Legislature(2005 - 2006)CAPITOL 106
01/26/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) || State Medical Board | |
| Commissioner, Department of Health and Social Services | |
| Overview (s) || Department of Health and Social Services - Influenza Pandemic | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
January 26, 2006
3:11 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Vic Kohring
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
Representative Carl Gatto
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
State Medical Board
Dr. Kevin M. Tomera - Anchorage
Nancy Puckett - Anchorage
Edward A. Hall - Anchorage
- CONFIRMATION(S) ADVANCED
Commissioner, Department of Health and Social Services
Karleen Jackson - Juneau
- CONFIRMATION(S) ADVANCED
OVERVIEW(S): DEPARTMENT OF HEALTH AND SOCIAL SERVICES -
INFLUENZA PANDEMIC
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
KEVIN M. TOMERA, MD, Appointee to the State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the State Medical
Board.
NANCY PUCKETT, Appointee to the State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the State Medical
Board.
EDWARD A. HALL, Physician Assistant (PA), Appointee to the State
Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the State Medical
Board.
KARLEEN JACKSON, Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified as appointed commissioner of
DHSS.
RICHARD MANDSAGER, MD, Director
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Co-presented the overview regarding the
influenza pandemic.
JAY BUTLER, MD, Chief
Epidemiology Section
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Co-presented the overview regarding the
influenza pandemic.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:11:35 PM.
Representatives Cissna, Gardner, Kohring, Seaton, and Wilson
were present at the call to order. Representative Gatto was
excused.
3:11:47 PM
^CONFIRMATION HEARING(S)
^State Medical Board
3:12:28 PM
KEVIN M. TOMERA, MD, Appointee to the State Medical Board,
provided his personal history as a urologist in the Anchorage
area since 1993. He said that he looks forward to serving the
community via this appointment, and, in response to a question,
said that he is too new to have a specific agenda.
REPRESENTATIVE CISSNA asked whether he is familiar with the pro
bono medical program established by the United Way to assist the
growing number of uninsured, low-income Alaskans. She also
asked whether he supports the before mentioned program.
DR. TOMERA stated that the Anchorage urology group already
participates in [pro bono medical ] program and have
historically provided services regardless of the patient's
ability to pay. Additionally, he expressed concern for the
rising cost of health insurance stating that there is not an
easy solution. When asked what he considers to be the major
role of the State Medical Board, he responded that the board
"should be in the practice of medicine," not "social
engineering."
REPRESENTATIVE GARDNER moved that the House Health, Education
and Social Services Standing Committee, forward the name of Dr.
Kevin J. Tomera to the joint session for consideration of
appointment to the State Medical Board. There being no
objection, the confirmation of Dr. Kevin J. Tomera was advanced.
3:18:14 PM
NANCY PUCKETT, Appointee to the State Medical Board, provided
her personal history as a 15-year Alaskan resident, and
highlighted her recent work with the private nonprofit sector.
She stated that she looks forward to this appointment as a
vehicle to continue serving the community. In response to a
question, she explained that the board is comprised of two
public seats, one physician assistant (PA) seat, and the balance
of seats are for physicians; she noted that she appointed to
fill one of the public seats. Therefore, she opined that she
expects to speak for the public and protect the public interest.
VICE CHAIR SEATON moved that the House Health, Education and
Social Services Standing Committee, forward the name of Nancy
Puckett to the joint session for consideration of appointment to
the State Medical Board. There being no objection, the
confirmation of Nancy Puckett was advanced.
3:22:14 PM
EDWARD A. HALL, Physicians Assistant (PA), Appointee to the
State Medical Board, stated that he has been in Alaska since
1994, and an active member of the Alaska Academy of Physician
Assistants (AKAPA). He explained that he represented AKAPA at
medical board meetings for several years, eventually supporting
a lobby for an AKAPA seat on the board. He applied for this
seat, as a continuum of his board meeting attendance and his
interest in serving AKAPA in this capacity. In response to a
question, he stated that PAs are integral in serving Alaska's
rural districts, and that AKAPA supports the pro bono health
program. Further, he named the rural areas that he has had an
opportunity to visit.
VICE CHAIR SEATON moved that the House Health, Education and
Social Services Standing Committee, forward the name of Edward
A. Hall to the joint session for consideration of appointment to
the State Medical Board. There being no objection, the
confirmation of Edward A. Hall was advanced.
^Commissioner, Department of Health and Social Services
3:28:46 PM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services (DHSS), provided personal highlights of her 40 years in
Alaska, including her higher educational pursuits. She provided
that three years ago she was recruited to serve as the deputy
commissioner, and that she has enjoyed working with the
management/leadership teams of the department since her hire.
In response to questions, she explained that DHSS has been
considering integrated case management, which will eliminate the
concern of casework isolation as the applicable divisions and
the associated state departments would be appropriately
informed/engaged. Also, she stated, the DHSS management team
has been discussing ways and means to upgrade and improve
children's services. She opined that although change will not
happen quickly, progress will be made.
REPRESENTATIVE KOHRING moved that the House Health, Education
and Social Services Standing Committee, forward the name of
Karleen Jackson to the joint session for consideration for
confirmation as Commissioner of the Department of Health and
Social Services. There being no objection, the confirmation of
Karleen Jackson was advanced.
^Overview (S)
^Department of Health and Social Services - Influenza Pandemic
The committee took an at-ease from 3:39:45 PM to 3:44:17 PM
3:48:03 PM
JAY BUTLER, MD, Chief, Epidemiology Section, Division of Public
Health, Department of Health and Social Services, began the
slide presentation explaining that influenza is a respiratory
tract infection caused by the influenza virus, and dispelling
stomach flu as a true influenza. He described the difficulty in
treating a virus, explaining that a virus is often not treated,
and how a virus is commonly spread via respiratory droplets.
Naming the three known influenzas, he stated that today's topic
of focus would be influenza A. He explained how influenzas:
receive a letter and a numeric "type" name; originate with
waterfowl; will occasionally mutate or "jump species" to affect
domestic fowl, equines, swine, seals, and whales; and are
limited in the number of types that can cause human influenza.
Introducing H5N1, he explained that this is the strain currently
circulating as bird influenza, and was originally isolated from
terns in South Africa, in 1961. It then emerged as a highly
pathogenic strain in domestic poultry in Hong Kong in 1997,
where it first infected humans and was commonly termed "bird
flu." Although it was thought to be contained within the
domestic flocks identified and culled at the time, the highly
pathogenic strain emerged again in Southeast Asia in December
2003, proving that in actuality the virus had spread.
3:52:51 PM
DR. BUTLER, responding to a question, clarified that the current
concern is for the influenza [type] A [strain H5N1] known as "Z
Clone," which emerged in December 2003 and has not yet appeared
in North or South America. He explained that the transmission
of H5N1 to human populations has either been by direct contact
with infected domestic poultry and their secretions, or via
human-to-human contact, which has thus far been rare. He
provided a map to illustrate how the disease has spread;
indicating the 14 countries with cases identified in poultry and
the six countries with cases identified in humans. He pointed
out that the map is changing almost daily.
3:54:59 PM
DR. BUTLER explained that a pandemic influenza occurs when:
there is a new strain of virus to which the population has no
immunity; the virus has an ability to replicate in humans and
cause disease; and the virus maintains an efficient and
sustained person-to-person transmission. He provided a history
of the three influenza pandemics of the 20th century, which
occurred in 1918, 1957, and 1968. Extrapolating on the
statistics from these three pandemics, he presented an estimate
of how a pandemic might effect Alaska's current population. The
statistics indicated that Alaska's annual death rate could be
expected to double. In response to a question regarding
effective treatment alternatives, he stated that the bird flu
fatalities reported from Indonesia involved patients who were
treated in intensive care units and had received anti-viral
drugs. He contrasted the Asian experience with the recent
influenza outbreaks appearing in the more developed country of
Turkey, where treatment has proven more successful and the death
rate lower.
REPRESENTATIVE CISSNA inquired about the differences of the
first two 20th century pandemics in America, and asked: were
the severity levels of the influenzas different; if they were
the same, what other factors caused death; and, today, are there
particular populations that are more likely to succumb to the
influenza virus.
DR. BUTLER answered that the primary determinant for the
severity of a pandemic is the strain of influenza involved. He
explained that the 1918 influenza created an immune response
that was primarily detrimental to the vigorous and healthy
victims, in the 20-40 age group, versus the young and elderly,
who were primarily effected by the pandemics later in the
century. As to what populations might be at highest risk, he
stated that there are no definite answers. However, he pointed
out that during the 1918 pandemic the western Alaskan villages
experienced mortality rates greater than 50 percent ranking them
among the highest in the world.
4:01:48 PM
DR. BUTLER described means to reduce the projected impact
numbers for Alaska. He explained that, unlike seasonal
influenza with a ready immunization, a pandemic strain vaccine
would not be available for perhaps six months following the
initial outbreak, and he highlighted the need for infection
control measures to be immediately initiated. Also, he stressed
the need to have anti-viral drugs available to minimize the
impact of the virus, and explained that the national influenza
pandemic plan calls for stock piling anti-viral drugs. However,
each state is required to bear one third of the responsibility
to create and maintain the necessary stockpile of drugs. He
pointed out how Alaska's unique dependency on air travel would
need to be factored into a pandemic scenario.
4:03:43 PM
VICE CHAIR SEATON asked whether the current recommendations,
regarding anti-viral medication usage recently issued from the
Center for Disease Control (CDC), will affect these projections.
DR. BUTLER stated that the CDC recommendations are for seasonal
influenza anti-viral drugs, and, in further response, discussed
the effectiveness of anti-viral agents. Regarding the role that
children play in the proliferation of the virus, he said "as the
mosquito is to malaria so children are to influenza," which is
one reason that the CDC has been expanding its recommendations
for routine influenza immunizations to include young children.
DR. BUTLER described the impact a pandemic could have on
businesses providing for employee absenteeism, widespread fear,
and possible restrictions on transportation and public
gatherings. He related common misperceptions about a pandemic
influenza, and clarified that pandemic strains always originate
in animals, progress to humans, and eventually mutate enough to
be able to be transmitted from person to person. In conclusion,
he said that there are a number of ways to prepare for a
pandemic, beyond waiting for the federal government to respond,
which the co-presenter would be highlighting.
4:13:20 PM
RICHARD MANDSAGER, MD, Director, Division of Public Health,
Department of Health and Social Services (DHSS), provided the
nine most effective ways to minimize a pandemic influenza
outbreak: practice hand hygiene; cover coughs and sneezes;
avoid touching eyes, nose, and mouth; remain at home when ill;
rest and exercise; eat a balanced diet; minimize the consumption
of alcohol; avoid tobacco smoke; and take an annual influenza
vaccination. He noted his agreement, with Chair Wilson that a
pocket sanitizer would go a long way in slowing down the spread
of disease and stated that a virus can reside on a hand for some
time thus making handshake transmission possible even if
symptoms are not apparent in the carrier.
REPRESENTATIVE CISSNA asked how avoiding tobacco smoke protects
against influenza.
DR. BUTLER responded that all smoke is a respiratory
compromiser, allowing for an increased susceptibility to more
severe manifestations of influenza infection.
DR. MANDSAGER explained the role of the Division of Public
Health in training communities to prepare for rapid disease
response. Responding to a question, he said that a pandemic
situation is managed in two parts. In the first part,
prevention procedures are followed, then, as the pandemic
manifests, secondary procedures are implemented to stem the
situation. This second phase would require "trade offs" to
precautions that were deemed necessary during the first phase.
To further illustrate his point, he described the public health
response to the polio epidemic of the 1950's.
DR. MANDSAGER explained how the health industry is better
prepared to handle a pandemic today due to: new public health
laws; emergency plans; mass prophylactic clinic exercises; human
disease surveillance; and bird disease surveillance. However,
there is more work to be done, he said, and listed strategies
that need to be implemented, stressing that the development of
public trust is an essential aspect of the preparation.
4:23:59 PM
DR. MANDSAGER stated that bird disease surveillance is "a hot
topic in Alaska" because the state is the central corridor for
bird flyways to Asia. He described the avian surveillance plans
which will be conducted, beginning this summer, and named the
various state, Native, federal, and private agencies who will be
participating in the effort. Considering how this pandemic
virus has been spreading, he opined that, even if the disease
does not become a major human threat, it will continue to be of
concern for the poultry industries of North America. In
response to questions, he clarified that if the virus arrives in
North America via birds, it will arrive in Alaska first, due to
the bird flyways; however, if it arrives via human carrier, it
could enter the continent at any international airport,
including Anchorage. In further response, he stated that the
culling of poultry flocks has not stopped the spread of the
virus. He explained that the virus has a devastating effect on
the poultry industry, because, even though the meat is safe when
fully cooked, consumers tend to boycott the meat out of fear.
Further, he responded that scientists are working to isolate
specific "risky" aspects of handling afflicted fowl.
4:28:46 PM
DR. MANDSAGER explained that volunteers will need to be prepared
and trained for their role in sustaining communities through a
pandemic. He posed questions that each community, along with
its community support managers, will need to answer. The
imminent exercise/test that Ketchikan is planning will be the
first community pandemic emergency response undertaking in
Alaska, he reported.
DR. MANDSAGER posed specific questions which each community will
need to be prepared to answer prior to a pandemic situation;
bulleted on the slide as: prioritization of immunizations;
rationing of community supplies; how to maintain an operational
community infrastructure; and ways to prepare the population
that will mitigate widespread surprise and confusion. He stated
that a planning assumption, in the state's emergency operation
plan, is that "public order will survive," and that holding
public forums is one way to ensure this assumption. In response
to further questions, he stressed the importance of reaching out
to special population groups, and contacting people who live in
isolated situations. He posed other questions in regard to
scenarios that are unique to Alaska. He also pointed out that a
pandemic of this magnitude is both a medical and a socio-
economic issue.
4:36:42 PM
REPRESENTATIVE SEATON inquired about practical supplies that
might be needed by the public during the time between a pandemic
outbreak and the development of the vaccine. Given the
possibility of an interruption in transportation, he asked if
[the state] should be identifying and procuring supplies for
immediate stockpiling.
DR. MANDSAGER stated that the governor's budget proposes funding
for anti-viral medication, and explained that the current plan
is to create an anti-viral medication stockpile. The stored
medications will be available to treat anyone who becomes ill,
but the exact contents/supplies of community stockpiles are in
the planning stage, he said. In response to a question he
explained that a vaccine must be tailored for the novel virus
that eventually surfaces and this is the reason that it takes
approximately six months to develop a vaccine. He provided that
part of President Bush's initiative is to advance technology and
shorten the time factor for vaccine development. Further, he
stated that the vaccine carries a five-year expiration date and,
when stockpiled, needs to be continually monitored and cycled.
He also explained the need to consider mandatory and voluntary
social distancing on a community level.
4:43:23 PM
DR. MANDSAGER introduced Governor Murkowski's Administrative
Order No. 228, issued January 9, 2006, which names the
Department of Military & Veterans' Affairs (DMVA), and DHSS as
the lead agencies for the state in [pandemic] planning and
strategy implementation. He also introduced the State of Alaska
Pandemic Influenza Concept Plan, which provides planning
assumptions that are in current use. He highlighted the
expectation that, if the virus arrives via a human carrier,
national resources may be overwhelmed in meeting population
needs in the lower 48. However, if the virus arrives via a
bird, Alaska would be the first state effected and could expect
to receive prioritized federal assistance. He stressed that we
must plan to be ready for either scenario. He continued with
the Alaska Pandemic Influenza Preparedness Concept Plan
objectives which provide for: the development and activities of
the Alaska Pandemic Influenza Annex; public information and
education dissemination; outreach activities; and training and
exercise activities to commence by the end of January 2006.
4:46:23 PM
DR. MANDSAGER explained that in providing guidance to business
leaders, "pre-pandemic" considerations urge them to: develop a
plan, encourage annual influenza vaccinations, and evaluate
employee access to health care and mental health services. In
response to a question, he stated that the goal this winter is
to raise public awareness of the [pandemic] subject. To that
end, he announced that on April 13, 2006, Michael Leavitt,
United States Secretary of Health and Human Services, will hold
a summit in Alaska to increase public awareness. He went on to
provide the "during pandemic" guidelines to business leaders,
which advises employers to: establish a sick leave plan; use
flexible workplace and work hours; restrict business travel to
affected areas; encourage employee hand hygiene and respiratory
etiquette; and provide infection control supplies to employees.
4:51:44 PM
REPRESENTATIVE CISSNA described technology that is available
which would allow for meetings and communications while being
able to follow some of the restrictions that Dr. Mandsager has
outlined.
4:54:12 PM
DR. MANDSAGER briefly provided some topics which will need to be
considered if the governor declares a state emergency. Further,
he outlined the budget initiative and the funding breakout of
the $7.23 million requested in fiscal year 2007.
DR. MANDSAGER summarized his presentation stating that: a
pandemic of influenza will happen in the future; it is important
to be prepared; this preparedness will also help the state to be
prepared for other threats and emergencies; and the legislature
plays a significant leadership role for Alaska's citizens.
Finally, he presented three pertinent web sites for further
information.
4:57:15 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:57:31 PM.
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