Legislature(1993 - 1994)
03/08/1993 03:00 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE March 8, 1993 3:00 p.m. MEMBERS PRESENT Rep. Cynthia Toohey, Co-Chair Rep. Con Bunde, Co-Chair Rep. Gary Davis, Vice Chair Rep. Al Vezey Rep. Pete Kott Rep. Harley Olberg Rep. Bettye Davis Rep. Irene Nicholia Rep. Tom Brice MEMBERS ABSENT None OTHER LEGISLATORS PRESENT Rep. Jerry Mackie COMMITTEE CALENDAR *HCR 7: Relating to Alcohol-Related Birth Defects Awareness Week. PASSED WITH INDIVIDUAL RECOMMENDATIONS *HB 3: "An Act relating to public home care providers; and providing for an effective date." PASSED WITH INDIVIDUAL RECOMMENDATIONS *HB 4: "An Act adding as an aggravating factor at sentencing that a victim was elderly or disabled; and relating to failure to report harm or assaults of the elderly or disabled." PASSED WITH INDIVIDUAL RECOMMENDATIONS (* First public hearing.) WITNESS REGISTER REP. IRENE NICHOLIA Alaska State Legislature State Courthouse, Room 606 Phone: (907) 465-4527 Juneau, Alaska 9801-1182 Position Statement: Prime Sponsor of HCR 7 ERMALEE HICKEL, First Lady 716 Calhoun St. Juneau, Alaska 99801 Phone: (907) 465-3500 Position Statement: Testified in favor of HCR 7 SUZANNE PERRY Regional Program Coordinator Division of Alcoholism and Drug Abuse Department of Health and Social Services P.O. Box 110607 Juneau, Alaska 99811-0607 Phone: (907) 225-2071 Position Statement: Presented slide show on FAS/FAE REP. JERRY MACKIE Alaska State Legislature State Courthouse, Room 602 Juneau, Alaska 99801 Phone: (907) 465-4925 Position Statement: Sponsor of HB 3 and HB 4 ELMER LINDSTROM Special Assistant to the Commissioner Department of Health and Social Services P.O. Box 110601 Juneau, Alaska 99811-0601 Phone: (907) 465-3030 PREVIOUS ACTION BILL: HCR 7 SHORT TITLE: ALCOHOL-RELATED BIRTH DEFECTS AWARENESS BILL VERSION: SPONSOR(S): REPRESENTATIVE(S) NICHOLIA,Brice,Nordlund, Finkelstein,Parnell,James,Navarre,Menard,Ulmer,Brown, B.Davis,Sitton; SENATOR(S)Lincoln,Jacko TITLE: Relating to Alcohol-Related Birth Defects Awareness Week. JRN-DATE JRN-PG ACTION 02/19/93 389 (H) READ THE FIRST TIME/REFERRAL(S) 02/19/93 390 (H) HEALTH, EDUCATION & SOCIAL SERVICES 02/22/93 421 (H) COSPONSOR(S): B.DAVIS, SITTON 03/04/93 (H) HES AT 03:00 PM CAPITOL 106 03/08/93 (H) HES AT 03:00 PM CAPITOL 106 BILL: HB 3 SHORT TITLE: REGULATION OF HOME CARE PROVIDERS BILL VERSION: SPONSOR(S): REPRESENTATIVE(S) MACKIE,Ulmer TITLE: "An Act relating to public home care providers; and providing for an effective date." JRN-DATE JRN-PG ACTION 01/04/93 25 (H) PREFILE RELEASED 01/11/93 25 (H) READ THE FIRST TIME/REFERRAL(S) 01/11/93 25 (H) HES, JUDICIARY, FINANCE 03/04/93 (H) HES AT 03:00 PM CAPITOL 106 03/08/93 (H) HES AT 03:00 PM CAPITOL 106 BILL: HB 4 SHORT TITLE: PROTECT ELDERLY AND DISABLED ADULTS BILL VERSION: SPONSOR(S): REPRESENTATIVE(S) MACKIE TITLE: "An Act adding as an aggravating factor at sentencing that a victim was elderly or disabled; and relating to failure to report harm or assaults of the elderly or disabled." JRN-DATE JRN-PG ACTION 01/04/93 25 (H) PREFILE RELEASED 01/11/93 25 (H) READ THE FIRST TIME/REFERRAL(S) 01/11/93 25 (H) HES, JUDICIARY, FINANCE 03/04/93 (H) HES AT 03:00 PM CAPITOL 106 03/08/93 (H) HES AT 03:00 PM CAPITOL 106 ACTION NARRATIVE TAPE 93-30, SIDE A Number 000 CHAIR TOOHEY called the meeting to order at 3:07 p.m., noted members present, and announced the calendar. HCR 7 - ALCOHOL-RELATED BIRTH DEFECTS AWARENESS Number 030 REP. IRENE NICHOLIA testified as PRIME SPONSOR of the resolution. She read a sponsor statement, which is on file in the committee room. In summary, she said HCR 7 was an attempt to inform the public about the problem of babies born with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effect (FAE), and the rates in which Alaska leads the nation. Such defects cost society as a whole in health care expenses. The individuals involved are hurt because their development is retarded. She said the problem is preventable. Information is the first step toward prevention, and resolutions such as hers are a first step toward greater public information. Number 071 ERMALEE HICKEL, ALASKA'S FIRST LADY, testified in Juneau in support of HCR 7. She said alcohol-related birth defects, which are preventable, are a leading cause of birth defects and developmental disabilities; cost the state in health care costs; are not limited to any one social group; and represent a growing problem in the state. She said men share the responsibility for helping pregnant women avoid alcohol. She cited the success of the Dena A Coy program, a Southcentral Foundation group home in Anchorage where expectant mothers with alcohol problems can live alcohol free in an effort to avoid alcohol-related birth defects. She presented the governor's proclamation declaring May 9 through 15, 1993, as Alcohol-Related Birth Defects Awareness Week. She encouraged passage of HCR 7 as part of a statewide education program. Number 175 REP. BUNDE thanked Mrs. Hickel, and expressed special concern over FAS/FAE in light of the state's high teen pregnancy rate. He asked whether women in the Dena A Coy program have drinking problems, and whether they can enter the program as soon as they discover they are pregnant. MRS. HICKEL answered yes, given space restrictions. Number 214 REP. VEZEY moved passage of HCR 7 with individual recommendations. REP. G. DAVIS said he appreciated Rep. Nicholia's sponsorship and Mrs. Hickel's support. He asked whether the resolution should not include notice that FAS/FAE was a preventable birth defect. Number 234 REP. BRICE pointed out that the fourth "whereas" clause in the resolution did address that point. Number 246 CHAIR TOOHEY invited public testimony. SUZANNE PERRY, REGIONAL PROGRAM COORDINATOR FOR THE DIVISION OF ALCOHOLISM AND DRUG ABUSE IN THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES, presented a slide show on FAS/FAE, outlining the symptoms of FAS/FAE and showing the physical characteristics and stunted development of children born with alcohol-related birth defects in Alaska. Number 400 CHAIR TOOHEY asked whether a female child born with FAS will later pass along the syndrome's physical deformities to her children. MS. PERRY answered no. She added that the best way to prevent FAS/FAE is for women to abstain from any alcohol during pregnancy. Number 419 CHAIR TOOHEY noted that a drug counselor had told her that about 68 percent of children born in either Bethel or Barrow, she did not remember which, were born with FAS or FAE. MS. PERRY agreed that the problem is an epidemic. Number 424 REP. BUNDE asked whether infants can get FAS through the alcohol that might be present in mother's milk. MS. PERRY answered no, but a child's development may be impaired by ingesting alcohol while young. REP. BUNDE referred to a case in which an ultimately unsuccessful attempt was made to convict a Bethel woman with child abuse for drinking alcohol while nursing and passing along alcohol to her child while nursing. Number 437 CHAIR TOOHEY asked for any objections to passing HCR 7 from the committee. Hearing none, he declared HCR 7 passed with individual recommendations. She then brought HB 3 to the table. HB 3 - REGULATION OF HOME CARE PROVIDERS Number 445 REP. JERRY MACKIE testified as PRIME SPONSOR of HB 3. He noted that similar bills passed through the Senate in 1992, but died in the session's final days. He read a sponsor statement, which is on file in the committee room. In summary, the statement said that HB 3 would protect elderly people by restricting public home care providers (HCPs) from assuming sole power of attorney for their clients, and by requiring background checks on home care providers paid under certain state programs. He referred to a case in which a health care provider took control of a client's finances through a power of attorney and spent $500,000 of the client's money. He said he was not attacking the HCPs, but was trying to afford their clients' protection. He noted that 30 percent of state required background checks reveal criminal histories. Number 496 REP. BUNDE asked whether a criminal record automatically barred a person from working as an HCP. REP. MACKIE stated that this might be a question that would be addressed in regulations under the bill, not by the statutory language. He said the bill proposed in the previous legislative session required background checks to be completed within 10 days of hiring and upon request, and that certain actions had to take place within five days of receipt of such reports. He said such provisions were in effect in HB 3. Number 522 REP. BUNDE asked again whether a criminal record automatically barred a person from working as an HCP. REP. MACKIE said it would depend on individual circumstances, and the issue would be addressed in regulations. Number 522 REP. VEZEY observed that HB 3 would do little to deter a determined fraud. REP. MACKIE said all legislation can do is provide penalties for crimes, but cannot order 100 percent compliance with law. He said the bill is a substantial improvement over current law. He stated that courts, which usually give powers of attorney, would have to determine an acceptable second person, most likely not a partner of the HCP, but a relative of the elderly person. REP. VEZEY asked the need for two powers of attorney if an elderly person had a relative to whom such power could be given. Number 546 REP. MACKIE said that would be a decision of the court. The bill would prevent the HCP from being sole power of attorney, he said. REP. VEZEY asked whether HB 3 deprived elderly people of the right to bestow power of attorney of their own, and if it was directing the court to appoint people who would have power of attorney. Number 552 CHAIR TOOHEY said lonely old people frequently become dependent on HCPs as surrogate families. She related a case in which one client granted power of attorney to the HCP, who then proceeded to wipe out the client's money. Chair Toohey said under the bill, the courts could bar an HCP from assuming the sole power of attorney for a client. REP. VEZEY asked what was to bar an elderly person from signing over a second power of attorney to the HCP's partner in crime. CHAIR TOOHEY answered that nothing prevented that. REP. VEZEY said the bill therefore provided no protection. CHAIR TOOHEY said she disagreed. Number 565 REP. BUNDE said that, in his experience working with nonprofits, he had learned that it was best to share responsibility for financial expenditures between two people as a way to reduce the possibility of theft. Number 572 REP. VEZEY said HB 3 provided very little protection against a determined fraud. REP. MACKIE asked for suggestions on how to address that concern. REP. VEZEY said he had none. REP. MACKIE pointed out the limits of law to deter determined criminals. Number 580 REP. VEZEY suggested amending HB 3 to bar HCPs from holding power of attorney for their clients. REP. MACKIE said that in some cases it may be beneficial to grant an HCP the authority to act on a client's behalf, with oversight from a relative of the client's. REP. VEZEY stated it was not necessary to have power of attorney in such cases. Number 590 REP. MACKIE said it was beneficial not to give power of attorney to just one person. He referred to a situation in which an HCP in Haines had sole power of attorney and abused that power. He said some elderly people are being robbed of benefits through physical intimidation, with no legal protection. CHAIR TOOHEY said nurse practitioners are state licensed and may lose their licenses for unethical actions, while most HCPs do not have licenses. She expressed support for HB 3 as a bill that would address the needs she has seen as a nurse. Number 604 REP. G. DAVIS asked Rep. Mackie whether the section of the bill identified as Section 13.26.358 resulted from changes to the bill in the 1992 legislative session. TAPE 93-30, SIDE B Number 000 REP. MACKIE said the bill was modified through much work by the committees and had been thoroughly considered. Number 015 REP. BUNDE cautioned against barring an HCP from being granted power of attorney for a client. He said the bill might reduce the temptation to commit fraud on elderly people. REP. MACKIE said it might be necessary to consider whether elderly people who had become state wards or subject to governance by an estate might not need to have a second power of attorney appointed for them in addition to the state or estate. Number 066 REP. BRICE noted that HB 3 dealt with publicly funded HCPs who were not necessarily invited into the client's home. REP. MACKIE said section 2 of his bill bars the state from paying for an HCP without subjecting that person to a background check within 10 days of hire. Number 100 CHAIR TOOHEY asked if Rep. Mackie was referring to Medicaid funding for HCPs. REP. MACKIE answered that he meant any public funds, not just funds through the Medicaid program. Number 106 REP. VEZEY said he had not interpreted HCPs as indicating solely a public employees. REP. MACKIE said the bill referred to HCPs paid with state funds. He said the bill did not bar an elderly person from hiring and giving power of attorney to any private individual. He stated it was aimed at taking steps to prevent the state from paying for HCPs that might try to take advantage of their clients by obtaining powers of attorney. Number 123 CHAIR TOOHEY said that caring for elderly people with home care providers was an alternative to institutionalizing the elderly. REP. BUNDE asked what might happen if the state funded an HCP for a person with no living relatives, and therefore no one to whom a second power of attorney could be granted. Number 140 REP. MACKIE said it would be in the elderly person's best interest to have another person other than the state, such as a minister or public official, with power to sign off on actions concerning that elderly person. Number 143 REP. VEZEY said he believed that courts require bonds of those to whom they grant powers of attorney, usually members of the bar association. REP. BUNDE noted that such people get paid for that service. REP. VEZEY said they get paid fees from the elderly person's benefits. REP. MACKIE said it only related to HCPs. REP. VEZEY said a court would never grant power of attorney to a non-bonded person, to ensure accountability. Number 156 REP. MACKIE said he wanted to make sure the courts did not appoint just an HCP as a person with power of attorney and not a second person. REP. VEZEY said requiring bonds of HCPs would alleviate the problem. Number 164 CHAIR TOOHEY noted that HCP jobs pay only about $8 per hour, and few, if any, are bonded. REP. BUNDE said the second person would probably be an attorney. He asked whether the attorney would be paid from the elderly person's estate. Number 180 REP. MACKIE said that question dealt with a different area of state statutes than that addressed by HB 3. He repeated that the bill just dealt with what HCPs could and could not do; an HCP cannot have sole power of attorney for a client. He said it might cause problems if the client had no relatives, but he said that the abuses of powers of attorney by HCPs far outweighed any inconvenience the court may have in dealing with such possibilities. REP. BUNDE said he was trying to visualize some of the demands that might come up. Number 198 REP. BRICE moved passage of HB 3 with individual recommendations. CHAIR TOOHEY, hearing no objections, declared HB 3 passed with individual recommendations. She then brought HB 4 to the table. (Rep. Kott arrived at 4:08 p.m.) HB 4 - PROTECT ELDERLY AND DISABLED ADULTS Number 202 REP. JERRY MACKIE testified as PRIME SPONSOR of HB 4. He read a sponsor statement, which is on file in the committee room. In summation, he said the bill is a companion bill to HB 3. It would place in state law deterrents to attacks on elderly and disabled adults. It would establish as an aggravating factor in sentencing the fact that such attacks were made on those who more easily victimized by crime and who were less able to defend themselves. He said the state's senior citizen population is growing, with about 200 reported cases of elderly abuse made each year in the state. He noted that 28 other states have similar laws. Number 236 REP. MACKIE said that the House Judiciary Committee did a lot of work on a similar bill in 1992, creating the aggravating factor rather than establishing a new crime. He also noted the penalties for failing to report abuse, which were included in the bill. (Rep. Olberg departed at 4:07 p.m.) REP. BUNDE asked who was the intended target of the bill's provisions for penalties for those who failed to report abuse. Number 272 REP. MACKIE said the bill could apply to anyone who failed to report such abuse, including a doctor, social worker, friend or neighbor. He said his intention was to provide a deterrent for failure to report known abuse to the authorities. REP. BUNDE noted the significant fiscal note from the Division of Occupational Licensing and the Department of Corrections, and invited the sponsor's comment. REP. MACKIE said the Department of Corrections' fiscal note showed no additional expenditure in FY94, and a $48,800 fiscal note for FY95. He said the possibility of putting more people in jail leads to the anticipation of increased incarceration costs. Number 301 REP. BUNDE said it appeared that the Department of Corrections anticipated charging more people under the bill than he did. He asked why the fiscal note from Occupational Licensing assumed the need for a new investigator. REP. MACKIE said it would be up to the Department of Commerce to answer the question. He said he did not see why the bill would require an additional investigator. Number 324 REP. BUNDE questioned the need for an additional investigator to deal with professionals who failed to report elderly abuse. REP. MACKIE said he had experienced problems with fiscal notes in the past as well. Number 330 REP. G. DAVIS said it appeared to him that the fiscal note referred to HB 3 and the need to investigate abuse by licensed home care providers. Number 337 CHAIR TOOHEY agreed, but said she had a problem with the fiscal note as well. She asked what would happen to money in the Department of Commerce fiscal note if it was not spent it for the purpose indicated. REP. MACKIE said the fiscal note was an estimate of the cost to fulfill the directives of the bill, not an appropriation. Number 355 ELMER LINDSTROM, SPECIAL ASSISTANT TO THE COMMISSIONER DEPARTMENT OF HEALTH AND SOCIAL SERVICES, said that one of the last actions at the end of the 1993 legislative session, as at the end of previous sessions, would likely be that the Finance Committee would tally all the fiscal impacts for FY94 for all bills likely to pass at the end of that session. Each of the amounts listed in each fiscal note would likely then be incorporated into the appropriations bill, he said. In subsequent years, those amounts would likely be included in each department's appropriations, and it would be difficult to differentiate as to what bills each appropriation was funding. REP. G. DAVIS moved passage of HB 4 with individual recommendations. CHAIR TOOHEY, hearing no objections, declared HB 4 passed with individual recommendations. There being no further business before the committee, she ADJOURNED the meeting at 4:16 p.m.