centers from advertising
their services unless they are certified as trauma
centers.
Number 165
CHAIR TOOHEY interrupted to ask Ms. Kreitzer if any
committee members had questions for her. She then asked if
SB 71 addressed medical dispatchers from just trauma centers
or ambulance dispatchers also.
MS. KREITZER said SB 71 dealt just with dispatchers of
emergency medical technicians (EMTs), paramedics, or
ambulances.
Number 175
CHAIR TOOHEY said it was therefore primarily for larger
cities. She asked how such dispatchers were to be trained,
if they were going to be trained.
Number 185
MARK JOHNSON, CHIEF, EMERGENCY MEDICAL SERVICES, DIVISION OF
PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
testified in Juneau in support of SB 71. He said many
Alaska EMDs had taken courses in other states who believed
that being certified would carry the advantage of some
immunity from liability enjoyed by some EMTs. He said he
would not require such training for ambulance dispatchers.
REP. BUNDE asked if Juneau 911 service used certified EMDs.
MR. JOHNSON said no, but Anchorage did.
Number 211
REP. BUNDE asked if the bill would require non-EMD certified
dispatchers to take the additional training or face the loss
of their jobs.
MR. JOHNSON answered no, the training was not a requirement,
but an incentive to avoid legal liability for giving advice
to callers.
Number 215
REP. BUNDE repeated his question.
MR. JOHNSON repeated his answer. He said much emergency
service can be administered before an ambulance arrives, and
a national standard of care was developing for such service.
Number 223
MS. KREITZER said she was from a rural area and had been
concerned that her local dispatchers who give pre-arrival
instructions would be hurt by the regulation. She said that
the bill actually standardizes the level of dispatch, but
does not obligate current dispatchers to receive the
training.
REP. BUNDE asked who paid for the training.
MS. KREITZER said the sponsor recommended that the
legislature should consider giving $100,000 for training.
Number 246
CHAIR TOOHEY expressed concern that the bill ignored those
emergency medical services organizations that operated in
the Bush.
MR. JOHNSON stated that a woman in Ketchikan had developed
and tested a training program for Bush emergency medical
service workers that might be used as a pilot program for
training of those in the Bush.
CHAIR TOOHEY said it was important to provide all such
workers with training before giving more training to one
group of people.
Number 264
MS. KREITZER said she used the term local to refer to
emergency medical service squads in Nome, Bethel, Tanana,
Soldotna and other smaller areas, as differentiated from
regional centers such as Anchorage. She said the $100,000
would be administered by regional councils, but would go
directly to the local squads to pay for training.
Number 274
REP. BUNDE said such training would provide the benefit of
decreased legal liability for emergency medical service
workers. He asked if there was any provision to require
such people to pay part of the cost for such training
themselves.
MS. KREITZER said she believed that, as EMTs volunteered
their own time, money, and equipment, providing them
training to reduce their legal liability was merely
recognition of their contributions.
Number 293
REP. BUNDE noted that if he phoned 911, he would be speaking
with paid dispatchers, and it was not unreasonable to ask
such people wanting additional certification to protect them
from liability to pay part of the cost.
MS. KREITZER said such questions would be up to local and
state authorities to decide, but she said that unpaid
workers in rural areas might deserve more consideration for
training.
Number 308
CHAIR TOOHEY asked whether volunteer emergency medical
service workers who had been trained were automatically
protected for liability if they were working within that
system.
MR. JOHNSON answered that they were covered for the scope of
the practice for which they had been trained.
CHAIR TOOHEY asked whether it was reasonable to assume that
anyone acting as a dispatcher in a 911 service had been
trained.
Number 316
MR. JOHNSON answered that not all dispatchers were EMTs.
CHAIR TOOHEY noted that not all EMTs were dispatchers,
either.
Number 319
MR. JOHNSON said that all dispatchers he had spoken to,
including those in Anchorage, had told him the bill's aims
were desirable.
CHAIR TOOHEY agreed that the bill's goals were desirable,
but she was concerned about the fiscal note. She noted that
she was a former EMT-3 and ambulance driver, but said that
it was important to be realistic.
MR. JOHNSON acknowledged her point and added that he was
proud of the economy with which emergency medical service
workers operated, which included finding creative ways to
provide training, such as an annual EMT symposium at which
training is available at no cost to the state.
Number 335
CHAIR TOOHEY said she hesitated to make training
requirements so strict that they barred volunteers from the
system.
Number 340
MR. JOHNSON said his philosophy was to provide options, and
he described different classifications of EMTs and the
training required: an ETT first responder required 40 hours
of training; an EMT-1, 110 hours; an EMT-2, 160 hours; and
an EMT-3, 210 hours. He said he wanted to let local
communities choose the level of training they wanted in
their emergency medical service workers. He said those who
get some experience desire additional training so that they
can feel more comfortable with their skills.
Number 358
REP. NICHOLIA noted that Tanana had EMTs and ETTs which were
essential to local medical services. She said the squad
members were very enthusiastic about their work and training
and the legislature should do what it could to improve the
system.
Number 364
MS. KREITZER resumed her section-by-section discussion of
SB 71.
Section 14 gave EMTs the option of becoming EMDs.
While the section did not mandate current dispatchers
become certified EMDs, it did give departments the
ability to establish paramedic training programs or to
require such certification.
Section 15 barred people from calling themselves
certified EMDs without such state certification.
Section 16 prevented trauma centers from advertising
themselves as being state-certified unless they were,
and required state certification of paramedic trainers.
Section 17 limited the liability for providing pre-
arrival instructions, with the exceptions of gross
negligence or intentional misconduct.
Section 18 granted liability immunity to state-
certified EMT-1s (unintelligible) EMT instructors. She
said the section was added because the University of
Alaska-Fairbanks had asked for its EMT instructors to
carry malpractice insurance, which she said was
unfeasible.
Section 19 was amended on the Senate floor to specify
those people able to disclose patient information to
EMTS, specifically, physicians, advanced nurse
practitioners, and physicians' assistants. The section
bars EMTs from revealing such information, and the
section is aimed at improving EMT education.
Sections 20-22 added several definitions into current
law.
Sections 23, 26 and 27 deleted references to an
obsolete statewide health coordinating council.
Sections 24 and 25 amended the law to make wording
consistent.
Section 28 assures the transition of membership for the
advisory council on EMS to the new Alaska Council on
EMS established by the bill, and assures that state-
licensed paramedics would not be affected by the
establishment of new training programs.
Number 416
CHAIR TOOHEY said Anchorage once had a paramedic training
course at the University of Alaska-Anchorage (UAA), but it
was dropped in the mid-1970s because it was felt there were
not enough jobs for the graduates. She asked if the year
long training course would be offered by the state.
Number 420
MR. JOHNSON replied that the Emergency Medical Services
Section of the Division of Public Health proposed to set
standards for training and then allow communities to decide
if they wanted to have a course. He said some long-time
EMT-3s who might want to upgrade to paramedics would
otherwise have to leave Alaska for training and there begin
training at the basic level. He said there was no money for
the state to set up the actual training.
CHAIR TOOHEY asked if the standards would be set by an
accredited paramedic school.
Number 435
MR. JOHNSON answered that there were national standards,
which the state would try to follow closely, but the state
would also try to meet the special needs of Alaska citizens.
Number 441
MATT ANDERSON, TRAINING COORDINATOR, EMERGENCY MEDICAL
SERVICES, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH
AND SOCIAL SERVICES, testified in support of SB 71. He said
that, in response to interest around the state in putting on
paramedic training programs, the division assembled some
boilerplate regulations concerning how such training
programs could assess whether they would be up to standards.
He said the state attorney general's office informed them
that the state medical board lacked the statutory authority
to promulgate regulations authorizing paramedic training
programs, and that provisions for that authority were
therefore included in SB 71. He stated there was interest
in innovative and creative training programs on the Kenai
Peninsula, in Juneau, and other areas and the division
should take advantage of those courses. He said there were
paramedic bridge courses, and the division has spoken to
people in Tacoma, Washington about the possibility of an
EMT-3 and paramedic bridge course. He said he wanted the
authority to develop standards for training that any
organization wanting to establish its own training program
could follow.
Number 457
CHAIR TOOHEY asked if the division was hoping that graduates
of such courses would be state certified.
MR. ANDERSON said graduates would be eligible to be licensed
as a paramedic in the state.
Number 467
CHAIR TOOHEY asked if certification in another state would
win someone certification as a paramedic in Alaska.
MR. ANDERSON said the program would allow people to meet
national standards for EMTs and paramedics, which would
allow them to become licensed in Alaska after passing
examinations. He said other states would recognize Alaska's
training program, but would likely still require people to
pass examinations before becoming licensed in that state.
The training would not have to be repeated, he said.
CHAIR TOOHEY asked if Alaska recognized training or
paramedic certification from other states or cities.
MR. ANDERSON pointed out that the state medical board
licensed paramedics, and the state will evaluate out-of-
state application for paramedic licensing.
CHAIR TOOHEY repeated her question.
Number 473
MR. ANDERSON answered yes, as long as the paramedic was
state licensed in his or her home state and had successfully
completed national paramedic examinations.
REP. BUNDE asked whether the training and certification
program was for current volunteer or paid emergency medical
service workers, or whether it was aimed at training up
those without prior experience.
Number 487
MR. JOHNSON said at first, most of those taking the training
would already be involved in the EMS system, but communities
which wanted to do so could train novices. He said the
standards would merely establish the training standards.
REP. BUNDE asked whether people would already have to be
accepted as volunteer or paid emergency medical service
workers before they could begin the training.
Number 497
MS. KREITZER said it depended on where the paramedic would
serve. Some Native corporations will send a novice away
from Alaska to be trained as an emergency medical service
worker, while in other cases, such as in Anchorage, those
already involved in the EMT system as a volunteer or paid
will seek additional training as a paramedic. She said
there was nothing that would keep novices out, but common
sense indicated that most of those taking the training would
have already been involved in the EMT system, at least at
first. She said she understood Rep. Bunde's concerns about
funding the training program, and said the question was for
whom the trainees would be working or volunteering.
REP. BUNDE said he did not oppose the EMT program, but it
was important for the state, with finite resources, to offer
those with prior training a priority for further training.
However, he said it was also important to write statutes to
avoid ambiguity and embrace clarity and specificity.
Number 518
MS. KREITZER asked Rep. Bunde if he wanted to see the
program restricted to avoid too many people from being
trained as paramedics.
REP. BUNDE answered no, but said it needed to be made clear
who could gain access to the training and how. He said he
understood her to say that whoever ran a training program
could write their own rules in their own little kingdom, and
that it was not appropriate for state government to operate
in such a manner.
Number 525
CHAIR TOOHEY said she agreed with Rep. Bunde. She noted
that UAA had a waiting list of people to take its paramedic
program, but the program was eliminated because there were
not enough jobs. She said she could not understand the
logic of that move, as the job of a school was education,
not the guarantee of employment upon graduation. She asked
if the emergency medical service workers training programs
would be restricted to those already in the system and how
much would it cost.
Number 534
MR. JOHNSON said the division had not meant to set limits,
but just to outline and offer training that would meet a
national standard. He said he did not envision dictating to
local communities who they should train or not. He said
that, as it would be up to the local community or
organization to fund their training programs, it would be
appropriate for them to establish their own entrance
criteria, as long as they met the minimum state standard.
Number 546
MS. KREITZER said EMT and ETT qualifications are clearly
laid out in state statute, and SB 71 just carried those
current training programs further. She said that the way
the EMT system was set up, needs were filled as they came up
because local communities or public safety organizations do
not pay to train people they can not use.
REP. BUNDE commented that it sounded like excessive demand
for paramedic training would be a local problem, and that
the state would certify any qualified trainees. He said he
feared that training slots in local programs might be
allocated according to local politics. He expressed a
desire to keep access to state-funded training available on
a fair basis. He observed that allowing people to pay for
their own training would resolve his concerns.
Number 566
MR. ANDERSON said there were no regulations regarding
paramedic training programs in the state, and the state had
no authority to say any one training program was good or
bad. He said applicants for paramedic licenses were
evaluated after their training. He stated the division
wanted to develop guidelines to provide a framework so that
public safety departments or other organizations wishing to
bring their personnel up to paramedic level could have a
standard. He noted that the division consulted experts
around the state in specific subject areas when it first
began work on draft regulations. He stated it was dangerous
to go ahead with designing training guidelines without such
oversight. He observed that UAA had considered reviving its
paramedic training program, but had declined because of
funding limitations. He commented that whenever a training
program was established it would benefit from guidelines.
Number 600
REP. BUNDE said he did not believe there were any private
paramedic training institutions in Alaska.
TAPE 93-60, SIDE B
Number 015
MR. JOHNSON said the laws under which his division operated
were 15 years old. He said a national team of experts had,
at his invitation, evaluated Alaska's statewide system and
produced a report, "State of Alaska: An Assessment of
Emergency Medical Services." (copies are on file in the
committee room) The report's recommendation that Alaska
update its statutes led to SB 71. He spoke in favor of
SB 71 and the state EMS system. He spoke of the patient
information system, whose grant funding from the Centers for
Disease Control will expire. He said the system has grown
from its start five years ago with seven Southcentral Alaska
hospitals to include all hospitals in the state. The system
provides good data on all cases of trauma in the state,
whether treated at hospitals or not, he said.
Number 061
CHAIR TOOHEY asked if it included Bush hospitals.
MR. JOHNSON answered yes.
CHAIR TOOHEY asked whether those statistics were reflected
in the division's budget.
Number 066
ELMER LINDSTROM, SPECIAL ASSISTANT TO THE COMMISSIONER,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, said he did not
understand Rep. Toohey's question.
CHAIR TOOHEY said the division was gathering statistics from
across the state.
Number 070
MR. JOHNSON noted that the Senate had passed a fiscal note.
He said the division was asking for money mostly to continue
the data system, which was important, but which would not be
continued without funding. He described the data system's
two main purposes as helping review the quality of care
provided by the emergency medical services system and
identifying the causes and severity of injuries, so as to
point to better prevention. He commented on trauma centers,
saying national standards exist for level one, level two and
level three trauma centers. While Alaska would likely not
have a level one center any time soon, he said, a level two
trauma center is feasible in Anchorage, and level three
centers were feasible in other communities. He said a state
task force had received a federal grant to set optional
standards for trauma care for facilities ranging from
hospitals to small clinics.
Number 145
CHAIR TOOHEY asked if Mr. Johnson had included Anchorage
hospitals in its discussion of trauma centers.
MR. JOHNSON answered yes.
CHAIR TOOHEY asked if ambulances from outside of Anchorage
would bring patients only to designated trauma centers in
Anchorage.
MR. JOHNSON answered no, all hospitals would treat trauma
patients. He said the current system of referral patterns
works well 99 percent of the time, but it could still be
improved. He repeated that the bill wanted to establish
standards toward which providers should aspire, but it could
be done without adverse impact on cost through such
strategies as preparing a trauma team to treat a patient
whose condition fell inside certain parameters even before
that patient arrived at the trauma center.
CHAIR TOOHEY observed that such a practice was already being
done.
MR. JOHNSON countered that it was done sometimes, but not
always. He said he relied on doctors, nurses and other
professionals to set standards and make recommendations.
Number 189
REP. BUNDE said he did not oppose improvements in the
paramedic program, but observed that voluntary compliance
standards might not be binding. He said he liked local
options, too, but asked if there was any mechanism in the
bill to enforce compliance with the standards.
MR. JOHNSON answered no. He said his division had tried to
use small grants to encourage hospitals by providing
training in a partnership arrangement. He said the
department had tried to encourage "truth in labeling" of
what services hospitals could offer.
Number 244
CHAIR TOOHEY asked Mr. Johnson whether the bill barred
hospitals from describing themselves as trauma centers.
MR. JOHNSON said no Alaska hospitals advertised themselves
as trauma centers, probably because they know that there are
American College of Surgeons standards for such centers that
they might not meet. He added, however, that Anchorage
hospitals were considering consulting soon with the College
representatives to obtain recommendations.
Number 241
MR. LINDSTROM offered to answer whether the funds were
represented in the fiscal note for SB 71 in the state House
or Senate versions of the budget, and answered no, they were
not. He asked Mr. Johnson to address the fiscal notes and
associated documents to clear up any confusion.
MR. JOHNSON said the division was following its April 6,
1993, position paper because the division found a mistake in
the first revised position paper which did not reflect some
changes made to the bill in the Senate. He said the
division was using the March 30, 1993, fiscal note, which
reflected the cost to continue the patient information
system and to pay for a team from the American College of
Surgeons to verify whether any Alaska health care facilities
met trauma center criteria. He said the amount was an
estimate, based on the number of hospitals that might apply
for such certification, a cost which the state would ask the
hospitals to pay back. He said that some of the requests
that Ms. Kreitzer had expressed were not reflected in the
fiscal note, and his division believed the fiscal note was
very conservative.
Number 276
TODD HUTTENLOCHER, M.D., CO-MEDICAL DIRECTOR, EMERGENCY
MEDICAL SERVICES SECTION, DIVISION OF PUBLIC HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, testified on
SB 71. He said he had practiced in Alaska for 15 years both
in several cities and in the Bush. He said he had also been
medical director of the Yukon-Kuskokwim Delta Regional
Hospital, chief of staff of Bartlett Memorial Hospital, and
medical director of the Southeast region EMS, and was
currently the co-medical director for the state EMS in
Juneau. He said the state needed SB 71. He said it would
cut across jurisdictional lines. He said the lack of
observed resistance from the medical-industrial complex
indicated that the state had done a good job tailoring the
bill to meet Alaska's needs.
Number 300
MR. HUTTENLOCHER said it was important to balance the need
for high emergency medical service standards in Alaska's
large cities with the need not to make it too complicated to
provide emergency medical service in smaller communities, or
through Native corporation health aide programs. He stated
SB 71 would ease up some patient confidentiality
restrictions and make it easier for doctors to give feedback
to EMTs and paramedics on how well they were handling trauma
patients. He said that no state laws barred any hospital or
clinic from advertising itself as a trauma center, and the
bill would encourage trauma centers to adhere to standards.
Number 328
REP. BUNDE asked if SB 71 would set required standards for
emergency medical service training in Alaska.
Number 330
DR. HUTTENLOCHER said the bill specifically said that the
state would approve training courses in some way. He said
that current practice in Juneau, which does not have
provisions for full paramedic service, was to train EMT-3s
to a level half-way between EMT-3 and paramedic. He said
the bill would allow the EMS office to provide guidance,
direction and certification for local needs, which he said
vary from community to community.
CHAIR TOOHEY agreed that the state needed flexibility in EMT
training for different communities. She asked Mr. Anderson
who provided insurance to those trained to the mid-level
between EMT-3 and paramedic, and to what degree they were
covered.
Number 355
MR. ANDERSON answered that the division used certificates to
endorse the skills of such people, and the division presumed
that immunity from liability granted to some emergency
medical service workers covered the application of those
extra skills. He said malpractice insurance was generally
paid for by the organization employing the person.
CHAIR TOOHEY asked how such skills were identified on the
certificate.
Number 361
MR. ANDERSON said the information was recorded both in the
application for service, where all the skills were listed,
and also on the individual's certificate.
MR. JOHNSON added that the division did not allow anyone to
use advanced-level skills without having a medical director
approve those skills. He said no emergency medical service
worker in Alaska could start intravenous therapy, or use a
defibrillator, or use drugs or intubation, or other such
treatments unless they had been licensed for such treatment
and had received a doctor's approval.
Number 379
REP. VEZEY asked Dr. Huttenlocher to describe his position
in Juneau.
DR. HUTTENLOCHER said he wore a lot of hats. He said he was
also the medical director for the Capitol City Rescue unit,
which provides pre-hospital EMS support.
REP. VEZEY asked if he was the physician for the fire-rescue
unit in Juneau.
DR. HUTTENLOCHER said that was correct.
REP. VEZEY asked a clarifying question, whether anything in
state law would prevent Dr. Huttenlocher, as a licensed
physician, from setting himself up in business as a trauma
center. He said he did not believe in licensing for its own
sake and he believed there needed to be a valid public
purpose for regulation and licensing.
DR. HUTTENLOCHER said hospitals had a problem with jumping
through hoops to prove that what they did was for the public
good. He said that trauma was a special disease, deserving
special care, and medicine and the EMS system had helped
significantly lower the rate of death from trauma in the
past 20 years.
Number 395
REP. VEZEY said he was not disputing that fact. But he
asked what was wrong with a doctor establishing a trauma
center.
DR. HUTTENLOCHER said that there was a need for a well
thought-out, organized system of dispatch and pre-hospital
treatment of trauma. He said the state had an interest in
maintaining minimum standards for its emergency medical
service system. He said he could not establish himself as a
hospital and bill Medicare without meeting minimum
requirements, because the state had a right to establish
standards and make sure that such centers were operated
right. He asserted that the Alaska State Hospital and
Nursing Home Association had reviewed the bill and had
expressed no major objections.
Number 418
REP. VEZEY questioned whether issuance of a license to
operate as a trauma center did not under other state law
make the center a utility, and subject to many other
regulations under the Alaska Public Utilities Commission.
He acknowledged, though, that there were many things he did
not know about the issue. He said that he saw nothing wrong
with competing systems, and asked whether it were
appropriate for the state to deny the public a choice of
medical service.
Number 426
REP. BUNDE observed that the state might want to take steps
to ensure that only the appropriate physicians, and not for
example proctologists, were allowed to advertise services as
a trauma center.
REP. VEZEY said that he did not know if proctology was a
specialty licensed by the American Medical Association,
though he acknowledged it was possible he might be wrong.
REP. BUNDE said he believed it was.
Number 437
REP. VEZEY asked if the state was making it more difficult
or expensive to provide that degree of medical services.
DR. HUTTENLOCHER said that trauma center designation was an
issue nation-wide, for many reasons. He said that in
Alaska, and specifically Anchorage, there had been problems
with hospitals acknowledging how trauma centers should be
established. He said he and others in the state saw SB 71
as a help, not a hindrance, which would ultimately bring
about a more streamlined system that will help health care
practitioners design a system that would save money.
Number 450
CHAIR TOOHEY asked whether a doctor practicing in a trauma
center would need special certification, or if being an
emergency room doctor would suffice. She predicted that
certifying trauma centers would lead to certifying trauma
doctors.
DR. HUTTENLOCHER said that surgeons have been the major
players in the trauma game and have directed the care for
other health care providers. He said that was most of what
was necessary for level two, and level three trauma centers
was already available in Alaska. He said that, to his
knowledge, there was no American College of Surgeons
"traumatologist" sub-specialty.
Number 462
MR. JOHNSON said there were none to his knowledge, either.
DR. HUTTENLOCHER said surgeons were not the main feature of
trauma care; it was an entire system involving other
specialists, lots of money, and much sophisticated equipment
and facilities.
Number 467
MS. KREITZER said she understood Rep. Vezey's concerns, and
said that the sponsor did not want over-regulation, either.
But she said it was beneficial to encourage those treating
trauma patients to meet certain standards. She said SB 71
encouraged hospitals to meet American College of Surgeons
standards for trauma care, and several hospitals already
possessed from 80 percent to 85 percent of what they would
need to qualify for certification as trauma centers. She
stated the report said trauma center designation
demonstrated commitment to an entire chain of trauma care.
Number 489
CHAIR TOOHEY announced her intention to take one more
question, and that, if no one else wanted to ask a question,
the committee would take up the bill the next day.
MR. JOHNSON referred to an article from the American Medical
Association, which said fewer than half of the states had
trauma care systems. He said major trauma included internal
bleeding requiring surgical attention. He said standards
for trauma care extend beyond the hospital facility to the
emergency medical service delivery system. He predicted
some Alaska hospitals could meet the trauma center standards
without much effort. He stated it was better not to
designate one hospital as an area's sole trauma center, and
instead to establish care standards and allow hospitals to
decide for themselves if they wanted to seek such
certification.
Number 515
CHAIR TOOHEY commented she was scared that the state would
enact regulations that would effectively designate one
trauma center and limit the doctors or nurses that could be
identified as trauma doctors and trauma nurses.
Number 524
LARRY FANNING, FIRE CHIEF, CAPITOL CITY FIRE & RESCUE, AND
REPRESENTATIVE OF THE ALASKA STATE FIRE CHIEFS ASSOCIATION,
testified in favor of SB 71, saying the Fire Chiefs
Association endorsed the bill. He said that a paramedic in
Juneau once took personal leave to go to Seattle for
training because such training was unavailable in Juneau.
He said it might be possible to license paramedics in Alaska
if the state were to adopt its own rules and regulations for
paramedic certification, allowing training both locally and
in other training centers outside the state. He referred to
the Seattle Medic One program as a privately-owned program
which certified its own paramedics without relying on state
certification. He said graduates could take the national
registry paramedic examination, though it was not a
requirement for graduation. He said the association also
endorses SB 71's provisions concerning EMDs, saying that
consistent training provided under a certification program
would ensure that dispatchers relayed information accurately
in a medical emergency, which could result in better patient
treatment.
Number 544
CHAIR TOOHEY said, "Where do you see this dispatcher ...
dispatching?"
MR. FANNING responded, "Wherever a 911 call comes into what
we call the PSAP, or public safety answering point. And so
if I'm injured, you call, it goes into a PSAP. It's at that
point when a person picks up the receiver to see what kind
of emergency do you have, and there is the opportunity there
for a computer screen or a log book to come up on the line
and say that you've got a broken leg, we'll do this and this
(unintelligible)."
CHAIR TOOHEY stated, "But this is a person employed by a
municipality or a city or a borough."
MR. FANNING remarked that this was not necessarily true. He
noted that Ketchikan used volunteer dispatchers at the fire
station, people who took regular tours of overnight duty
without pay.
CHAIR TOOHEY asked how many cities had volunteer
dispatchers.
MR. FANNING answered that most cities did. He continued
with his testimony, saying that he supported SB 71 for those
two reasons, and also because it would support the patient
information system. He said that system helped emergency
responders by letting them know how their patients responded
to their treatment. He said the $40,000 requested for the
trauma data register also would help emergency medical
service workers study their trauma service delivery to look
for ways to improve. He asked the committee to endorse the
bill.
TAPE 93-61, SIDE A
Number 000
REP. BUNDE said he was impressed that dedicated citizens
would volunteer to act not only as EMTs, which had the fun
of going out on rescue runs, but also as dispatchers sitting
by the telephone.
Number 008
REP. VEZEY said he had a hard time visualizing the program
proposed by SB 71 as a state-wide program. He said he did
not see why it was necessary for small clinics in remote
locations to meet trauma center standards.
MR. FANNING observed that the program was voluntary, not
obligatory. He said that by setting a standard, people
could train to that standard and advertise that they met
that standard and could provide a certain level of care to
patients. He said the state should encourage as many 911
centers as possible to get the EMT training necessary to
provide quality care to those they serve.
Number 038
MS. KREITZER said she had experience as an EMT in Cold Bay,
and said that proper training of dispatchers can prevent
unnecessary and costly medivac flights in rural areas.
CHAIR TOOHEY ADJOURNED the meeting at 4:40 p.m.
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