Legislature(1993 - 1994)

04/07/1993 03:00 PM HES

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

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