Legislature(1993 - 1994)

03/03/1994 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                                      
                          March 3, 1994                                        
                            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. Irene Nicholia                                                          
  Rep. Tom Brice                                                               
  MEMBERS ABSENT                                                               
  Rep. Bettye Davis (Excused)                                                  
  OTHER LEGISLATORS PRESENT                                                    
  Rep. Jim Nordlund                                                            
  COMMITTEE CALENDAR                                                           
  *HB 337:  "An Act relating to the possession of controlled                   
            substances within 500 feet of recreation and youth                 
            PASSED OUT OF COMMITTEE                                            
  *HJR 52:  Urging the Congress to amend the Social Security                   
            Act so that the higher cost of living in Alaska is                 
            reflected when the per capita income of the state                  
            is used as a factor in determining the federal                     
            share of Medicaid costs."                                          
            PASSED OUT OF COMMITTEE                                            
  *HB 356:  "An Act relating to living wills and do not                        
            resuscitate orders; and providing for an effective                 
            HEARD AND HELD                                                     
  *HB 506:  "An Act relating to student loans; to sanctions                    
            for defaulting on a student loan, including denial                 
            of a state occupational license or disbursement of                 
            state money; and providing for an effective date."                 
            HEARD AND HELD                                                     
  WITNESS REGISTER                                                             
  KIM BUSCH, Director                                                          
  Division of Medical Assistance                                               
  Department of Health and Social Services                                     
  P.O. Box 110660                                                              
  Juneau, Alaska 99811-0660                                                    
  Phone:  (907) 456-33552                                                      
  Position Statement:  Testified in support of HJR 52                          
  MARK JOHNSON, Chief                                                          
  Emergency Medical Services                                                   
  Department of Health and Social Services                                     
  P.O. Box 110616                                                              
  Juneau, Alaska 99811-0616                                                    
  Phone:  (907) 463-5807                                                       
  Position Statement:  Testified in support of HB 356                          
  VONA HALL, Member                                                            
  American Association of Retired Persons                                      
  9416 Long Run Rd.                                                            
  Juneau, Alaska 99801                                                         
  Phone:  (907) 789-7422                                                       
  Position Statement:  Testified in support of HB 356                          
  CRAIG LEWIS, Executive Director                                              
  Interior Region Emergency Medical Services Council                           
  1881 Marika St.                                                              
  Fairbanks, Alaska 99709                                                      
  Phone:  (907) 456-3978                                                       
  Position Statement:  Testified in support of HB 356                          
                       (Spoke via offnet)                                      
  ERNEST LINE                                                                  
  2645 Whispering Woods                                                        
  Wasilla, Alaska 99645                                                        
  Phone:  (907) 376-6709                                                       
  Position Statement:  Testified in support of HB 356                          
                       (spoke via teleconference)                              
  SANDY TACKETT, Nurse                                                         
  Petersburg Hospital                                                          
  P.O. Box 589                                                                 
  Petersburg, Alaska 99833                                                     
  Phone:  (907) 772-4291                                                       
  Position Statement:  Testified in support of HB 356                          
                       (spoke via teleconference)                              
  JULIE RENWICK, Coordinator of Social Services                                
  Wesley Rehabilitation and Care Center                                        
  P.O. Box 1066                                                                
  Seward, Alaska 99664                                                         
  Phone:  (907) 224-5241                                                       
  Position Statement:  Testified in support of HB 356                          
                       (spoke via teleconference)                              
  LINDA SWENSON, Nurse                                                         
  Seward General Hospital                                                      
  P.O. Box 365                                                                 
  Seward, Alaska 99664                                                         
  Phone:  (907) 225-5205                                                       
  Position Statement:  Testified in support of HB 356                          
                       (spoke via teleconference)                              
  RICHARD JONES, Administrator                                                 
  Wesley Rehabilitation and Care Center                                        
  P.O. Box 1066                                                                
  Seward, Alaska 99664                                                         
  Phone:  (907) 224-5241                                                       
  Position Statement:  Testified in support of HB 356                          
                       (spoke via teleconference)                              
  NANCY JO BLEIER, Director of Social Services                                 
  Southeast Alaska Regional Health Corporation                                 
  3245 Hospital Dr.                                                            
  Juneau, Alaska 99801                                                         
  Phone:  (907) 463-4040                                                       
  Position Statement:  Testified in support of HB 356                          
                       (spoke via teleconference)                              
  CAPTAIN STEVE IHA, EMS Coordinator                                           
  Capital City Fire/Rescue                                                     
  820 Glacier Hwy.                                                             
  Juneau, Alaska 99801                                                         
  Phone:  (907) 586-5322                                                       
  Position Statement:  Testified in support of HB 356                          
  JOE MCCORMICK, Executive Director                                            
  Alaska Commission on Postsecondary Education                                 
  3030 Vintage Blvd.                                                           
  Juneau, Alaska 99801-7109                                                    
  Phone:  (907) 465-6740                                                       
  Position Statement:  Testified in support of HB 506                          
  BRIAN BRUBAKER, Coordinator                                                  
  University of Alaska Coalition of Student Leaders                            
  P.O. Box 84791                                                               
  Fairbanks, Alaska 99708                                                      
  Phone:  (907) 474-5156                                                       
  Position Statement:  Testified on HB 506                                     
                       (spoke via teleconference)                              
  NICHOLAS ABRAMCZYK, Member                                                   
  Associated Students of the                                                   
  University of Alaska, Fairbanks                                              
  P.O. Box 99775                                                               
  Fairbanks, Alaska 99775                                                      
  Phone:  (907) 474-5156                                                       
  Position Statement:  Testified on HB 506                                     
                       (spoke via teleconference)                              
  ANDREA PAIGE ADAMS, Vice-President                                           
  United Students of University of Alaska, Southeast                           
  222 Tongass                                                                  
  Sitka, Alaska 99835                                                          
  Phone:  (907) 966-8413                                                       
  Position Statement:  Testified on HB 506                                     
                       (spoke via teleconference)                              
  BARBARA GABIER, Program Coordinator                                          
  Division of Occupational Licensing                                           
  Department of Commerce and Economic Development                              
  P.O. Box 110806                                                              
  Juneau, Alaska 99811-0806                                                    
  Phone:  (907) 465-2534                                                       
  Position Statement:  Testified on HB 506                                     
  PREVIOUS ACTION                                                              
  BILL:  HB 337                                                                
  SPONSOR(S): REPRESENTATIVE(S) NORDLUND,Porter,Finkelstein,                   
  JRN-DATE    JRN-PG                     ACTION                                
  01/03/94      2015    (H)   PREFILE RELEASED                                 
  01/10/94      2015    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  01/10/94      2015    (H)   HES, JUDICIARY                                   
  01/13/94      2055    (H)   COSPONSOR(S):  B. DAVIS                          
  01/14/94      2084    (H)   COSPONSOR(S):  GREEN                             
  01/18/94      2101    (H)   COSPONSOR(S):  NICHOLIA                          
  03/02/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  03/02/94              (H)   MINUTE(HES)                                      
  BILL:  HJR 52                                                                
  SPONSOR(S): REPRESENTATIVE(S) NORDLUND,Brice,Foster,Larson,                  
  JRN-DATE    JRN-PG                     ACTION                                
  01/21/94      2123    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  01/21/94      2123    (H)   HEALTH, EDUCATION & SOCIAL                       
  01/26/94      2159    (H)   COSPONSOR(S):  HANLEY                            
  02/02/94      2230    (H)   COSPONSOR(S):  NICHOLIA,                         
                              B. DAVIS                                         
  02/03/94      2247    (H)   COSPONSOR(S):  DAVIDSON                          
  03/02/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  03/02/94              (H)   MINUTE(HES)                                      
  BILL:  HB 356                                                                
  JRN-DATE    JRN-PG                     ACTION                                
  01/10/94      2021    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  01/10/94      2021    (H)   HES, JUDICIARY                                   
  03/03/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  BILL:  HB 506                                                                
  SHORT TITLE: STUDENT LOAN PROGRAM                                            
  JRN-DATE    JRN-PG                     ACTION                                
  02/16/94      2416    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  02/16/94      2416    (H)   HES, L&C, FINANCE                                
  03/03/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  ACTION NARRATIVE                                                             
  TAPE 94-35, SIDE A                                                           
  Number 000                                                                   
  CHAIR BUNDE called the meeting to order at 3:06 p.m., noted                  
  members present and announced the calendar. He brought HB
  337 to the table.                                                            
  HB 337 - DRUG FREE RECREATIONAL AND YOUTH CENTERS                            
  REP. JIM NORDLUND, Prime Sponsor of HB 337, addressed his                    
  bill.  He stated that in current law there are provisions                    
  for drug free school zones that increase the penalties for                   
  individuals who are arrested for possession of drugs in                      
  school areas.  He said the proposal would expand the zone to                 
  include recreation and youth centers.  He indicated that his                 
  committee substitute (CS) would specify those recreation and                 
  youth centers as those operated by the municipality or the                   
  state.  He referred to the sponsor statement and said that                   
  within his district the legislation would address the                        
  problems in the Spenard, Fairview, and Mountainview                          
  Recreational Centers.  He indicated that the Chief of                        
  Police, Kevin O'Leary, maintains that the areas around                       
  recreation and youth centers are fertile ground for those                    
  who promote and sell drugs to children.  He also indicated                   
  that police officer Patrick O'Brien, school liaison officer,                 
  asserts that the parking lot of the Fairview Recreation                      
  Center is the sight of a huge drug trade.                                    
  REP. NORDLUND stated that HB 337 has no fiscal note.  He                     
  indicated that the CS would narrow the zones down to                         
  recreational centers operated by the municipality or the                     
  state.  Also, the CS would make provisions to allow centers                  
  operated by the municipality the option of posting signs                     
  indicating drug free zones.                                                  
  Number 170                                                                   
  REP. TOOHEY asked how a person would know an area is a drug                  
  free zone.                                                                   
  REP. NORDLUND said when some of the violators are arrested,                  
  they will learn that the penalties are more severe than they                 
  used to be.  Also, media sources and the general public will                 
  help to disseminate the provisions of the new law.                           
  Number 192                                                                   
  (CHAIR BUNDE indicated that Rep. Vezey arrived at 3:09 p.m.                  
  and both Rep. Nicholia and Rep. Brice arrived at 3:11 p.m.)                  
  REP. TOOHEY asked how much a sign would cost.                                
  REP. NORDLUND said he did not know.                                          
  CHAIR BUNDE stated that all-weather signs are approximately                  
  $200 apiece.                                                                 
  REP. TOOHEY suggested that the recreation centers have a                     
  bake sale to raise money for the signs.  She felt that the                   
  signs needed to be seen.                                                     
  Number 215                                                                   
  CHAIR BUNDE clarified that the CS narrows the zones to                       
  municipal and state recreation and youth centers.                            
  REP. NORDLUND agreed.                                                        
  REP. TOOHEY made a motion to adopt the CS as a working                       
  CHAIR BUNDE, hearing no objections, said the CS for HB 337                   
  was before the committee and asked for further testimony.                    
  Number 249                                                                   
  REP. NORDLUND stated that he did not bring other witnesses                   
  to testify because he felt the concept of the bill is                        
  simplistic and does not need much explanation.  He indicated                 
  a number of letters of support in the committee bill                         
  CHAIR BUNDE asked for further questions.  He then asked the                  
  pleasure of the committee.                                                   
  REP. BRICE made a motion to pass the CS for HB 337 out of                    
  committee with individual recommendations and accompanying                   
  fiscal note.                                                                 
  CHAIR BUNDE, hearing no objections, declared that the CS for                 
  HB 337 was so moved.  He brought HJR 52 to the table.                        
  HJR 52 - INCREASE IN FEDERAL MEDICAID FUNDING                                
  Number 309                                                                   
  REP. JIM NORDLUND, Prime Sponsor of HJR 52, addressed the                    
  resolution.  He stated that the resolution deals with the                    
  issue of fairness regarding the state of Alaska.  He said                    
  currently the federal Medicaid rates vary nationwide from                    
  50% to 70% based on relative per capita income of the                        
  various states.  He explained that Alaska's high cost of                     
  living is not taken into account when reimbursement is set.                  
  The purpose of the resolution is to amend the Social                         
  Security Act to take into account Alaska's high cost of                      
  living and to set the differential accordingly.  He pointed                  
  out another disadvantage in the way Medicaid rates are set                   
  for the state.  He said, "although, the cost of living is                    
  considered in terms of deciding who is eligible to receive                   
  Medicaid, therefore increasing the Medicaid pool, in turn we                 
  do not receive the difference... in receiving the greater                    
  amount of money... or that's not taking into                                 
  consideration... the cost of living is not taken into                        
  consideration in setting the rate."  He said that if the                     
  state had a 25% increase, which is approximately what the                    
  cost of living difference is for the state, it would mean an                 
  additional $31 million dollars to the state of Alaska.                       
  REP. NORDLUND indicated that the resolution also recognizes                  
  the work that Senator Stevens has been doing in Congress to                  
  make the necessary changes.                                                  
  Number 387                                                                   
  CHAIR BUNDE asked for testimony from Kim Busch.                              
  Number 390                                                                   
  KIM BUSCH, Director, Division of Medical Assistance,                         
  Department of Health and Social Services, testified in                       
  support of HJR 52.  She stated that the Medicaid federal                     
  matching percentage is based on per capita income with a                     
  floor of 50%.  She said if the floor did not exist, Alaska                   
  would receive an even lower match rate.  She said the                        
  formula is also used for AFDC, the JOBS program, and other                   
  federally funded programs.  She explained that the                           
  government uses a 25% cost of living differential to set the                 
  poverty level in Alaska.  She said the result for FY 94 is                   
  $48.8 million that are not coming into Alaska.  Medicaid                     
  would receive an extra $33 million and AFDC would receive                    
  $15.7 million.                                                               
  MS. BUSCH felt it was critical to insert the provisions in                   
  Title 19 of the Social Security act now, because all of the                  
  health care reform legislation that is before Congress is                    
  using the same formula and Alaska is seriously                               
  Number 487                                                                   
  REP. TOOHEY asked when the resolution would take effect.                     
  Number 490                                                                   
  MS. BUSCH said it would take effect when the legislature                     
  adopts it.  She said if Congress moves the resolution, it                    
  would take effect this fall.                                                 
  CHAIR BUNDE closed public testimony.                                         
  Number 512                                                                   
  REP. BRICE made a motion to pass the CS for HJR 52 out of                    
  committee with individual recommendations.                                   
  CHAIR BUNDE objected as to explain his no vote.  He stated                   
  that the additional funds from the federal government would                  
  still be taken from the general public's pockets.  He said                   
  it is not free money.  He maintained that the Medicaid                       
  program is wildly out of control and he thought Alaska                       
  should lead by example and not ask for extra money.                          
  Number 538                                                                   
  REP. VEZEY asked what would happen if the cost of living in                  
  Anchorage turned out to be lower than Washington, D.C.                       
  MS. BUSCH stated if the cost of living changed dramatically                  
  and was no longer higher than most, the state would not need                 
  the differential.  She asserted that the situation currently                 
  is grossly unfair.  She also said that Congress must find                    
  savings in order to fund the increase, indicating that                       
  savings would be found within Title 19 to fund increase for                  
  Alaska.  She said that many other congressmen have been able                 
  to act to get consideration for increases for their state.                   
  Number 606                                                                   
  REP. BRICE said, "Better to buy... have this money come to                   
  the state in the form of extra federal money for Medicaid,                   
  Medicare, whatever, than to be buying whatever on the East                   
  Coast for nonproductive use, which is another thing that our                 
  federal government is known for.  Buicks or bombs, that's                    
  what I say."                                                                 
  CHAIR BUNDE said, "It's federal, it's free."                                 
  Number 623                                                                   
  REP. G. DAVIS agreed with Chair Bunde's point, but said the                  
  system is a match program that is mandated by the federal                    
  government.  He said, "It's a mandate from the feds, and                     
  it's a match program.  So it's costing state dollars.  At                    
  the current rate the mandate from the feds is mandating that                 
  the state spend so many dollars.  Under this resolution the                  
  mandate is that the state will not need to spend so much                     
  dollars.  So, I can certainly agree with that."                              
  Number 641                                                                   
  REP. NICHOLIA stated that there is definitely a higher cost                  
  of living in the rural areas.  She said it is very expensive                 
  for rural residents to go to Anchorage and Fairbanks for                     
  medical treatment, citing that many forgo medical treatment                  
  until the illness has gone past the point of medical care,                   
  resulting in people dying unnecessarily.  She felt that                      
  Medicaid dollars could go far for those people.  She also                    
  reminded the committee that a large percentage of people on                  
  Medicaid are children.  She said a no vote would deny                        
  children better medical services.  She further stated that                   
  in regards to the JOBS program there are a limited number of                 
  people who are allowed to go to job training, and she felt                   
  that number would increase as a result of the resolution.                    
  Number 685                                                                   
  CHAIR BUNDE asked if most Natives are covered under the                      
  Native Health Service.                                                       
  Number 688                                                                   
  REP. NICHOLIA indicated that federal funding is also limited                 
  for Indian Health Services.  She said a lot of people are                    
  turning to Medicaid.  She then pointed out that the interior                 
  has the highest cancer rate for the whole state of Alaska.                   
  Number 710                                                                   
  CHAIR BUNDE, hearing no further discussion, called for the                   
  vote.  Representatives Toohey, Gary Davis, Kott, Olberg,                     
  Nicholia and Brice voted yea; and Representatives Bunde and                  
  Vezey voted nay.  Chair Bunde indicated that the CS for HJR
  52 was so moved.  He then brought HB 356 to the table.                       
  HB 356 - LIVING WILLS AND MEDICAL CARE ORDERS                                
  REP. CYNTHIA TOOHEY stated that HB 356 complements current                   
  statutes pertaining to the rights of the terminally ill by                   
  adding specific recognition of do not resuscitate (DNR)                      
  orders to the existing legislation with regards to the                       
  rights of the terminally ill to make a declaration relating                  
  to the use of life-sustaining procedures.  She said a new                    
  section, Section 18.12.035, that allows attending physicians                 
  to issue DNR orders requires the Department of Health and                    
  Social Services (DHSS), with the approval of the State                       
  Medical Board, to issue regulations adopting a standardized                  
  protocol governing the withholding of CPR by physicians and                  
  other health care providers and establishes the requirements                 
  under which health care providers other than physicians must                 
  comply with DNR orders.                                                      
  REP. TOOHEY further stated that Section 18.12.037 requires                   
  the DHSS to develop standardized designs for DNR                             
  identification cards, forms, necklaces, and bracelets to                     
  indicate that the person who is in possession of one of the                  
  items has executed a living will or that a DNR order has                     
  been issued by a physician.  Other provisions of the bill                    
  amend existing provisions by including DNRs along with                       
  living wills in areas such as immunities for health care                     
  providers, acting under the provisions of living wills, DNR                  
  orders, and  penalties.  Rep. Toohey maintained that DNR                     
  orders are issued only in the case of terminal illness.                      
  REP. TOOHEY explained that under existing practice,                          
  emergency response providers are required to institute CPR                   
  on site even if the person has a living will.  She indicated                 
  that a properly executed DNR order and procedural protocol,                  
  recognized by all concerned parties, would help to avoid                     
  futile and unwanted interventions.  Similarly, within health                 
  care institutions, DNR orders are necessary in the absence                   
  of a living will when attempts at resuscitation serve only                   
  to prolong the process of dying.                                             
  CHAIR BUNDE indicated that there would be testimony via                      
  REP. BRICE asked if the memo from Craig Lewis would be                       
  CHAIR BUNDE indicated that Mr. Lewis was on teleconference.                  
  Number 825                                                                   
  REP. VEZEY asked Rep. Toohey to explain the penalty section,                 
  Section 5.                                                                   
  REP. TOOHEY stated that if an individual at a hospital,                      
  where fees are being charged, resuscitates a person against                  
  a DNR order, the individual will not be paid.                                
  REP. VEZEY referred to the $1000 civil penalty.                              
  REP. TOOHEY stated that the penalty is in existing law.                      
  REP. VEZEY said he failed to see the merit of mandating a                    
  $1000 civil penalty.  He asked Rep. Toohey if she thought                    
  that was in the best interest of the bill.                                   
  REP. TOOHEY deferred the question to Craig Lewis.                            
  Number 861                                                                   
  CHAIR BUNDE indicated that Mr. Lewis would address that                      
  question during public testimony.  He said that Fairbanks,                   
  Mat-Su, Petersburg, Seward, and Sitka were on                                
  Number 865                                                                   
  MARK JOHNSON, Chief, Emergency Medical Services, Department                  
  of Health and Social Services, testified in Juneau in                        
  support of HB 356.  He stated that emergency care providers                  
  are trained to aggressively care for patients, but he also                   
  felt there are terminally ill patients whose discomfort                      
  should not be prolonged.  He said when such patients, in                     
  consultation with their physician, choose to have a DNR                      
  order in place, the emergency medical providers would prefer                 
  to respect those wishes.                                                     
  Number 910                                                                   
  CHAIR BUNDE explained to the teleconference listeners that                   
  HB 506 would probably be brought to the table by 4:00 p.m.                   
  Number 921                                                                   
  VONA HALL, Member, Legislative Task Force for the American                   
  Association of Retired Persons (AARP), testified in Juneau                   
  in support of HB 356.  She stated that she had been told the                 
  meeting was the prior day, and at that time, had planned to                  
  give a very elaborate speech including horror stories about                  
  the financial and emotional expense endured by clients who                   
  have had devastating effects from too much terminal care.                    
  She stated that her testimony would be brief as she had                      
  found her husband the day before with a broken hip on the                    
  ice in the driveway and she was due at the hospital as he                    
  was undergoing surgery.  She said her husband was alive and                  
  indicated that under different circumstances the DNR                         
  legislation could have played an important role in their                     
  lives.  She also said that the legislation is not just for                   
  old people.  She suggested that it is for everybody that                     
  goes snowmobiling, drives a car, or perhaps walks in front                   
  of a car.  She said her children and friends are aware of                    
  her do not resuscitate orders.  She strongly emphasized the                  
  importance of the living will.                                               
  Number 995                                                                   
  REP. TOOHEY asked how her husband was.                                       
  MS. HALL said he was undergoing surgery right then.                          
  CHAIR BUNDE expressed his appreciation for her testimony,                    
  and wished Ms. Hall's husband the best.                                      
  Number 018                                                                   
  CRAIG LEWIS, Executive Director, Interior Region Emergency                   
  Medical Services Council (IREMSC), testified via offnet in                   
  support of HB 356.  He stated that he had several                            
  suggestions to make that perhaps would improve the                           
  legislation and asked if he should summarize or do a line by                 
  line analysis.                                                               
  CHAIR BUNDE asked him to summarize and said the committee                    
  would ask specific questions if necessary.                                   
  MR. LEWIS indicated that the words "attending physician,"                    
  which are used throughout the bill, should be enhanced                       
  because in some rural areas there is no attending physician.                 
  He asked that the definition of attending physician be                       
  expanded and clarified.  He also explained that the term                     
  cardiopulmonary resuscitation (CPR) is a process of hands on                 
  patient care.  Regarding the term, he suggested that                         
  artificial exchange of oxygen needed to be specified.  He                    
  said that if the change is not made, an emergency care                       
  provider may conclude that an oxygen mask should not be put                  
  on the patient's face.  He said that withholding                             
  resuscitation needs to be very specific.                                     
  MR. LEWIS expressed his concern that the legislation is not                  
  as "rurally oriented" as it could be.  He said a very                        
  specific mechanism needs to be in place to address the                       
  unique emergency treatment needs of rural areas.  Mr. Lewis                  
  explained that an Emergency Medical Technician (EMT) could                   
  have administered hours of aggressive treatment and not be                   
  able to get the patient anywhere near a physician, let alone                 
  an "attending physician."                                                    
  TAPE 94-35, SIDE B                                                           
  Number 000                                                                   
  MR. LEWIS further indicated that on page 2, lines 11-17, the                 
  word "qualified" was very unclear.                                           
  Number 050                                                                   
  REP. TOOHEY stated that the word "qualified" means that the                  
  person who possibly would be undergoing emergency treatment                  
  has already signed a living will and has proof on their body                 
  that they do not want resuscitation.                                         
  MR. LEWIS read lines 11-17 on page 2 to indicate the                         
  vagueness of the term qualified.  He continued on with his                   
  summary and stated that he did not want the legislation to                   
  only address health care facilities.  He said rural Alaska                   
  has many situations where DNR orders are relevant and                        
  appropriate.  Rural Alaska does not have health care                         
  facilities if the definition means hospital or multi-                        
  physician clinic.  He felt that the definition had to be                     
  more rurally oriented.                                                       
  MR. LEWIS further suggested that the provision on page 3,                    
  lines 10-12, is not a realistic approach in rural settings.                  
  He said he was unsure of the necessity of the provision on                   
  page 4, lines 7-15.  Mr. Lewis expressed further concern                     
  regarding page 5, lines 4-8, which addresses the issue of                    
  complying with the DNR orders from other states.  He said to                 
  his understanding the legislation would allow an Alaskan                     
  medical provider to recognize other DNR orders from other                    
  states.  He felt that it may be a regulation issue and                       
  related that EMTs are trained to aggressively treat                          
  patients, not to withhold treatment.                                         
  Number 195                                                                   
  ERNEST LINE, Concerned Citizen, testified via teleconference                 
  in support of HB 356.  He stated that the committee should                   
  consider possible future legislation regarding physician                     
  assisted suicide.  He then addressed the bill.  He                           
  maintained that the State Medical Board may be opposed to                    
  the provision on page 1, line 9.  He suggested that the                      
  legislature could approve the regulations.  He further                       
  indicated that on page 2, line 18, the provision would                       
  actually compel compliance if the facility is a state run                    
  operation.  Mr. Line suggested that the phrase "shall not                    
  attempt resuscitation until all provisions of Section 3,                     
  paragraph b, are exhausted" should be inserted.  Mr. Line                    
  also supported the idea of increasing the $1000 fine to                      
  violators of DNR orders, citing that it would ensure                         
  Number 300                                                                   
  REP. TOOHEY asked if Mr. Line knew of people whose DNR                       
  orders were not carried out.  She asked if he thought it was                 
  a major problem in medical facilities.                                       
  MR. LINE stated that he has read about cases where the                       
  physician did not personally believe in DNR orders.                          
  Number 327                                                                   
  SANDY TACKETT, Nurse, testified via teleconference in                        
  support of HB 356.  She stated that health care people                       
  needed to have the information within HB 356 to carry out                    
  the wishes of a patient.                                                     
  Number 345                                                                   
  CHAIR BUNDE asked witnesses to limit their testimony by                      
  associating themselves with the similar positions of prior                   
  testifiers and by adding any yet unheard testimony.                          
  Number 350                                                                   
  JULIE RENWICK, Coordinator of Social Services, Wesley                        
  Rehabilitation and Care Center, testified via teleconference                 
  in support of HB 356.  She stated that she was concerned                     
  about the definition of qualified patient.  She indicated                    
  that she originally thought the legislation was only                         
  addressing the terminally ill.  She also said she hoped the                  
  provision regarding protocol would be written to protect the                 
  wishes of the individual and/or family guardian.  She also                   
  said in Section 3 individuals need to be more involved with                  
  the decision making with the doctor.  She further stated in                  
  regards to DNRs in other states that there is a nationwide                   
  organization called Right to Life that issues small living                   
  will cards to people who travel throughout the nation.  She                  
  questioned whether the cards would comply with any single                    
  state with living will provisions.                                           
  Number 424                                                                   
  LINDA SWENSON, Nurse, Seward General Hospital, testified via                 
  teleconference in support of HB 356.  She stated that in                     
  regard to the oral DNR order provided for on page 2, line 2,                 
  the DNR order should never be given orally in an urban                       
  hospital.  She also expressed concern as to what is a                        
  qualified patient.  She stated that people make living wills                 
  with DNR orders anticipate that they, at some time, will not                 
  be able to speak for themselves.                                             
  Number 475                                                                   
  RICHARD JONES, Administrator, Wesley Rehabilitation and Care                 
  Center, testified via teleconference in support of HB 356.                   
  He asked what protocol would be if an individual who had                     
  previously provided a DNR order is in need of emergency                      
  treatment at a hospital and is unable to express their                       
  wishes at that time.  He asked if the prior DNR order would                  
  be honored or would a physician have to order another DNR.                   
  He asked who was responsible for the legislation, and                        
  expressed his thanks.                                                        
  Number 526                                                                   
  CHAIR BUNDE stated that Rep. Toohey was responsible for                      
  introducing HB 356.                                                          
  Number 528                                                                   
  NANCY JO BLEIER, Director of Social Services, Southeast                      
  Alaska Regional Health Corporation, testified in support of                  
  HB 356.  She stated that she also had concerns with the                      
  terms "qualified" and "health care facility."                                
  Number 570                                                                   
  REP. TOOHEY read for the record from statute 18.15.010:  "A                  
  qualified patient means a patient who has executed a                         
  declaration in accordance with this chapter and who has been                 
  determined by an attending physician to be in terminal                       
  CHAIR BUNDE said his understanding of the issue is that the                  
  legislation addresses terminal patients only and perhaps it                  
  could also include someone who is in the peak of health but                  
  meets with a catastrophic accident.                                          
  Number 587                                                                   
  CAPTAIN STEVE IHA, EMS Coordinator, Capital City                             
  Fire/Rescue, testified in Juneau in support of HB 356.  He                   
  stated that Juneau has had DNR protocol in place for 3-1/2                   
  years, and it has been quite successful.  He said it was his                 
  understanding that a living will can be initiated by anyone                  
  regardless of that person's health condition.  However, he                   
  said the living will is not enacted until a physician (or                    
  perhaps two) determines that the patient is terminally ill.                  
  He said that stipulation creates a Catch 22 situation.  He                   
  asked what protocol would be in the case of a healthy, 35                    
  year old man who chokes on a piece of meat.  He said that                    
  technically he could be in a DNR state.  He felt that the                    
  legislation needs to be more specific.                                       
  CAPT. IHA also said there is no way for EMTs to really know                  
  the validity of an out-of-state DNR order.  He said that for                 
  the most part his EMTs honor DNR orders within the Juneau                    
  system.  He suggested that the term "qualified" be more                      
  Number 648                                                                   
  REP. TOOHEY asked what the medical protocol would be if                      
  Capt. Iha found a person collapsed on the street corner of                   
  the capitol with a DNR arm band on.                                          
  CAPT. IHA said there is no protocol for such an instance.                    
  He stated that the DNR patients in Juneau have been                          
  determined to be terminally ill by a physician and have                      
  filled out a form that has been sent to Fire/Rescue                          
  dispatch.  He said that it is understood that those patients                 
  on the DNR list at dispatch would be responded to at their                   
  REP. VEZEY asked what the protocol would be if he choked on                  
  a piece of meat.  He asked how an EMT would know he had a                    
  living will.                                                                 
  CAPT. IHA said, "If you're talking about putting do not                      
  resuscitate type bracelets or identifications, then it would                 
  become an issue."                                                            
  REP. VEZEY said that he never thought that executing a                       
  living will would put himself in the position of not                         
  receiving medical attention.                                                 
  CAPT. IHA said if DNR orders are part of the living will, it                 
  must be very clear.                                                          
  Number 696                                                                   
  CHAIR BUNDE said there is a difference.  He then asked Rep.                  
  Toohey how she would like to address all the aforementioned                  
  REP. OLBERG said that Rep. Vezey would fall under the Do Not                 
  Resuscitate Legislators provision.                                           
  CHAIR BUNDE said he wanted to amend that to specify minority                 
  REP. TOOHEY clarified that the legislation is a companion                    
  bill to a living will in a hospital.  It would allow EMTs                    
  who have found a terminally ill person collapsed on the                      
  street corner to respect that person's DNR order.                            
  Number 744                                                                   
  MR. JOHNSON stated that all the aforementioned concerns                      
  could be dealt with quite easily.   He referred to testimony                 
  from Mr. Line and indicated that he has every confident in                   
  working with the medical board and felt there would be no                    
  problems in doing so.                                                        
  CHAIR BUNDE closed public testimony on HB 356.                               
  HB 506 - STUDENT LOAN PROGRAM                                                
  CHAIR BUNDE then brought HB 506 to the table and turned the                  
  gavel over to Rep. Toohey to preside over the remainder of                   
  the meeting.                                                                 
  CHAIR TOOHEY took a brief at-ease from 4:08 p.m. to 4:20                     
  Number 795                                                                   
  REP. BUNDE addressed HB 506.  He stated that Joe McCormick                   
  would further address the bill.                                              
  REP. BRICE stated for the record that he presently has an                    
  active student loan, and indicated that there might be a                     
  conflict of interest.                                                        
  CHAIR TOOHEY thanked Rep. Brice and said his comment was so                  
  REP. BUNDE stated that the legislation would attempt to make                 
  the student loan "a little more business-like."  He said                     
  administratively progress has been made, but he would like                   
  to see even more progress to maintain the student loan                       
  program, and indicated that as it exists, it costs more                      
  money to bond the program than is being received.  He said                   
  under those circumstances, the program would eventually run                  
  out of money.  He indicated that the bill addresses seven                    
  items within the loan program:                                               
       1.  It would change the interest rate from a fixed rate                 
           to a variable rate.                                                 
       2.  It would allow for restrictions for eligibility of                  
           a loan if an individual has had a prior loan                        
           written off as a bad debt.                                          
       3.  It would allow wages to be garnished.                               
       4.  It would deny state licensure if an individual is                   
           in default of a student loan.                                       
       5.  It would also deny state warrants.                                  
       6.  It would allow for the refinancing of student                       
       7.  It would allow for an expanded family education                     
           loan eligibility.                                                   
  Number 870                                                                   
  REP. BUNDE asked if there were any questions.                                
  TAPE 94-36, SIDE A                                                           
  Number 000                                                                   
  REP. OLBERG asked if the interest rate would have a floor or                 
  could it go down to 1%.                                                      
  Number 050                                                                   
  JAMES MCCORMICK, Executive Director, Alaska Commission on                    
  Postsecondary Education, testified in Juneau in support of                   
  HB 506.  He stated that it does not have a floor, but would                  
  be tied to the cost of the money that is secured in the bond                 
  market.  He said it would be unrealistic to assume that the                  
  cost of money would go down to 1% or less.                                   
  REP. OLBERG asked if the rate would have a cap.                              
  MR. MCCORMICK said no.                                                       
  REP. OLBERG asked what the interest rate is based on.                        
  MR. MCCORMICK replied that it is based on the cost of money                  
  when bonds are issued to replace the capital of the loan                     
  fund.  He said the interest rate from loans disbursed from                   
  the bond proceeds would be tied to the cost of the bond                      
  REP. OLBERG asked if the rate could be annually adjusted.                    
  MR. MCCORMICK said it could be a possibility.  He said the                   
  problem would be that a greater administrative burden would                  
  be put upon the entity that would administer the loan fund,                  
  because the interest rate would change from year to year.                    
  Number 076                                                                   
  REP. OLBERG said he felt that the software required for that                 
  process would not be a difficult transition.  He then asked                  
  if teaching certificates would be included under denial of                   
  Number 085                                                                   
  MR. MCCORMICK answered that he had a friendly amendment to                   
  restrict the impact of Section 1 to only persons licensed                    
  for professional or occupational licenses only.  He then                     
  stated that he was unsure if teaching certificates would                     
  fall under the provision.                                                    
  REP. BUNDE stated that he currently sits on a committee that                 
  is rewriting the provisions for granting a teacher's                         
  license.  He felt that a teaching certificate would fall                     
  under that section, and he would encourage the amendment.                    
  Number 121                                                                   
  REP. OLBERG agreed with the amendment.                                       
  REP. BUNDE maintained that there are many other student loan                 
  programs that offer a lower interest rate and that students                  
  should be encouraged to shop around.                                         
  REP. VEZEY asked what the average maturity date of a student                 
  loan is.                                                                     
  MR. MCCORMICK responded by saying the average student is in                  
  school 2-1/2 years with one year grace and a standard ten                    
  year repayment.  He said that many students qualify for                      
  extended repayment plans of 15 years.  He stated that the                    
  average is 12 to 13 years.                                                   
  REP. VEZEY said, "paying on the loan or have the loan out."                  
  MR. MCCORMICK said, "paying on the loan."                                    
  REP. VEZEY clarified that the average loan has a 15 year                     
  MR. MCCORMICK added that there is no stated forgiveness on                   
  the loan, so it could be an outstanding balance for an                       
  indefinite amount of time.                                                   
  Number 188                                                                   
  REP. VEZEY asked what kind of maturity was on the bonds that                 
  are issued.                                                                  
  MR. MCCORMICK stated that the bonds have approximately a 10                  
  year maturity.                                                               
  REP. VEZEY questioned whether it would be prudent to take                    
  out a long term, variable rate loan.                                         
  MR. MCCORMICK maintained that the legislation provides for a                 
  fixed rate loan, fixed to the cost of that money for that                    
  bond issue.  The rate would not change for the bond issue.                   
  REP. VEZEY clarified that money would be available one year                  
  at one rate and at another rate the next year, but the rate                  
  would be fixed for the life of each individual loan.                         
  MR. MCCORMICK agreed.  He also said that it is possible to                   
  have a variable rate bond and a variable rate interest on                    
  the loan.  He indicated that it would require more                           
  sophisticated software.                                                      
  REP. VEZEY suggested that if the loans went to a variable                    
  rate, investments would need to be accessed to ensure that                   
  there would be no exposure to an arbitrage situation.                        
  MR. MCCORMICK agreed and said language within the bill                       
  states that the commission will ensure that the rate covers                  
  the administrative cost of the loan.  He asserted that the                   
  thrust of the bill is to recognize the actuarial soundness                   
  of the loan fund and specified that an interest rate must be                 
  actuarially sound given the terms of the loan.                               
  Number 321                                                                   
  REP. VEZEY stated that the student loan program did not have                 
  a loan forgiveness program.                                                  
  MR. MCCORMICK explained that there is no loan forgiveness on                 
  loans that are currently being granted, but there is loan                    
  forgiveness for loans that have been made in the past that                   
  will continue into the future for which there is no offset.                  
  He said currently no fees are charged and no premiums are                    
  collected to cover the loan forgiveness, and he anticipated                  
  there would be a depletion in the fund annually as students                  
  qualify for forgiveness.                                                     
  REP. VEZEY asked if there is a significant depletion in the                  
  loan reserve.                                                                
  MR. MCCORMICK said historically there has been a significant                 
  depletion, but it has slowed.  He further stated that money                  
  is lost in three areas -- interest not charged to a borrower                 
  (in school plus one year of grace), loans that default, and                  
  loans that have forgiveness provisions.                                      
  REP. OLBERG suggested that the term of the loan be tied to                   
  the source of the funds, and explained that if there are ten                 
  year bonds, there should be ten year term loans.                             
  MR. MCCORMICK stated that the term of the loan is dealt with                 
  in the section pertaining to refinancing.  He also said that                 
  in current statute there is a provision that allows up to 15                 
  years if the student has an extremely high debt.  He felt                    
  the terms of the loan will be much more flexible when there                  
  is a consolidation provision that would allow students to                    
  collapse various loans into one new promissory note at a new                 
  interest rate which would be tied to the bond issue.                         
  REP. BUNDE stated that the current interest rate is 8%, but                  
  if all the interest free time that a student has is                          
  considered, it is actually closer to 5%.  The loan was                       
  bonded at 6%, indicating a loss.                                             
  CHAIR TOOHEY said that forgiveness loans are dying out as                    
  the practice stopped in 1987.                                                
  REP. VEZEY suggested that the student loan program showed a                  
  positive cash flow.                                                          
  MR. MCCORMICK agreed, but he indicated that when he used the                 
  term "actuarially sound," he was talking in terms of the                     
  total life of the loans and total life of the bonds, not                     
  just what the balance sheet reflects for one particular                      
  REP. VEZEY asked if, at the current fixed rate of 8% with                    
  forgiveness periods and the cost of funds, is the program                    
  operating in the black?                                                      
  MR. MCCORMICK said yes.                                                      
  REP. BRICE asked Mr. McCormick what constitutes a defaulted                  
  loan.  He also asked if he knew of the University of Alaska                  
  Coalition of Student Leaders (UACSL) and of their position                   
  on the bill.                                                                 
  CHAIR TOOHEY asked if Rep. Brice would hold his questions to                 
  allow for teleconference testimony.                                          
  Number 500                                                                   
  BRIAN BRUBAKER, Coordinator, University of Alaska Coalition                  
  of Student Leaders, testified via teleconference on HB 506.                  
  He stated that the coalition favors a cap to be put on the                   
  variable rate, as well as provisions for exceptions on a                     
  case by case basis.  He also said that the withholding of                    
  licensure should also be dealt with on a case by case basis.                 
  He stated that the coalition has become involved as a result                 
  of past problems with the time frame that loans were being                   
  delivered in.  He also said that the student loan program                    
  does need to move ahead to a more business like approach,                    
  citing that as being one reason they support the variable                    
  rate with a ceiling.  He further stated that a major portion                 
  of university money comes from student loans, and indicated                  
  that next year the cost of a credit will be $67.  He then                    
  asked how the Alaska Commission on Postsecondary Education                   
  (ACPE) would ensure that the lowest interest rates would be                  
  Number 618                                                                   
  NICHOLAS ABRAMCZYK, Member, Associated Students of the                       
  University of Alaska, Fairbanks, testified via                               
  teleconference on HB 506.  He stated that a student must                     
  fill out the same application year after year.  He felt that                 
  some type of consolidation process should be used to avoid                   
  redundancy, and suggested that it would steer the program                    
  toward a more business like program.  He said he supported a                 
  cap on a variable rate.                                                      
  Number 669                                                                   
  ANDREA PAIGE ADAMS, Vice-President, United Students of                       
  University of Southeast, Sitka, testified via teleconference                 
  on HB 506.  She stated that she has been working with Mr.                    
  McCormick to keep him informed of the students' ideas.  She                  
  said that on February 20, 1994, the students passed a                        
  resolution in support of ACPE's recommendations for HB 506.                  
  She said she would like to see the recommendations go                        
  Number 692                                                                   
  CHAIR TOOHEY closed teleconference testimony and asked that                  
  Rep. Brice's questions be addressed.                                         
  REP. BUNDE asked that someone address the fiscal note.                       
  MR. MCCORMICK said he understood the student's concern for                   
  capping the interest rate, but it would defeat the purpose                   
  of going to a variable rate in the context of not having to                  
  come before a legislative body to change the rate again.  He                 
  said, because the program is audited by the state and                        
  private firms, and financial advisors are hired to advise                    
  administration on the cost of money and the issuance of                      
  bonds, the public can be assured that students are receiving                 
  the lowest possible interest rate.  He further stated that                   
  the program must be operated in such a way that students                     
  will want to borrow from the program.  The rate will have to                 
  be competitive with that of other loans.  He also indicated                  
  that the process must competitive and indicated that a new                   
  application would be coming out in the following weeks that                  
  would simplify the application process.  He maintained that                  
  the bill would allow for the simplification of repayment of                  
  a loan and urged that there be appropriate administrative                    
  funds to make the process work.                                              
  Number 779                                                                   
  CHAIR TOOHEY complimented Mr. McCormick on being a fine                      
  caretaker of the state's money.                                              
  REP. BUNDE, referring to the students asking for a cap on                    
  the interest rate, said that they can't take advantage of                    
  low interest rates when they are available and not pay their                 
  fair share when they are higher.  He further stated that                     
  Alaskan students are paying only 23% of the actual cost of                   
  their education.                                                             
  Number 816                                                                   
  REP. BRICE asserted that the government's role is to help                    
  students along.  He felt there should be a cap, especially                   
  if the prime rate does go up to 21% again.  He felt the cap                  
  should be at 15% and explained that the state must make the                  
  loans attractive to students.  He suggested an amendment to                  
  Section 2 that would establish a ceiling at 15%.                             
  REP. BUNDE said that he sympathized with the student's                       
  plight, but indicated that there is a provision within the                   
  bill for refinancing.                                                        
  Number 885                                                                   
  REP. BRICE asked if the provisions for refinancing were only                 
  for certain circumstances.                                                   
  REP. BUNDE observed that if the cost of money went over 15%,                 
  money to operate the program would come out of general                       
  funds.  He then reminded the committee that the "sympathy                    
  for running this program in the legislature under general                    
  funds is waning."  He indicated that there are legislators                   
  that would like to eliminate or privatize the program.                       
  MR. MCCORMICK asserted that there has been no general fund                   
  expenditures for the loan program since 1993.                                
  Number 908                                                                   
  REP. BRICE asked under what circumstances can a person                       
  refinance, and what is the limit to the amount of times a                    
  person can refinance?                                                        
  MR. MCCORMICK replied that there would be no limitations                     
  specified in the language of the bill.  He said that                         
  typically when a student wants to refinance, there is a cash                 
  flow problem.  The student would then collapse the loans                     
  into one, and the individual payment would be less than the                  
  total amount of payments of the individual loans.  He                        
  further stated that the refinancing terms should not be                      
  dictated by the bill itself.  He felt that the language was                  
  flexible enough as to have a viable refinancing structure.                   
  He asserted that there are appeal mechanisms in place that                   
  would be implemented when a student challenges the denial of                 
  a license.                                                                   
  MR. MCCORMICK made reference to a friendly amendment that                    
  would be submitted to Rep. Bunde at a later time.  He                        
  suggested that the Department of Commerce would need the                     
  authority to require applicants for professional licenses to                 
  disclose their social security numbers so computer matches                   
  could be done between the two departments.                                   
  REP. BUNDE asked if there was someone from Occupational                      
  Licensing to address the fiscal note.  He then made a                        
  suggestion to continue discussions of HB 506 the following                   
  Number 965                                                                   
  BARBARA GABIER, Program Coordinator, Division of                             
  Occupational Licensing, Department of Commerce and Economic                  
  Development, testified in Juneau on HB 506.  She stated that                 
  there would be 1800 matches of professional licenses for                     
  matches on loans.  Of that 1800, there is a potential for                    
  10% default.  Hence, she said that there would be possibly                   
  180 persons that would be sought after for revocation of                     
  license.  She anticipated that 90 of those persons would ask                 
  to have a hearing, and a hearing costs $3,000.  She further                  
  stated that through streamlining procedures the cost could                   
  be cut down to approximately $500 per hearing and related                    
  that cost to the fiscal note.                                                
  REP. BUNDE asked what would be the net gain or loss for                      
  tracking down those who are in default.                                      
  MR. MCCORMICK maintained that to break even he would have to                 
  collect 20 loans.  He said that if the average loan is $5000                 
  per person, 20 people would figure to $100,000.  He further                  
  stated that any loans collected beyond the 20 students would                 
  be above a break even figure.  He felt the thrust of the                     
  revocation provision is not the actual seizure of a license,                 
  but is the psychology of the threat of denial or revocation                  
  of licensure if a loan is in default.                                        
  MS. GABIER said, "We have built into the fiscal note...                      
  reviewing it annually and recovering only the costs that...                  
  are actually incurred by the division."                                      
  Number 068                                                                   
  REP. VEZEY asked if the Department of Commerce requires                      
  people to disclose their social security number.                             
  MS. GABIER said no.                                                          
  REP. BUNDE suggested that if disclosure of the social                        
  security number is refused, perhaps licensure could be                       
  CHAIR TOOHEY asked for further testimony.  There was none.                   
  She then asked the pleasure of the committee.                                
  REP. VEZEY asked if he could propose an amendment.                           
  CHAIR TOOHEY asked if it was an involved amendment.                          
  REP. VEZEY said yes.                                                         
  CHAIR TOOHEY asked that the amendment be proposed at the                     
  next hearing of HB 506.                                                      
  Seeing no further business before the committee, CHAIR                       
  TOOHEY ADJOURNED the meeting at 5:02 p.m.                                    

Document Name Date/Time Subjects