03/23/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB356 | |
| HJR33 | |
| HB430 | |
| SB255 | |
| HB436 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HJR 33 | TELECONFERENCED | |
| += | HB 430 | TELECONFERENCED | |
| += | SB 255 | TELECONFERENCED | |
| *+ | HB 436 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 356 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
March 23, 2006
3:08 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Carl Gatto
Representative Vic Kohring
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
COMMITTEE CALENDAR
HOUSE BILL NO. 356
"An Act relating to consent for medical and dental services,
including bone marrow donation, for a minor."
- HEARD AND HELD
HOUSE JOINT RESOLUTION NO. 33
Urging the Alaska Department of Health and Social Services to
seek authority and funding from the United States Department of
Veterans Affairs to establish a system allowing Alaska veterans
treatment in both public and private Alaska facilities.
- HEARD AND HELD
HOUSE BILL NO. 430
"An Act making an appropriation for the construction of the
Palmer Senior Citizen Center; and providing for an effective
date."
- MOVED HB 430 OUT OF COMMITTEE
CS FOR SENATE BILL NO. 255(FIN)
"An Act extending the termination date and duties for the Board
of Examiners in Optometry; amending the licensing, endorsement,
and renewal provisions for optometrists; and providing for an
effective date."
- MOVED CSSB 255 (FIN) OUT OF COMMITTEE
HOUSE BILL NO. 436
"An Act requiring the Department of Health and Social Services
to employ a sufficient number of social workers; relating to the
protection of children in need of aid by reducing the caseloads
and supervisory duties to comply with certain national
standards; and providing for an effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 356
SHORT TITLE: MINORS: MEDICAL CONSENT,INCL BONE MARROW
SPONSOR(s): REPRESENTATIVE(s) GATTO
01/11/06 (H) READ THE FIRST TIME - REFERRALS
01/11/06 (H) HES, JUD
03/02/06 (H) HES AT 3:45 PM CAPITOL 106
03/02/06 (H) <Bill Hearing Canceled>
03/21/06 (H) HES AT 3:00 PM CAPITOL 106
03/21/06 (H) Scheduled But Not Heard
03/23/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HJR 33
SHORT TITLE: SUPPORTING IN-STATE MED. CARE FOR VETS
SPONSOR(s): REPRESENTATIVE(s) KOTT
02/13/06 (H) READ THE FIRST TIME - REFERRALS
02/13/06 (H) MLV, HES
03/02/06 (H) MLV AT 1:00 PM CAPITOL 120
03/02/06 (H) Moved Out of Committee
03/02/06 (H) MINUTE(MLV)
03/03/06 (H) MLV RPT 4DP
03/03/06 (H) DP: ELKINS, THOMAS, DAHLSTROM, LYNN
03/23/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 430
SHORT TITLE: APPROP: PALMER SENIOR CITIZEN CENTER
SPONSOR(s): REPRESENTATIVE(s) GATTO
02/06/06 (H) READ THE FIRST TIME - REFERRALS
02/06/06 (H) HES, FIN
03/02/06 (H) HES AT 3:45 PM CAPITOL 106
03/02/06 (H) <Bill Hearing Canceled>
03/23/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: SB 255
SHORT TITLE: OPTOMETRY: EXTEND BD/ LIC. ENDORSEMENT
SPONSOR(s): RULES BY REQUEST OF LEG BUDGET & AUDIT
01/30/06 (S) READ THE FIRST TIME - REFERRALS
01/30/06 (S) L&C, FIN
02/14/06 (S) L&C AT 1:30 PM BELTZ 211
02/14/06 (S) Moved CSSB 255(L&C) Out of Committee
02/14/06 (S) MINUTE(L&C)
02/16/06 (S) L&C RPT CS 5DP NEW TITLE
02/16/06 (S) DP: BUNDE, DAVIS, ELLIS, SEEKINS,
STEVENS B
03/01/06 (S) FIN RPT CS 5DP NEW TITLE
03/01/06 (S) DP: BUNDE, HOFFMAN, OLSON, DYSON,
STEDMAN
03/01/06 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/01/06 (S) Moved CSSB 255(FIN) Out of Committee
03/01/06 (S) MINUTE(FIN)
03/03/06 (S) TRANSMITTED TO (H)
03/03/06 (S) VERSION: CSSB 255(FIN)
03/06/06 (H) READ THE FIRST TIME - REFERRALS
03/06/06 (H) HES, L&C, FIN
03/13/06 (H) L&C AT 3:15 PM CAPITOL 17
03/13/06 (H) <Pending Referral>
03/23/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 436
SHORT TITLE: SOCIAL WORKER CASELOADS & WORKLOADS
SPONSOR(s): REPRESENTATIVE(s) GARA
02/08/06 (H) READ THE FIRST TIME - REFERRALS
02/08/06 (H) HES, FIN
03/23/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
AMY SALTZMAN, Staff
to Representative Carl Gatto
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 356 on behalf of the sponsor,
Representative Gatto.
CODY RICE, Staff
to Representative Carl Gatto
Alaska State Legislature
POSITION STATEMENT: Answered questions, during hearing of HB
356, and presented HB 430 on behalf of Representative Gatto,
sponsor.
MICHAEL O'HARE, Staff
to Representative Pete Kott
Juneau, Alaska
POSITION STATEMENT: Presented HJR 33 on behalf of the sponsor,
Representative Kott.
DAVID STOCKWELL, Associate Director
Alaska Veterans Healthcare System and Regional Office
U.S. Department of Veterans Affairs
(No address provided)
POSITION STATEMENT: During hearing of HJR 33, answered
questions.
DAVE WILLIAMS, Program Coordinator
Division of Alaska Pioneer Homes
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During hearing of HJR 33, answered
questions.
VIRGINIA SMILEY, Director
Division of Alaska State Pioneer Homes
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During hearing of HJR 33, answered
questions.
RICK DAVIDGE, President
Vietnam Veterans of America, Alaska Chapter 904
Anchorage, Alaska
POSITION STATEMENT: Testimony on HJR 33 was read by Kevin
McGee.
MARCIA HOFFMAN-DEVOE, Alaska Veterans Healthcare System and
Regional Office
U.S. Department of Veterans Affairs
Anchorage, Alaska
POSITION STATEMENT: During hearing of HJR 33, answered
questions.
TOM MAHER, Staff
to Senator Gene Therriault
Alaska State Legislature
POSITION STATEMENT: Presented SB 255 on behalf of Senator
Therriault.
PAT DAVIDSON, Legislative Auditor
Legislative Audit Division (LAD)
Legislative Affairs Agency
POSITION STATEMENT: Answered questions on CSSB 255.
REPRESENTATIVE LES GARA
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Spoke as the sponsor of HB 436.
TAMMY SANDOVAL, Deputy Commissioner
Office of Children's Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified on HB 436.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:08:49 PM
Representatives Seaton, Gatto, Kohring, Cissna, Gardner, and
Wilson were present at the call to order.
HB 356-MINORS: MEDICAL CONSENT,INCL BONE MARROW
3:09:15 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 356, "An Act relating to consent for medical and
dental services, including bone marrow donation, for a minor."
3:09:43 PM
AMY SALTZMAN, Staff to Representative Carl Gatto, Alaska State
Legislature, presented HB 356 paraphrasing from the sponsor
statement as follows [original punctuation provided]:
House Bill 356 allows a minor with doctoral and
parental consent to donate bone marrow.
Bone marrow contains stem cells, which can be
transplanted into a person to restore stem cells that
were destroyed by high doses of chemotherapy and/or
radiation. The National Cancer Institute reports that
bone marrow transplants are most commonly used for
treating persons with leukemia or lymphoma, and may
also be used to treat childhood brain tumors and
neuroblastoma.
Eligibility to receive a bone marrow donation is based
on the tissue compatibility with that of the donor.
Tissue type is inherited, thus patients are most
likely to match someone of their same race and
ethnicity. According the Alaska Blood Bank of the
available 3.5 million volunteers on the National
Registry only 1.3% could be possible matches to a
Native American. With the large Native population in
Alaska it is essential that there be an increase in
the availability of possible matches for bone marrow
transplants.
The National Bone Marrow Donor Program (NMDP) does not
allow for minors to participate in testing determining
capability for bone marrow donation. The reasoning
cited by the NMDP has been that minors are not capable
to consent to the medical procedures. The reasoning
for this limitation is unclear. This procedure would
only be done for a minor with the proper consent of
the parent, guardian, and physician.
Current medical procedures have created the
possibility for less painful transplant procedures.
Donating marrow typically does not create significant
problems for the donor because only a small amount of
marrow is needed. The body replaces the lost marrow in
only a few weeks.
Allowing for donations of bone marrow by minors could
significantly improve the odds of survival for many
Alaskans. This legislation is imperative if Alaskans
are to win the fight against leukemia or lymphoma.
3:10:50 PM
REPRESENTATIVE GATTO added that only 1 percent of the registry
occupants are Native, and thus within that 1 percent is where a
match would be for [Native Americans]. It's only "a percent of
a percent," he said. Therefore, the hope is that by allowing
young people to donate, the number of Native Americans eligible
to donate would be increased.
3:11:24 PM
MS. SALTZMAN informed the committee that there are two different
procedures used to [donate and transplant] bone marrow, one of
which is similar to blood donation. She also informed the
committee that if a match is found, there is less than 5 percent
chance that the transplant won't work.
3:12:16 PM
REPRESENTATIVE CISSNA inquired as to the statutory protections
for a minor with parental and doctoral consent, although the
minor doesn't want to donate the bone marrow.
MS. SALTZMAN noted that regardless of age, there is counseling
when there is a bone marrow donation. Furthermore, a donation
would only occur if it's in the best interest of everyone
involved. In regard to specific statutory protections, Ms.
Saltzman offered to research that.
3:13:23 PM
CODY RICE, Staff to Representative Gatto, Alaska State
Legislature, related his understanding the minors aren't capable
of giving consent and thus [whether there is protection for a
minor] is a moot point. He suggested that whether a minor could
give or refuse consent if the parent gave consent would probably
require a legal opinion.
3:13:55 PM
CHAIR WILSON, drawing upon her experience as a nurse, related
that when a child doesn't want an IV, although it's in the
child's best interest, the IV is given if the parents have given
permission.
3:14:09 PM
REPRESENTATIVE CISSNA opined that it's different when the
donor's body part is being used for someone else. She mentioned
the possibility of a sibling constantly being used as a "body
bank" for another sibling, which could endanger the donating
sibling's life. She questioned whether one child should be used
as a body bank for another.
MR. RICE said although that is a legitimate question, the
question assumes that a doctor would breach the Hippocratic Oath
that he/she "shall do no harm." He agreed with Representative
Cissna that giving an IV to a child for his/her best interest is
different than to force one to donate, which may not be in that
[child's] best interest. The aforementioned would be a
difficult ethical situation for a doctor.
3:15:29 PM
REPRESENTATIVE CISSNA requested an answer to her earlier
question regarding whether there are statutory protections for a
minor who doesn't consent to providing bone marrow. She
inquired as to what other states are doing.
REPRESENTATIVE GARDNER said she shares the same concerns. She
then inquired as to the risk factors involved to the donor
child.
CHAIR WILSON requested that the answers be provided by the time
the legislation reaches the House Judiciary Standing Committee,
which is the next committee of referral for HB 356.
REPRESENTATIVE GARDNER suggested that the language may not do
what is being requested because the services being requested
aren't for the [donating] minor.
CHAIR WILSON said that, too, would be addressed in the next
committee of referral.
3:17:34 PM
REPRESENTATIVE SEATON highlighted a Washington Post article in
the bill packet that relates that the National Marrow Donor
Program (NMDP) opposed legislation similar to HB 356 due to the
associated medical risks. He inquired as to the risks for a
minor that are not associated with an adult donor.
MS. SALTZMAN related her understanding that bone marrow is
"ripe" at the age of 16 and over. The NMDP chose the age of 18
because that's the general age of consent. The Maryland
legislation was left broad such that when the physician consents
and it's in the best interest of the donor and the donee, the
minor can donate bone marrow.
MR. RICE interjected his belief [that the Maryland legislation]
placed the policy call into the hands of those most familiar
with the risk and the need, which is the physician.
3:19:56 PM
MS. SALTZMAN, in further response to Representative Seaton, said
that she spoke with many physicians who didn't relate or imply
that [there are different risks for those 16-18 years of age and
those older]. However, physicians did say that every individual
is different and that a thorough background check is completed
for the donor and the recipient.
3:21:41 PM
REPRESENTATIVE GATTO turned attention to the Maryland
legislation, which specified that the bone marrow donation must
be in the best interest of the donee and that there is no
substantial risk to the donor. The language "substantial risk"
seems to clearly identify that there is a risk, but it seems to
be weighed against the benefit. Representative Gatto concluded
by opining that he couldn't imagine any physician taking bone
marrow from a child who didn't want the procedure.
3:23:38 PM
REPRESENTATIVE CISSNA posed a hypothetical situation in which a
three-year-old may be the only donor match for his/her five-
year-old sibling. In such a life and death situation it's
difficult to make decisions, and thus it's important to address
matters before such a situation. She expressed the need to hear
from physicians who have actually been involved in these cases.
3:25:24 PM
REPRESENTATIVE GATTO mentioned that the situation Representative
Cissna posed isn't the issue being addressed by HB 356.
REPRESENTATIVE CISSNA pointed out that this legislation merely
refers to a minor and doesn't specify any age.
3:25:46 PM
CHAIR WILSON noted that one's bone marrow cells need to be
mature, and thus [bone marrow donation] isn't usually done with
younger children. She then reminded the committee that bone
marrow could be mature for those age 16 and over.
3:26:23 PM
REPRESENTATIVE CISSNA pointed out that HB 356 adds bone marrow
donation to those [medical services for which a parent or legal
guardian of a minor can give consent]. Therefore, [medical
services] could refer to any number of things.
MR. RICE said that wasn't the intention of the sponsor, and thus
he suggested that the sponsor would be amenable to an amendment
to provide clarity.
3:26:49 PM
REPRESENTATIVE GARDNER expressed the need to know more about the
risk factors to the donor as well as the issue with regard to
the age [of a minor]. Representative Gardner said that she read
the legislation such that medical services could include the
donation of a kidney.
MR. RICE said he suspected that if such isn't listed under [what
is considered to be medical services], it would be difficult to
prove that it's acceptable to do other procedures such as give
consent for a minor to donate a kidney.
REPRESENTATIVE GARDNER commented that she didn't believe it
would be excluded.
REPRESENTATIVE CISSNA suggested that a legal opinion would be
necessary.
3:27:49 PM
REPRESENTATIVE GATTO suggested that these matters could be
addressed after testimony is taken.
CHAIR WILSON announced that no one had signed up to testify.
3:28:05 PM
REPRESENTATIVE SEATON requested that the sponsor check with the
NMDP with regard to the risks that caused the organization to
oppose lowering the donor's age to 16.
3:28:26 PM
CHAIR WILSON pointed out that the statute already includes the
dental and medical services and covers a minor not living with
the guardian. Therefore, she said that Representative Cissna's
concerns are already covered, although not for bone marrow.
3:29:00 PM
REPRESENTATIVE SEATON pointed out that the statute being
modified is for the minor giving consent for his/her own medical
treatment, if he/she isn't with the parent. However, the
[language in HB 356] addresses a parent giving consent for a
minor, which seems to be in the wrong [statute] and thus needs
to be clarified.
[HB 356 was held over.]
HJR 33-SUPPORTING IN-STATE MED. CARE FOR VETS
CHAIR WILSON announced that the next order of business would be
HOUSE JOINT RESOLUTION NO. 33, Urging the Alaska Department of
Health and Social Services to seek authority and funding from
the United States Department of Veterans Affairs to establish a
system allowing Alaska veterans treatment in both public and
private Alaska facilities.
3:30:16 PM
MICHAEL O'HARE, Staff to Representative Pete Kott, introduced
HJR 33, on behalf of Representative Kott paraphrasing from the
sponsor statement as follows [original punctuation provided]:
With approximately 72,000 veterans that call our great
state home, I believe that Alaska's veterans deserve
top quality health care in their own communities.
Currently forced to seek medical treatment with U.S.
Veteran's facilities, many of these heroes have to
leave their communities and even go outside of Alaska.
Many millions of dollars have been spent in airfare
alone in order to get Alaskan's treatment when the
treatment and facilities are available in state. This
policy is costly and inefficient, and it disrupts
Alaskans' lives.
House Joint Resolution 33 urges the United States
Department of Veterans' Affairs to authorize funding
and management to establish a system whereby Veterans
can seek treatment from medical facilities other than
that of the U.S. Military and Veteran's Affairs
doctors and hospitals, many of which are available in
the State of Alaska. This would give veterans a
greater choice and flexibility for healthcare and
increase the interaction between the Department and
Military and Veterans Affairs doctors and the public
and private medical facilities in the state thus,
significantly reducing medical costs and increasing
efficiency for veterans' medical care. This system
would support the use of a veteran's medical
identification card as an insurance card for medical
billing to the U.S. Department of Military and
Veteran's Affairs.
The passage of HJR 33 will give veterans a choice, and
will allow them local access to quality healthcare.
3:32:29 PM
CHAIR WILSON related that veterans who come to a clinic have to
call ahead and receive permission to receive treatment at the
clinic. The aforementioned permission takes some time to
obtain. How would this legislation change the aforementioned,
she asked.
MR. O'HARE related his understanding that the veteran would
present his/her veteran's medical identification card. There
would be an agreement between the U.S. Department of Veterans'
Affairs and the medical community to accept the aforementioned
identification card as an insurance card in order that veterans
can receive treatment in a competitive manner within the
community. In response to Representative Gatto, Mr. O'Hare
specified that the nearest Veterans' Administration (VA)
hospitals are located in Seattle and Oregon.
3:33:46 PM
REPRESENTATIVE GATTO indicated that perhaps even taking the
airfare into consideration, in-state treatment options may be
more costly. He questioned whether there is any way to match
information with regard to the cost of Alaska's veterans
receiving medical services in state versus out of state.
3:35:16 PM
REPRESENTATIVE CISSNA, drawing upon her experience with her late
husband who was a veteran and discussions with other veterans,
related that the travel required to reach approved VA hospitals
poses a risk on the ill veteran. She recalled that often her
husband couldn't receive his treatment because, after traveling
to the hospital, he wasn't well enough. Furthermore, the
airfare can be expensive. She, too, inquired as to the current
regulations for veterans living in the Bush.
MR. O'HARE related his understanding that veterans are required
to go to a veterans' hospital for certain treatments. This
resolution attempts to help minimize the cost, time, and trauma
of travel in order to allow the veterans to seek treatment in an
in-state facility if possible. Mr. O'Hare acknowledged that the
costs [for medical treatment] may be more expensive in Alaska
than in the Lower 48, even with the flight costs. Therefore, he
suggested that there should be an option for the veteran with
regard to where to receive treatment.
3:38:49 PM
CHAIR WILSON noted that some insurance companies will offer the
option of flying a patient to [the Lower 48], if it's cost
effective.
3:39:05 PM
DAVID STOCKWELL, Associate Director, Alaska Veterans Healthcare
System and Regional Office, U.S. Department of Veterans Affairs,
explained that the $2 million was the entire travel budget for
the year stated. However, only around $600,000 was spent to
send patients to the Seattle and Portland VA facilities. He
noted that a fair amount of money is spent for patients to
access medical care in the state as well. Mr. Stockwell related
that for fiscal year (FY) 04 a little over $17 million was saved
by using federal facilities.
3:40:16 PM
REPRESENTATIVE GATTO pointed out that the analysis of the fiscal
note by the Department of Health and Social Services (DHSS)
indicates that three new positions would be necessary. However,
none of the three new positions are shown in the fiscal note for
succeeding years. He then inquired as to the meaning of the
references to "$14,700 mil", "$10,000 mil", and "$25,000 mil".
MR. STOCKWELL said that he didn't have the fiscal note to which
Representative Gatto referred. However, he related that the
U.S. Department of Veterans Affairs budget for Alaska is about
$103 million a year.
3:42:24 PM
DAVE WILLIAMS, Program Coordinator, Division of Alaska Pioneer
Homes, Department of Health and Social Services (DHSS),
explained that the $85.3 [million] is to fund one position to
work out how this funding process would be addressed. Mr.
Williams related support for the concept proposed in HJR 33, but
he emphasized that it will take some work to achieve the goal of
treating the state's veterans in state. With regard to the
analysis provided in the fiscal note, Mr. Williams said that the
figures presented were received from the U.S. Department of
Veterans Affairs. He specified that the "$14,700 mil" refers to
$14.7 million. The U.S. Department of Veterans Affairs
estimated that it would have spent $10 million if veterans had
been sent to in-state hospitals.
3:45:40 PM
REPRESENTATIVE SEATON turned attention to the portion of the
fiscal note analysis that relates that 40 percent of Alaska's
health care budget for veterans paid providers in Alaska
community settings to provide care to veterans to supplement
what is provided directly through the in-state VA outpatient
clinics. Therefore, he questioned whether the goal of HJR 33 is
being accomplished already with that 40 percent of the budget.
MR. STOCKWELL agreed that the aforementioned 40 percent of the
budget is spent to obtain health care from community providers
and hospitals within the state on behalf of veterans.
Therefore, when a patient isn't medically stable to transport,
the care is purchased in the community. He then highlighted
that about 600 patients a year are admitted to the Joint Venture
Hospital on Elmendorf Air Force Base and cared for by VA
providers. He acknowledged that everyone can't manage to get to
Anchorage for care at the medically appropriate time, and thus a
fair amount of care is already purchased from the community.
3:47:10 PM
CHAIR WILSON surmised that [to accomplish the goal of HJR 33],
the state would have to get permission at the federal level,
which could be difficult if it's an increase.
3:47:37 PM
MR. STOCKWELL, in response to Chair Wilson, clarified that
Alaska only has the largest number of veterans when viewed on a
per capita basis. In fact, Alaska has practically the least
total number of veterans in the state.
3:47:59 PM
REPRESENTATIVE GARDNER recalled that during a recent visit with
the staff of the Alaska Veterans Healthcare System it was
related that the Veterans Administration in Anchorage is working
on arrangements with hospitals in Anchorage to encourage and
increase the use of those facilities by veterans.
MR. STOCKWELL noted that there is a new construction project to
build a larger outpatient facility next to the existing federal
hospital on Elmendorf Air Force Base in order to expand the
scope of services offered for outpatients. There is also a
contract with [Providence Medical Center] such that almost one-
third of all admissions go to the aforementioned facility. Mr.
Stockwell said that there is no strategic effort to expand the
use of community hospitals.
REPRESENTATIVE GARDNER asked if there is a reason that only 30
percent of veterans are going to Providence Medical Center. She
further asked if more could be sent there if the contract was
different.
MR. STOCKWELL specified that the first choice is for veterans to
go to the Elmendorf Air Force Base facility, but if the services
aren't available the veteran is sent to Providence Medical
Center. The other third of the admissions in state are due to it
not being medically safe to transport the patient. About that
same number of patients are sent to Seattle for major tertiary
care. He noted that some of the care for which veterans are
sent out of state to obtain can't be obtained in state.
3:50:47 PM
VIRGINIA SMILEY, Director, Division of Alaska State Pioneer
Homes, Department of Health and Social Services (DHSS), in
response to Chair Wilson, explained that the Palmer Pioneers'
Home that is to be used as a veterans' home hasn't been
certified as such. At the moment the facility is in the
renovation process. In further response to Chair Wilson, Ms.
Smiley confirmed that about 101 veterans are in the pioneers'
homes. She related that the division and the VA in Anchorage
have been discussing developing a liaison who would work with
the veterans in the Palmer facility to maximize benefits for
those in veterans homes.
3:52:19 PM
REPRESENTATIVE GATTO returned to his earlier point that the
three positions listed in the first year of the fiscal note do
not appear in subsequent years.
MR. WILLIAMS said that the main interest was the first year
because the work has to be done and depending upon that the
division wasn't sure when the three positions would appear. He
clarified that those three positions represent the minimum of an
office that could negotiate with hospitals to receive veterans
rates, process claims, make payments, and create reports.
MS. SMILEY offered that the following years didn't show the
positions because if this actually was developed, it would take
a long time to achieve and have a full staff.
3:54:49 PM
REPRESENTATIVE GATTO opined that it's best to include the
funding for the three positions so that the legislature can make
a fair evaluation.
3:55:34 PM
REPRESENTATIVE SEATON said that he is in favor of the spirit of
the resolution. However, he expressed the need to differentiate
between doctors and hospitals because the resolution almost
seems to relate that veterans aren't able to see doctors locally
or in Alaska. He requested that the aforementioned be
incorporated in the legislation, but he left it to the sponsor
to address.
3:58:40 PM
REPRESENTATIVE SEATON moved Amendment 1, as follows:
Page 2, line 9, following "hospitals":
Delete "and"
Insert "with"
Page 2, line 17:
Delete "possible"
Insert "United States Department of Veterans
Affairs doctors and hospitals are not easily
accessible"
There being no objection, Amendment 1 was adopted.
3:59:36 PM
KEVIN MCGEE, Vietnam Veterans of America & American Federation
of Government Employees read testimony for Rick Davidge,
President, Vietnam Veterans of America, Alaska Chapter 904,
paraphrasing from the following written statement:
My name is Ric Davidge and I serve as President of the
Vietnam Veterans of America, Chapter 904 - the
Anchorage Chapter and the largest in Alaska. I also
serve as President of the Alaska Veterans Foundation,
Inc. a statewide veteran service organization that
serves Alaskan War Veterans. And I serve as Vice
Chairman of the Anchorage Military & Veterans Affairs
Commission.
In 1965 I was a medic with the First Air Cavalry in
Vietnam and served honorably for 6 years.
Why do we have this resolution before you and just
what does it really do?
I assume you have, in your packet, a copy of the most
recent "Talking Paper" that we update regularly about
the problems Alaskan veterans face in securing
appropriate healthcare. This paper is an open ended
discussion of problems that continue to come to light
as our working group, made up of a wide range of
veterans, VA employees, politicos of both political
parties, and medical service professionals, wrestles
with the challenges of meeting the moral and legal
obligations of our community in the provision of
healthcare for our veterans. We would be delighted to
add any of you to the email tree we have set up on
this issue so that you and your staff are kept
informed of any developments. There is much to learn.
As our talking paper points out, the health care of
Alaska's veteran's faces serious and difficult
structural problems in securing the funding authorized
by federal law but not appropriated because veteran
healthcare has become a partisan football. Veteran
healthcare like so many other federal programs is
politically "negotiated," regardless of need, every
year unlike healthcare provided to our poor, our
homeless, our elderly, and even our illegal aliens.
Are not our war veterans at least as deserving as
these groups when it comes to healthcare? Are not
the men and women who voluntarily stand guard for
America worth at least as much to our community?
The other day a member of our legislature said to me,
"You know veterans are really just another welfare
group." This Alaskan of prominence never served in
the military, and clearly does not understand that
healthcare for veterans is not "welfare" but the
moral, ethical, and legal obligation of our people and
our leaders for the service and sacrifices we faced to
ensure your liberties. We are only asking for what
was promised and appropriate.
As a community of veterans we are tired of all the
talk. We are tired of all the political promises. We
are tired of receiving healthcare based on
"administrative convenience" rather than appropriate
care at home. We are tired of being shipped outside
of our communities and our state to receive healthcare
available right here at home. We are tired and we are
angry.
So, why are we here before the State Legislature
asking you to direct the Commissioner of Health and
Social Services to "talk" to the Veterans
Administration about what the state might be able to
do to help Alaskan veterans? Yes, that's all we are
asking is that our legislature recognize this problem,
one that will likely not be solved in Washington DC as
it should, but that will continue to harm, even
destroy the lives of Alaskan veterans and their
families. 72,000 veterans have chosen to be Alaskans.
The highest per-capita in the nation. When extended
to their immediate families, we estimate that at least
150,000 Alaskans are directly affected by veteran
policies. We should be proud that this many veterans
choose to live in Alaska. And now our Alaskan guard
and Reserves face the largest and longest active duty
deployments in combat in our state's history. But as
a state, what are we - what is Alaska doing to ensure
they receive the healthcare they have earned when they
come home?
We don't have all the answers, but we are gathering
lots of the questions. We have asked the VA to
provide the facts and figures identified in the last
page of our talking paper. This is something our
legislature and our state government can help us with,
and this resolution will facilitate that and more.
We have talked about veteran healthcare, but let's now
look at some of the other implications of current VA
policies on our Alaskan based medical services
industry. We are told for example that the VA spent
over $2 million in air fare alone to send veterans out
of state for healthcare. We know that at least most
of these medical services are available not only in
Alaska but often in the veteran's home community. We
are told that over $17 million of healthcare services
were proved [provided to] veterans outside of Alaska.
With all other costs considered, that's over $20
million in healthcare services that are taken out of
our economy.
We know of prominent Alaskan doctors who have recently
lost their significant veteran client base as their
patients are now sent out of state. We know of
Alaskan based hospitals, now loosing money because the
services they built to serve a particular medical need
in their community, including long-term veteran
patients, are no longer economically viable due to the
loss of these patients causing other Alaskan patients
to assume these losses. So, there are serious
economic implications to VA policies that now ship
more and more Alaskan veterans outside for medical
services. Certainly if these services are not
available in Alaska one can understand this. But when
they are here, and the veterans are currently being
served here in their home communities, there are other
"costs" associated with these policies. Taking a
veteran away from his/her family at a critical and
vulnerable time, is clearly not in the best interests
of our veterans, their families, or of Alaskans as a
community.
So, we are asking our State Legislature to direct the
Commissioner of Health and Social Services to "talk"
with the VA and see if there is something we in Alaska
can do to better serve our veterans. That's all.
Now, what we would like the Commissioner to also do is
gather information that should be reported back to
you. We believe the Commissioner can prepare an
assessment of these problems and their implications to
veterans, our economy, and our community in a few
months and provide it back to this and other
committees of the legislature so that we can begin to
get a real handle on what is happening, what it all
means, and why. We believe the Commissioner has it
within his department's budget to gather a taskforce
of veterans, medical groups, and the VA and seriously,
openly, look at the healthcare of our veterans in
Alaska and what it will mean over time. We believe
you can do this with committee language in the
appropriations bill for the Office of the Commissioner
of Health and Social Services.
"Never will one generation of veterans abandon
another." That is the motto of the Vietnam Veterans
of America and the Alaska Veterans Foundation. Please
remember that when we came home, not only did our
nation, and our communities dishonor our service, most
national veteran service organizations refused us
membership. That is why the Vietnam Veterans of
America was chartered by Congress.
We have stood guard for America and human liberty in
the jungles and deserts of our world when you, our
elected officials, have asked us to do so. We now
stand before you and ask for your help. Help to
ensure we receive the healthcare we have earned, is
morally and ethically appropriate, and consistent with
what is in the best interests of our families, our
state, and our nation.
CHAIR WILSON closed public testimony and inquired as to the
wishes of the committee.
4:09:51 PM
REPRESENTATIVE GARDNER pointed out that the committee packet
includes a list of questions for the VA to which only two had
answers. She suggested that the remainder of the questions
should be answered.
4:10:26 PM
MARCIA HOFFMAN-DEVOE, Alaska Veterans Healthcare System and
Regional Office, U.S. Department of Veterans Affairs, informed
the committee that the department has received the questions and
is preparing responses, which she assumed Mr. Davidge would pass
along to the committee.
4:11:01 PM
REPRESENTATIVE CISSNA moved to report HJR 33, [as amended], out
of committee with individual recommendations and the
accompanying fiscal notes.
4:11:34 PM
REPRESENTATIVE GARDNER objected and opined that this is
premature and more information is required. It seems that the
resolution acknowledges a debt to veterans, but it seems to be a
federal obligation. Therefore, she said she wasn't convinced
that the state should take on the service that the VA may or may
not be meeting adequately.
4:12:25 PM
REPRESENTATIVE SEATON reminded the committee that it received
testimony that the $2 million figure specified as being spent on
airfare during 2004 to fly Alaska veterans out of state to
receive medical services is about $600,000. Therefore, he
suggested that the resolution be changed to reflect the correct
amount.
4:13:23 PM
MS. HOFFMAN-DEVOE offered to provide the correct figures with
the responses to the list of questions.
4:13:52 PM
REPRESENTATIVE CISSNA withdrew the motion to report HJR 33 [as
amended] out of committee.
4:14:29 PM
CHAIR WILSON announced that HJR 33 would be held until the
committee receives further information.
HB 430-APPROP: PALMER SENIOR CITIZEN CENTER
4:15:20 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 430, "An Act making an appropriation for the
construction of the Palmer Senior Citizen Center; and providing
for an effective date."
4:15:46 PM
The committee took an at-ease from 4:16:10 PM to 4:20:01 PM.
4:20:04 PM
CODY RICE, Staff to Representative Carl Gatto, introduced HB 430
on behalf of Representative Gatto, by paraphrasing from the
sponsor statement as follows [original punctuation provided]:
We are all aware the Mat-Su Borough is experiencing
above average growth, but it may not be as commonly
known that a subgroup of this population is growing
even faster. According to the most recent Census data
available, Alaska's senior population is both the
fastest growing segment of Alaska's population and
surprisingly also one of the fastest growing senior
population in the nation. The number of Alaskans over
age 60 is expected to triple from 53,000 (8.5% of
Alaska's population) in the year 2000 to 165,000 (20%
of Alaska's population) by 2025, less than 20 years
away. More specifically, in the Mat-Su the senior
population increased by 150% from 1990 to 1999 and is
expected to double again before the year 2018. Palmer
Senior Citizens Center (PSCC) currently serves 450
Mat-Su seniors every day.
The current facility has problems including defective
electrical systems. Interestingly, the Executive
Director's computer loses power when the photocopier
is used. There are fifty parking spots and a fleet of
15 vans for 35 on-site employees and 100 seniors at
meal times. Many employees of PSCC work off-site due
to limited space availability at the center.
PSCC is a 501 (c)(3) non-profit organization, already
owns the new site, and is only seeking funds for
design and construction.
I urge your support and favorable action on this
legislation.
4:23:21 PM
REPRESENTATIVE SEATON asked if there is a funding priority list
for the senior centers statewide and, if so, how does the Palmer
Senior Citizens Center (PSCC) funding request rank.
4:24:00 PM
MR. RICE responded that to his knowledge there is not a list of
that type.
4:24:27 PM
REPRESENTATIVE SEATON moved to report HB 430 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 430 was reported out of the
House Health, Education and Social Services Standing Committee.
SB 255-OPTOMETRY: EXTEND BD/ LIC. ENDORSEMENT
4:24:42 PM
CHAIR WILSON announced that the next order of business would be,
CS FOR SENATE BILL NO. 255(FIN), "An Act extending the
termination date and duties for the Board of Examiners in
Optometry; amending the licensing, endorsement, and renewal
provisions for optometrists; and providing for an effective
date."
4:25:23 PM
TOM MAHER, Staff to Senator Gene Therriault, presented SB 255 on
behalf of Senator Therriault by paraphrasing from the following
written statement [original punctuation provided]:
On the behalf of Senator Therriault, Chair of the
Legislative Budget and Audit Committee, I thank you
and members of the Committee for Hearing Senate Bill
255 (finance) - relating to the termination date and
duties for the Board of Examiners in Optometry;
amending the licensing, endorsement, and renewal
provisions for optometrists; and providing for an
effective date."
Just a quick bit of background on the Sunset audit
process that this legislation stems from. Last
session legislation was passed that revised the sunset
process.
First, the standard sunset period for occupational
boards and non-occupational boards was changed from
"not to exceed four years" to "not to exceed eight
years
Second, as Alaska's sunset process has matured, most
of the sunset reviews are less about eliminating board
and commissions, and more about operational
performance. To better measure operational
performance, last session, two new criteria were added
to statute that must be considered in the course of a
sunset review by the auditors:
The extent to which the board, commission, or agency
has effectively attained its objectives and the
efficiency with which it has operated.
AND
The extent to which the board, commission, or agency
duplicates the activities of another governmental
agency or the private sector.
Moving on with the bill ...
Sec. 1 of this legislation extends the sunset date of
the Board of Examiners in Optometry from June 30, 2006
to June 30, 2014 per the audit conclusions contained
in the report before you on page 5. Legislative Audit
concluded that the Board of Examiners in Optometry
continues to serve a public need and is operating in
the public interest. The regulation and licensing of
qualified optometrists is necessary to protect the
public's health, safety and welfare. Further, the
Board of Examiners in Optometry has operated
effectively, adopted regulatory changes and supported
legislation that improved its oversight process and
promoted more effective regulation of licensed
optometrists. Accordingly, SB 255 provides for an
eight-year sunset extension.
With the exception of sec. 4, the balance of SB 255
incorporates the recommendation by the Legislative
Auditor concerning licensing on page 7, rec. #2 of the
report. The Auditor recommended the Legislature amend
the optometry statutes to ensure they support current
license endorsements for the diagnostic use of
pharmaceutical agents. Currently, statutory language
provides for a single endorsement for both prescribe
and use. However, the Board of Examiners in Optometry
is issuing two types of endorsements. The first
allows a practitioner to both prescribe and use
pharmaceutical agents and the second type of
endorsement allows a practitioner "use" only. Current
law does not authorize the use only endorsement. SB
255 corrects this situation by adding a section
authorizing a use only endorsement and also, in sec.
7, "grandfathers" in the practitioners that were given
that endorsement over the years. (since 1992)
On page 18 you will find the Department of Commerce,
Community, and Economic Development's response to this
recommendation - they are in support of the changes
made here.
Our intent with this legislation is simple - change
the law to make current practices legal, grandfather
license holders in, and make sure we do not leave any
practitioners out which could have an impact on the
number of providers serving the public and hopefully
maximize the number of practitioners that can practice
in Alaska.
Finally, contained in sec. 4, the Senate Labor and
Commerce Committee approved an amendment offered by
the Department of Commerce, Community and Economic
Development that deleted the statutory cite requiring
24 hours of continuing education instruction, allowing
the Board to establish through regulation, the number
of hours without amending statute. This amendment was
requested by the BEO [Board of Examiners in Optometry]
in its response to the audit.
Finally, there is one fiscal note from Occupation
Licensing - passage of this legislation will incur no
additional costs beyond those already contained in the
FY07 Governor's operating budget request .
4:30:40 PM
REPRESENTATIVE SEATON asked whether the audit recommendations
are contained in the bill.
4:31:04 PM
PAT DAVIDSON, Legislative Auditor, Legislative Audit Division
(LAD), Legislative Affairs Agency, responded that the
recommendations which require statutory changes are included in
the legislation. She pointed out that recommendations regarding
"the endorsements" were specific recommendations to the
legislature, and represent housekeeping language which the BEO
requested and the LAD deemed reasonable. The licensing fee
recommendation is because the auditors recognized that the fees
are building a surplus and could be reduced, but that is a
decision for the department and board, she explained. Further,
she assured the committee that all of the audit recommendations
are included in the bill.
4:32:27 PM
REPRESENTATIVE GARDNER inquired as to whether there has been any
objection to the provisions being considered.
4:32:48 PM
MS. DAVIDSON stated that letters of response from the BEO and
the LAD are contained in the audit report, as part of the
committee's packet. She pointed out that the letters contain
discussion points of the recommendations and endorsements
previously discussed.
4:34:52 PM
REPRESENTATIVE SEATON moved to report CSSB 255 (FIN) out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSSB 255 (FIN) was
reported out of the House Health, Education and Social Services
Standing Committee.
HB 436-SOCIAL WORKER CASELOADS & WORKLOADS
4:35:08 PM
CHAIR WILSON announced that the final order of business would be
HOUSE BILL NO. 436, "An Act requiring the Department of Health
and Social Services to employ a sufficient number of social
workers; relating to the protection of children in need of aid
by reducing the caseloads and supervisory duties to comply with
certain national standards; and providing for an effective
date."
4:35:50 PM
REPRESENTATIVE LES GARA, Alaska State Legislature, sponsor,
explained that the main intent of HB 436 is to require that the
state have enough staff to manage the case loads such that
foster children and those children who are victims of abusive
situations are protected. The Child Welfare League of America
(CWLA), a national organization, has adopted a national standard
that specifies that there should be 1 case worker, of those
working in child protective service roles, for every 12-15
children. The reasons for the aforementioned standard are
multiple. Representative Gara informed the committee that in
Alaska's foster care and child-in-need-of-aid systems, the case
worker, once he/she receives a report of harm, investigates the
case, assess the child's educational and counseling needs when
the child is placed in the foster care system. The case worker
is charged with finding services for the child and moving the
child out of foster care as quickly as possible and back into
the home or an adoptive home. However, the state doesn't have
the staff to do such in an effective manner.
4:38:16 PM
REPRESENTATIVE GARA then informed the committee that since the
introduction of HB 436, the [Office of Children's Services] has
decided to have an outside consulting agency review the agency's
workload rather than the caseload because 12 cases in Anchorage
is different than 12 cases on the Kuskokwim River. There have
been problems with the study and thus the report won't be
available in time for this session. Therefore, the hope is to
utilize the legislation to educate everyone that Alaska largely
can't meet the federal goal of reuniting children in foster care
with their parents within 12 months or placing those foster
children who can't be reunified with their family up for
adoption and permanent placement within 24 months. The most
concerning, perhaps, is that when a report of harm that a child
may be subject to abuse at home is received, staff limitations
don't allow the detailed investigation required to make a proper
decision to occur. The aforementioned might result in removing
a child from a home too quickly or not removing a child when
he/she should be removed. Therefore, he expressed the need for
the legislature to adopt the guidelines from OCS's workload
study.
REPRESENTATIVE GARA related that the caseload for social workers
in Anchorage was close to 30 children. As of last year, one
social worker in Dillingham had 52 cases, which meant that those
children were not being protected. However, he mentioned that
the situation in Dillingham may have been corrected by this
year. He went on to say that although the state has done a
decent job of adding social workers over the last few years, it
seems that the state is at least 15 case workers short
statewide. Representative Gara acknowledged the notion that
since the state began adding positions to OCS things must be
okay. However, he opined that although things have improved,
the situation isn't okay. In many regions in this state, it is
a crisis base service system rather than a system that provides
what the children need to prosper. Without enough staff, the
children can't be provided what they need to prosper, he opined.
He related that anecdotally he has been told that Alaska
probably sends more foster children to jail than to college.
Representative Gara related that HB 436 is a discussion point
until the workload study is complete, the recommendations of
which could possibly spawn a committee bill.
4:45:00 PM
REPRESENTATIVE GARDNER said that Representative Gara did a good
job relating the tasks of the social worker's job as they relate
to the child's needs. However, that's only a small part of the
larger job because the social worker's job is to identify the
problems in the household and work on reunification. Therefore,
the social worker has to meet with the parents, arrange for the
parents to have assessments and receive services, monitor
compliance, write court reports, attend court, et cetera. The
study should be very helpful, she said. If social workers can
do things thoroughly at the front end children can return home
faster if the social worker has confidence that he/she can visit
and monitor the child. Furthermore, doing things right at the
beginning saves money over the long term.
4:46:49 PM
REPRESENTATIVE CISSNA characterized this [legislation] as one
part of what needs to be done. She opined that when the state
takes custody of a child, the state is essentially saying that
the it can do a better job than the parents. However, if an
appropriate permanent placement is not found quickly, the
psychological processes such as bonding are disturbed.
Representative Cissna suggested that HB 436 may help retain
foster parents, which would be a step in the right direction.
4:48:44 PM
CHAIR WILSON said HB 436 is important in the way of prevention.
4:49:40 PM
TAMMY SANDOVAL, Deputy Commissioner, Office of Children's
Services, Department of Health and Social Services (DHSS),
relayed that while [OCS] has mostly met the goals of the federal
government's performance improvement plan. Since the goals have
been set low, there is room to get better if the desire is to
work on prevention. If there were lower caseloads, she opined
that the goals could be met.
4:51:14 PM
CHAIR WILSON inquired as to the number of social workers
required to protect and actually help the children without
burning out social workers or foster parents.
4:51:33 PM
MS. SANDOVAL agreed that's the key. She explained that the data
from the workload study is being cleaned up so that the study
can be released. She highlighted that the department entered a
fiscal note for 18 staff, which she estimated may actually be
more or less by a few. The data cleanup will run through the
end of March and the contractors are willing to "re-put" the
formula. Therefore, the study may be available by the end of
session, but she did note that the contractors are willing to
speak with any legislator with questions.
4:54:13 PM
CHAIR WILSON said that once the study is released, the matter
could come before the committee again.
4:54:56 PM
REPRESENTATIVE GARA suggested that if the study relates the
staff shortage, perhaps a memorandum from the committee to the
co-chairs of the House Finance Committee and the House
leadership expressing the need to add [funding for staff] would
be the quickest way to address the situation.
CHAIR WILSON said, "We'll work on something ... because there's
nothing more important than our kids."
4:55:30 PM
REPRESENTATIVE SEATON pointed out that the legislation proposes
a certain ratio of social workers per children without providing
any funding. He asked if the department is willing to support
such even if the funding has to be taken from elsewhere in the
department's budget.
MS. SANDOVAL said that the department doesn't believe it can put
in an increment for a staff increase this year because the
results of the workload study weren't available. The
department's plan is to work with the commissioner and the
governor with regard to the 2008 increment. Ms. Sandoval opined
that there aren't the resources to hire 15 new staff.
4:58:03 PM
CHAIR WILSON inquired as to whether the funding would come
through the supplemental budget.
MS. SANDOVAL said she didn't know.
4:58:32 PM
REPRESENTATIVE CISSNA suggested that there would probably be a
substantial savings when reviewing the cost of keeping the child
in the system for a long duration [versus the cost of funding
the proposed positions]. She asked if the committee would be
interested in making a plea to the House Finance Committee for
supplementals that would address this specific issue.
4:59:27 PM
CHAIR WILSON suggested that the committee should wait and see
what [the study reveals]. She again indicated that the
committee would "work on something."
4:59:51 PM
REPRESENTATIVE GARA remarked that the preferred route would be
to come up with the funding when it's known what is needed
rather than having a mandate with inflexible standards. The
reason for the legislation, he reminded the committee, is to
push the discussion. If the problem is solved through the
workload study and the budget, the legislation won't be
necessary. However, if the necessary progress isn't made, he
opined that he would like to see legislation pass in order to
act as a "hammer."
5:00:48 PM
[HB 436 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 5:00:56 PM.
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