Legislature(2005 - 2006)CAPITOL 106
05/03/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB150 | |
| HB288 | |
| HB271 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 288 | TELECONFERENCED | |
| + | SB 150 | TELECONFERENCED | |
| + | HB 271 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
May 3, 2005
3:28 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Lesil McGuire
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
Representative Vic Kohring
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 150(HES)
"An Act relating to the Alaska children's trust grant awards."
- MOVED CSSB 150(HES) OUT OF COMMITTEE
HOUSE BILL NO. 288
"An Act relating to the Medicaid personal needs allowance for
assisted living home residents; and providing for an effective
date."
- HEARD AND HELD
HOUSE BILL NO. 271
"An Act relating to limitations on overtime for registered
nurses in health care facilities; and providing for an effective
date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 150
SHORT TITLE: ALASKA CHILDREN'S TRUST FUND GRANTS
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
03/21/05 (S) READ THE FIRST TIME - REFERRALS
03/21/05 (S) HES, FIN
04/06/05 (S) HES AT 1:30 PM BUTROVICH 205
04/06/05 (S) Heard & Held
04/06/05 (S) MINUTE(HES)
04/15/05 (S) HES AT 1:30 PM BUTROVICH 205
04/15/05 (S) Moved CSSB 150(HES) Out of Committee
04/15/05 (S) MINUTE(HES)
04/18/05 (S) HES RPT CS 3DP 2NR
NEW TITLE
04/18/05 (S) DP: DYSON, WILKEN, GREEN
04/18/05 (S) NR: ELTON, OLSON
04/18/05 (S) HES AT 1:30 PM BUTROVICH 205
04/18/05 (S) <Above Bill Hearing Canceled>
04/25/05 (S) FIN RPT CS(HES) 4DP 2NR
NEW TITLE
04/25/05 (S) DP: WILKEN, GREEN, DYSON, STEDMAN
04/25/05 (S) NR: HOFFMAN, OLSON
04/25/05 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/25/05 (S) Moved CSSB 150(HES) Out of Committee
04/25/05 (S) MINUTE(FIN)
04/26/05 (S) TRANSMITTED TO (H)
04/26/05 (S) VERSION: CSSB 150(HES)
04/27/05 (H) READ THE FIRST TIME - REFERRALS
04/27/05 (H) HES, FIN
05/03/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 288
SHORT TITLE: MEDICAID PERSONAL NEEDS ALLOWANCE
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
04/28/05 (H) READ THE FIRST TIME - REFERRALS
04/28/05 (H) HES, FIN
05/03/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 271
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES
SPONSOR(S): REPRESENTATIVE(S) WILSON
04/15/05 (H) READ THE FIRST TIME - REFERRALS
04/15/05 (H) L&C, HES, FIN
04/30/05 (H) L&C AT 1:00 PM CAPITOL 17
04/30/05 (H) Moved Out of Committee
04/30/05 (H) MINUTE(L&C)
05/02/05 (H) L&C RPT 4DP 3NR
05/02/05 (H) DP: CRAWFORD, LYNN, GUTTENBERG,
ANDERSON;
05/02/05 (H) NR: LEDOUX, ROKEBERG, KOTT
05/03/05 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JASON HOOLEY, Staff
to Senator Fred Dyson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 150 on behalf of the Senate
Health, Education and Social Services Standing Committee,
sponsor, which is chaired by Senator Dyson.
JOEL GILBERTSON, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified on behalf of the department
during the hearing on SB 150.
MARGO MCCABE, Chair
Alaska Children's Trust (ACT)
Anchorage, Alaska
POSITION STATEMENT: Testified on behalf of ACT during the
hearing on SB 150.
JON SHERWOOD, Medical Assistance Administrator
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified on behalf of the department
during the hearing on HB 288.
JANE BARNES, Nursing Director
Alaska Psychiatric Institute (API)
Anchorage, Alaska
POSITION STATEMENT: Cautioned that HB 271 would have a negative
impact on patient care.
DIANNE O'CONNELL, Labor Program Director
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 271.
CAROL WIDMAN, Registered Nurse
Alaska Psychiatric Institute
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 271.
DAVE WILLIAMS, Project Coordinator
Alaska Pioneer Homes
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 271.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:28:52 PM.
Representatives Seaton, Gardner, and Cissna were present at the
call to order. Representative McGuire arrived as the meeting
was in progress.
SB 150-ALASKA CHILDREN'S TRUST FUND GRANTS
CHAIR WILSON announced that the first order of business was CS
FOR SENATE BILL NO. 150(HES) "An Act relating to the Alaska
children's trust grant awards."
3:30:10 PM
JASON HOOLEY, Staff to Senator Fred Dyson, Alaska State
Legislature, presented SB 150 on behalf of the Senate Health,
Education and Social Services Standing Committee, sponsor, which
is chaired by Senator Dyson. He said that in the late 80s, the
Alaska Children's Trust was created by the legislature to
provide start-up funding to community-based programs dedicated
to preventing child abuse. The amount of the grants is
prescribed in state statute. Since then, he said, "the board of
trustees has requested some additional flexibility in
determining the amount of grants that they award." The proposed
legislation would meet that request by: removing the $50,000
annual cap on the grants; refining the funding formula set in
statute; including a four-year limit on the grant awards in
order to enforce the original intent to provide seed money to
the community organizations; setting up a requirement that
applicants include a self-sustainability plan in their proposal;
and giving the board of trustees the authority to reduce or
eliminate grants in order to enforce program requirements or
performance goals.
3:31:36 PM
REPRESENTATIVE GARDNER asked what triggered the bill.
3:32:06 PM
JOEL GILBERTSON, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), said the
commissioners of the Department of Education and Early
Development and the Department of Health & Social Services, by
their office, were appointed to the Alaska Children's Trust when
it was initiated; however, the bulk of the members are not state
employees. In response to Representative Gardner's question, he
said what prompted the legislation to move forward was a strange
circumstance, which is that the trust has not done any new
grants in over two years. Because the funding doesn't go into
operations, but rather is used to start up innovative programs,
getting them up and running, and moving on to something else,
the original statute contemplated a step-down in funding support
over a four-year period. Some legislators assumed that by the
fifth year, the program being funded would be on its own;
however, the statute is vague. As a result, there are programs
that have continued to receive a base amount of approximately 25
percent into the eighth year.
COMMISSIONER GILBERTSON said the challenge with the Children's
Trust is that the principal of the fund has not grown
drastically and has a fairly conservative investment strategy.
The grant making comes solely from the interest that the fund
earns; the principal cannot be touched. Because the market has
been fairly flat, there has been a relatively fixed amount of
money that comes out of earnings of the fund on an annual basis;
it has ranged from between $210,000-$240,0000 per year. He said
there comes a point in which a 25 percent obligation to 30 to 40
grants fully utilizes the money and doesn't allow for new
funding. The key element of SB 150 is to clarify what
Commissioner Gilbertson said was the intent of the original
legislation, which is that after the four years of step-down
funding, the amount goes to zero. He described the process as a
natural attrition every four years, which would allow new grants
to be brought onto the program.
COMMISSIONER GILBERTSON noted that the trust has received an
earmark in the last federal fiscal year for specific
programming; however, that funding doesn't go into the corpus of
the fund. He offered further details.
3:37:02 PM
CHAIR WILSON directed attention to a booklet in the committee
packet, entitled, "Alaska Children's Trust Annual Report 2004,"
and noted that on page 12 the grantees are listed.
3:37:15 PM
REPRESENTATIVE GARDNER noted that the bill would also repeal the
cap on grants, and she asked how that fits in with the idea of
trying to make money for new programs.
COMMISSIONER GILBERTSON responded that the cap provision
probably has less direct application in the short term. He said
he thinks the trustees would like to be able to "be positioned
where they could do something sizeable in this state," should a
large amount of money became available. He stated, "What I've
seen is we can spend a lot of money doing very little things,
and at the end of the day, they rarely, in their cumulative
weight and success, accomplish what you can get done if you do
one sizeable project and you put your money behind it." He said
the scope of child abuse is wide and, because there is a small
amount of money, the mission needs to be tightly defined and
funds need to be targeted around accomplishing "a clear change
around what the trustees define as child abuse and neglect."
Without SB 150, he cautioned, there will be no new grant making
for the third straight year.
3:40:23 PM
REPRESENTATIVE CISSNA said she has been asking about "the
measurements" for the last seven years she has served as a
Representative, and she has yet to see the programs come back
with them. She stated, "Creating the model is almost as much of
a necessity it seems to me as doing a lot of other things that
wouldn't have lasting effect."
3:41:27 PM
COMMISSIONER GILBERTSON encouraged the committee to involve
Margo McCabe in the discussion, because she is the chair of the
trust, while he is just a member. In response to Representative
Cissna's concern, he said he thinks the trustees will "self-
acknowledge that there really hasn't been good performance
measures in the grants." He offered examples. He mentioned an
idea of moving from grants to performance contracts or measures.
3:43:04 PM
MARGO MCCABE, Chair, Alaska Children's Trust, said she thinks
Commissioner Gilbertson has done a good job covering the intent
of the proposed legislation and explaining why the trust
supports it. She echoed the commissioner in emphasizing that
over the last couple of years the trust has only had enough
money to fund recurring grants. She said the trust thinks there
are a lot of innovative programs in existence worth looking at
and would like to have its money freed up to do so. Regarding
performance measures, she said the trust is about to issue a new
[request for proposals (RFP)] and has done good work in giving
examples of performance measures that grantees can track. She
said there is a system in place for the trustees to meet with
grantees to ensure they are meeting the indicators. She said
she thinks SB 150 will move the trust closer to ensuring the
grantees are performing and will sustain the programs once the
grant monies are gone. She concluded, "The sustainability
requirement just enforces what we're putting in our RFP."
MS. MCCABE, in response to a request from the chair, listed the
Alaska Children's Trust board members. In response to a follow-
up comment from Chair Wilson, she agreed that currently there
are not many members from smaller communities. In response to a
question from the chair, she noted that the trustees are
appointed to the board by the governor.
CHAIR WILSON said she would like to see more representation on
the board from rural Alaska.
3:46:26 PM
MS. MCCABE concurred. She said many of the grantees are from
smaller communities around the state, so a considerable amount
of time is spent focusing on those communities.
3:47:11 PM
COMMISSIONER GILBERTSON said the trust conducts geographic
mapping of some of the issues around child abuse. He mentioned
a media campaign that focuses on modeling behaviors. He said
child abuse and neglect occurs in every community in Alaska, but
there is great disparity geographically, which needs to be
acknowledged as resources are being put forth.
3:49:11 PM
REPRESENTATIVE GARDNER inquired about license plate and heirloom
birth certificate programs.
MS. MCCABE said those programs, which are offered through the
Office of Vital Statistics, were in place before she began
serving on the board and have become self-sustaining. She
deferred further comment to the commissioner.
3:50:22 PM
COMMISSIONER GILBERTSON noted that the trust does not have an
administrative budget or staff, but has done a tremendous
volunteer effort getting involved in RFPs and contracts, and
going above and beyond what normal trustees would have to do.
He said the Department of Revenue provides support to the trust
by managing the financial accounts, investing the fund, and
providing a portion of staff time to advise the trustees on
financial issues. The Department of Health & Social Services
provides administrative support and uses resources in its
department for the actual administration of the grants. The
heirloom certificates and license plates are two other ways to
raise funds. He described the heirloom certificates as
"slightly more ornate than the traditional document you would
get from vital statistics."
3:51:31 PM
REPRESENTATIVE SEATON expressed concern regarding removing the
$50,000 cap. He noted that the highest grants the trust has
given have been for $20,000, and it would appear that if the
trust went above $50,000, then all the efforts would be
concentrated in the most populated areas of the state. He
questioned if there really is a need to remove the cap or
whether the trust is just looking at possibly having more money
to grant in the future.
COMMISSIONER GILBERTSON said he thinks it's important to remove
the cap. First, it would position the trust going into the
future as the corpus of the fund grows. Also, smaller grants
are not as efficient. He said it shouldn't be assumed that a
single grant cannot have statewide application; the trustees are
committed to a statewide application of the trust. In fact, on
a per capita basis, the grants are probably heavily weighted
towards rural regions, which he opined is appropriate. He
concluded, "It's very difficult for us to manage the trust with
some of the constraints that are placed on it right now."
MS. MCCABE said that she supports lifting the cap in order to
position the trust board to receive larger grants in the future
which then can be distributed in the most appropriate way. She
said there is no intent to change the strategy in terms of how
many [grants] are distributed. She stated, "We're committed to
continue funding programs all around the state."
COMMISSIONER GILBERTSON offered some examples of how the trust
uses its funds. He noted that the trust has been unable
administratively to expend funds given to the it to do a media
campaign because of the existing statute.
CHAIR WILSON asked who holds the trust accountable.
3:56:52 PM
COMMISSIONER GILBERTSON replied that the trust is a public
entity appointed by the governor. Ultimately, he said, the
individual ultimately responsible is the commissioner of DHSS.
He explained:
Procedurally, the way the trust actually works is the
trustees make the spending decisions, those spending
decisions are integrated into the grant making of the
Office of Children's Services and, as commissioner,
I'm the one who actually signs the authorization to
expend the funds, ... approves the RFP, and approves
the grant awards.
CHAIR WILSON asked if [the trust] would object to reporting each
year to both the Senate Health, Education and Social Services
Standing Committee and the House Health, Education and Social
Services Standing Committee.
3:58:13 PM
COMMISSIONER GILBERTSON responded that the trust publishes an
annual report that documents where the funds go, and he said he
could certainly make a commitment to the chair that every
legislator gets a copy.
REPRESENTATIVE SEATON referred to [the sponsor statement,
included in the committee packet, which includes a chart
describing the funding formula]. He questioned whether the way
the chart was written may be ambiguous.
COMMISSIONER GILBERTSON explained that the funding scale is
existing law. He said the grantee comes forward with a proposal
with an amount for a program set. The percentages are figured
each year from the set amount. In response to a question from
Chair Wilson, he reiterated that everyone he has spoken to has
said the intent was that there would be a natural turnover after
four years, but that sentence is missing in statute. Of the
sixteen grantees going into the upcoming grant years, 12 of them
will be past four years, three of the remaining the fourth year
and one will be in its third year. There will be no grantees in
the first or second year.
4:02:59 PM
COMMISSIONER GILBERTSON, in response to a question from Chair
Wilson as to where that language exists in the bill, directed
attention to page 2, lines 7-8, which read:
(d) The board may not award grants to a single
project or program for more than four years.
COMMISSIONER GILBERTSON, in response to a follow-up question
from Chair Wilson, said there are two more areas in the bill
with "salient pieces of new language." One part of the bill
would require the grantees to have a sustainability or self-
sufficiency plan. The other new language read as follows:
(g) The board may reduce or discontinue a grant
awarded or distributed under this section at any time
during the grant period if the project is not being
successful in accomplishing its objectives, as
determined by the board.
4:04:17 PM
REPRESENTATIVE CISSNA reiterated her concerns regarding
performance measures. She said the state needs to have partners
in the private sector that provide services. She offered
further examples. She suggested adding language to include new
organizations with ideas for programs.
4:06:52 PM
COMMISSIONER GILBERTSON said he doesn't disagree with
Representative Cissna. He said he has a lot programs in his
department that need to be addressing the issues that
Representative Cissna is talking about. He said questions that
need to be addressed are: "How do we bring competition into the
marketplace for grant making; ... how do we make our decisions
on awarding grants based on performance - on outcomes that we
the payer have set; and how do we hold our grantees, ...
contractors, ... vendors, or our providers accountable for those
outcomes?" He added that the Alaska Children's Trust is not the
entity to engage in that conversation, because the sole purpose
of the trust is about primary prevention and keeping it simple.
CHAIR WILSON closed public testimony.
4:09:49 PM
REPRESENTATIVE SEATON moved to report CSSB 150(HES) out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSSB 150(HES) was
reported out of the House Health, Education and Social Services
Standing Committee.
The committee took an at-ease at 4:10:45.
HB 288-MEDICAID PERSONAL NEEDS ALLOWANCE
[Not on tape, but reconstructed from the committee secretary's
log notes, was the following:]
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 288 "An Act relating to the Medicaid personal
needs allowance for assisted living home residents; and
providing for an effective date."
4:13:47 PM
JON SHERWOOD, Medical Assistance Administrator, Office of the
Commissioner, Department of Health and Social Services,
testifying on behalf of the department, said that HB 288 helps
to address a change made to regulation. He said it would only
apply to people who are not receiving cash assistance. He
mentioned an increase to personal needs allowance, as well as a
possible amendment.
The committee took an at-ease from 4:16:00 to 4:17:13.
[The recording begins again starting here.]
4:17:16 PM
REPRESENTATIVE WILSON said, "The folks that want this bill
aren't here, and so we're going to table the bill -- let's go
ahead and put the amendment on it, and then we'll table the bill
until they see fit to be interested enough to come and talk
about it."
4:17:33 PM
REPRESENTATIVE CISSNA moved Amendment 1, labeled, "24G-1,
5/2/2005, (8:14 A.M.)," which read as follows [original
punctuation provided]:
Page 1, line 6:
Delete "$260"
Insert "$1,396"
Page 1, line 13:
Delete "$260"
Insert "$1,396"
[There being no objection, it was so ordered.]
[HB 288 was held over.]
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES
4:18:05 PM
CHAIR WILSON announced that the final order of business was
HOUSE BILL NO. 271 "An Act relating to limitations on overtime
for registered nurses in health care facilities; and providing
for an effective date."
4:18:25 PM
[CHAIR WILSON turned the gavel over to Vice-Chair Seaton.]
The committee took an at-ease from 4:18:37 PM to 4:19:26.
4:19:31 PM
CHAIR WILSON, as sponsor of HB 271, stated that mandatory
overtime causes significant problems, including increased injury
rates, for both patients and health care workers, and can be
life threatening. She reported that the abuse of mandatory
overtime shifts has been associated with: unhealthy weight
gain, increased use of alcohol and tobacco, and lowered levels
of functional ability in job performance. A national study
showed that between 44,000-98,000 hospital deaths can be
attributed to medical errors each year. The final
recommendation of the Institute of Medicine was that all
overtime done by nurses - voluntary and mandatory - should be
curtailed.
CHAIR WILSON noted that in a study entitled, "The Working Hours
of Hospital Staff Nurses and Patient Safety," published in the
July/August issue of Health Affairs, found that the risk of
making an error is three times higher when nurses work shifts
longer than 12 hours, which she indicated is one of the main
reasons nurses are leaving their profession. She recalled a
study a couple of years ago that said by the year 2010, 4,000
more nurses will be needed in Alaska. She offered anecdotes
about her experience as a nurse.
CHAIR WILSON said the proposed legislation will not prohibit a
nurse from working overtime, but it will discourage an employer
from assigning mandatory overtime. It would also prohibit an
employer from threatening or retaliating against a nurse who
refuses overtime. Nationwide, she said, 10 other states have
mandated this type of legislation, while similar legislation has
been proposed in 20 other states.
REPRESENTATIVE GARDNER said she supports this legislation
because it seems like a human rights issue. Notwithstanding
that, she asked what the result would be for patient care in
Alaska if the bill passes.
4:28:16 PM
CHAIR WILSON noted that critical access hospitals would be
exempted. She said hospitals in Alaska work with personnel as
much as they can to ensure that they don't use mandatory
[overtime] for nurses. She said the only complaints she has
received were from state institutions: API, the Pioneer's
Homes, and [the Department of Corrections]. In response to a
follow-up question from Representative Gardner, she confirmed
that the bill would apply to state institutions.
REPRESENTATIVE CISSNA said that part of this is really a quality
issue for patients.
4:31:24 PM
VICE CHAIR SEATON asked why the bill only applies to registered
nurses and further asked if the effect will be that lesser
qualified employees are substituted for those nurses.
CHAIR WILSON said that is a possibility; however, she said there
are guidelines regarding what level of practitioner must be on
duty to supervise others.
4:33:57 PM
VICE CHAIR SEATON clarified that he wants to know if it's being
said that overtime is dangerous for registered nurses, but not
for licensed practitioner nurses.
CHAIR WILSON said, "I'm sure that that would be also the same
for them." She said she wouldn't have any objection to adding
LPNs.
4:34:26 PM
JANE BARNES, Nursing Director, Alaska Psychiatric Institute
(API), told the committee that API employees 40 registered
nurses and has no LPNs. Currently there are 5 staff nurse
vacancies, which is about the norm. Some improvement was made
when the a raise was approved in 2002; at that time there were
12 vacancies, or 25 percent of the staff nursing positions. Ms.
Barnes said API does use mandatory overtime in order to meet
patient care demands. It uses mandatory overtime only when
needed to minimally staff the patient care unit, and the
mandatory overtime used is minimal. She offered some details.
She stated that the use of voluntary overtime is higher, at
about 337 hours monthly. It is estimated that over half of the
nurses who volunteer for overtime do so to avoid being assigned
mandatory overtime.
MS. BARNES said should HB 271 pass, she expects about half of
the nurses currently doing voluntary overtime to decline working
overtime altogether. She said she anticipates that the result
would be maybe 200 hours of overtime that wouldn't be met by
voluntary means. She predicted that [API] would have to use
"agency nurses" at $60/hour for 13-week periods. It could also
ask for the establishment of additional positions, but given the
fact that there is already a difficulty filling the positions,
that may be of little help.
MS. BARNES, regarding agency nurses, indicated that it's
problematic that those nurses are there for short periods of
time and sometimes don't know how to use certain equipment or
have to learn a program unique to API's therapeutic milieu and
work with a team. A new nurse at API, she noted, partakes in
intensive training for four weeks, which she pointed out is a
third of an agency nurse's contract time.
MS. BARNES concluded:
The total elimination of mandated overtime, without
any options for a lesser bill, such as limiting that
overtime to so many hours at a time, places a real
burden on us as an employer, and I believe will have a
negative impact on patient care.
REPRESENTATIVE GARDNER asked if it is fair to say that the real
problem is that [API] cannot find the staff it needs to hire or
can't retain staff.
4:40:44 PM
MS. BARNES answered that API can usually find people to hire but
cannot retain them. She said API is one of the few hospitals in
town that will hire a "full-time, permanent placement, brand new
nurse, new [graduate]." Most other hospitals require nurses to
have 6-12 months experience as an associate nurse. She
explained that the nurses API hires often work for one year to
get that experience and then leave to work someplace else where
they can earn 25-35 percent more per hour.
REPRESENTATIVE GARDNER concluded that bottom line is that the
pay rate is too low to retain qualified people.
MS. BARNES answered yes.
REPRESENTATIVE CISSNA surmised that not only is the pay too low,
but also API must pay more in constant training. She asked if
that has ever been calculated.
MS. BARNES offered her understanding that the committee received
a fiscal impact statement. She said she doesn't have a good
calculation regarding what it takes to train any new employee.
VICE CHAIR SEATON asked if API is paying less for registered
nurses than compared to hospitals in town.
MS. BARNES answered that's correct. She added that API has also
lost nurses to doctor's offices. In response to a follow-up
question from Vice Chair Seaton, she guessed that API's pay
scale is set by the legislature.
4:44:03 PM
DIANNE O'CONNELL, Labor Program Director, Alaska Nurses
Association, said she has been working with "a number of nurses
throughout the state, and quite a few at API, actually, in
developing, ... supporting, and encouraging the passage of HB
271." She said there is more than one way of attacking the
problem at hand. She noted, "It's been primarily a state
institution problem." She indicated that nurses from many
facilities throughout the state are concerned that their
colleagues are in "what they consider an untenable situation,"
but also that the problem will spread if nothing is done now.
MS. O'CONNELL, referring to Vice Chair Seaton's previous
question, stated her belief that the pay scale [at API] is set
by the Department of Administration and perhaps approved by the
legislature. She said currently there is a request in for a
reclassification study, which would take registered nurses, for
example, "down a notch or two" in order to make up for the 25-35
percent pay differential. She said hopefully that will take
place; however, she noted that that's a "separate project" than
mandatory overtime, although they are related. She revealed
that she had worked as a chaplain at API, and she said it was an
emotional place to work [compared to some health care
institutions]. She said, "And if you're there and you're faced
with this mandatory overtime in addition to the lower salaries,
in addition to the stress, in addition to being a brand new
nurse, you're going to leave."
MS. O'CONNELL stated that the reason the bill addresses RNs only
at present is that that's where the biggest shortage is and
that's where most of the responsibility lies for patient care.
She echoed Ms. Barnes' notation that although there may be only
40 hours of mandatory overtime, there are 337 hours a month of
what is euphemistically called "voluntary overtime."
4:50:04 PM
CAROL WIDMAN, Registered Nurse, Alaska Psychiatric Institute,
testified in support of HB 271. She said every time she goes to
work she is subject to mandatory overtime. She said she has
difficulty coming in on her days off because she has two small
children; therefore, she is generally at the top of the list of
those who have to stay [for mandatory overtime]. She said she
gives medications to 20-30 patients. She stated that mandatory
overtime is very dangerous and has caused many medication and
judgment errors.
4:51:14 PM
DAVE WILLIAMS, Project Coordinator, Pioneers' Homes, said that
RNs are crucial to pioneers' homes, but there are also LPNs and
Certified Nurse Assistants (CNAs). He said there is a lot of
overtime. Most of it is voluntary, but some of it is mandatory.
He said the pioneers' homes staff of RNs work overtime
voluntarily because they care greatly for the residents they
serve. He said the bill would require careful documentation as
to whether overtime was voluntary or mandatory, because "some of
the provisions in the bill would penalize if it wasn't." In
response to a question from Vice Chair Seaton, he stated his
belief that every one of the RNs, LPNs, and CNAs work overtime.
He noted that the RNs are "Nurse I, II, and III in the state
system" and are the people who the pioneers' homes are required
by licensure to have on board in order to provide services. He
said he does not know what the pioneers' homes would do if
nobody showed up to work and it was necessary to call someone up
without the ability to use mandatory overtime.
MR. WILLIAMS said one alternative may be to use contracted
services; however, he said he doesn't know how practical that
would be, especially in a more remote place. He stated that the
issue is supply; there are not enough RNs available. He opined
that nurses who work at the pioneers' homes carefully weigh the
benefits they receive, because "it's the package of wages and
benefits that need to be balanced against what's in the private
sector." He proffered that if working at the pioneers' homes is
made more valuable, then there may come a time when the
hospitals would have a "hole" in their system. He indicated
that he also works with hospitals and he confirmed that they do
"look at contract nurses." He reemphasized the need to have RNs
available in order to operate. He said he would get a fiscal
note to the committee to reflect how much overtime at the
pioneers' homes is voluntary and how much is mandatory.
4:55:42 PM
REPRESENTATIVE CISSNA asked if "lifting" is used to alleviate
the nursing load. In response to a request for clarification,
she said by "lifting" she means shifting some of the
responsibilities that don't require the education of an RN to
other employees.
MR. WILLIAMS said the pioneers' homes do that, which is why it
employs a lot of CNAs.
4:57:11 PM
VICE CHAIR SEATON closed public testimony.
CHAIR WILSON moved to adopt the fiscal note from the Department
of Labor and Workforce Development, dated 4/19/05. There being
no objection, it was so ordered.
VICE CHAIR SEATON returned the gavel to Chair Wilson.
[HB 271 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:57:55 PM.
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