Legislature(2005 - 2006)CAPITOL 106

03/17/2005 03:00 PM HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 151 RESPONSIBILITY FOR CARE AFTER EYE SURGERY TELECONFERENCED
Moved CSHB 151(HES) Out of Committee
*+ HB 156 COMMISSION ON AGING TELECONFERENCED
Moved CSHB 156(HES) Out of Committee
*+ HB 185 POSTSECONDARY STUDENT IMMUNIZATION TELECONFERENCED
Moved Out of Committee
Bills Previously Heard/Scheduled
= HB 193 LICENSING MEDICAL OR CARE FACILITIES
Heard & Held
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                         March 17, 2005                                                                                         
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Tom Anderson                                                                                                     
Representative Vic Kohring                                                                                                      
Representative Lesil McGuire                                                                                                    
Representative Sharon Cissna                                                                                                    
Representative Berta Gardner                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
HOUSE BILL NO. 193                                                                                                              
"An Act  relating to the licensing,  regulation, enforcement, and                                                               
appeal  rights of  ambulatory surgical  centers, assisted  living                                                               
homes, child  care facilities,  child placement  agencies, foster                                                               
homes,  free-standing   birth  centers,  home   health  agencies,                                                               
hospices  or  agencies  providing  hospice  services,  hospitals,                                                               
intermediate   care  facilities   for   the  mentally   retarded,                                                               
maternity  homes,  nursing  facilities,  residential  child  care                                                               
facilities, residential psychiatric  treatment centers, and rural                                                               
health clinics; relating to criminal  history requirements, and a                                                               
registry, regarding certain  licenses, certifications, approvals,                                                               
and  authorizations  by  the  Department  of  Health  and  Social                                                               
Services;  making conforming  amendments;  and  providing for  an                                                               
effective date."                                                                                                                
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
HOUSE BILL NO. 185                                                                                                              
"An Act  relating to immunization  of postsecondary  students for                                                               
meningitis; and providing for an effective date."                                                                             
                                                                                                                              
     - MOVED HB 185 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 156                                                                                                              
"An Act  relating to the  membership of the Alaska  Commission on                                                               
Aging; and providing for an effective date."                                                                                    
                                                                                                                                
     - MOVED CSHB 156(HES) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 151                                                                                                              
"An Act relating to provider responsibility for ocular                                                                          
postoperative care; and providing for an effective date."                                                                       
                                                                                                                                
     - MOVED CSHB 151(HES) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 13                                                                                                               
"An Act relating to reimbursement of municipal bonds for school                                                                 
construction; and providing for an effective date."                                                                             
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 193                                                                                                                  
SHORT TITLE: LICENSING MEDICAL OR CARE FACILITIES                                                                               
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/02/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/02/05       (H)       HES, JUD, FIN                                                                                          
03/15/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/15/05       (H)       Scheduled But Not Heard                                                                                
03/17/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 185                                                                                                                  
SHORT TITLE: POSTSECONDARY STUDENT IMMUNIZATION                                                                                 
SPONSOR(S): REPRESENTATIVE(S) CHENAULT                                                                                          
                                                                                                                                
02/28/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/28/05       (H)       HES, FIN                                                                                               
03/17/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 156                                                                                                                  
SHORT TITLE: COMMISSION ON AGING                                                                                                
SPONSOR(S): REPRESENTATIVE(S) HOLM                                                                                              
                                                                                                                                
02/18/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/18/05       (H)       HES, FIN                                                                                               
03/17/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 151                                                                                                                  
SHORT TITLE: RESPONSIBILITY FOR CARE AFTER EYE SURGERY                                                                          
SPONSOR(S): LABOR & COMMERCE BY REQUEST                                                                                         
                                                                                                                                
02/14/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/14/05       (H)       HES, L&C                                                                                               
03/01/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/01/05       (H)       Scheduled But Not Heard                                                                                
03/08/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/08/05       (H)       Heard & Held                                                                                           
03/08/05       (H)       MINUTE(HES)                                                                                            
03/17/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
RICHARD MANDSAGER, M.D., Director                                                                                               
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided information on HB 193 and                                                                         
testified in support of HB 193.                                                                                                 
                                                                                                                                
STACIE KRALY, Attorney                                                                                                          
Senior Assistant Attorney General                                                                                               
Department of Law                                                                                                               
Department of Labor & Workforce Development                                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided information on HB 193 and                                                                         
testified in support of HB 193.                                                                                                 
                                                                                                                                
ERICH DELAND, Staff                                                                                                             
to Representative Mike Chenault                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 185 on behalf of                                                                              
Representative Mike Chenault and answered questions.                                                                            
                                                                                                                                
BARBARA COTTING, Staff                                                                                                          
to Representative Jim Holm                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 156 on behalf of                                                                              
Representative Jim Holm and answered questions; suggested                                                                       
changes to HB 156.                                                                                                              
                                                                                                                                
LINDA GOHL, Executive Director                                                                                                  
Alaska Commission on Aging                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided information on behalf of the                                                                      
Alaska Commission on Aging.                                                                                                     
                                                                                                                                
STEVE ASHMAN, Director                                                                                                          
Division of Senior and Disability Services                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided information on behalf of the                                                                      
Division of Senior and Disability Services.                                                                                     
                                                                                                                                
WAYNE HAGERMAN, O.D.                                                                                                            
Sitka, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in opposition to HB 151.                                                                         
                                                                                                                                
CARL ROSEN, M.D.                                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 151.                                                                            
                                                                                                                                
ERIK CHRISTIANSON, O.D.                                                                                                         
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 151.                                                                         
                                                                                                                                
WILLIE SHIELDS, M.D.                                                                                                            
Washington                                                                                                                      
POSITION STATEMENT:  Provided his opinions regarding eye care                                                                   
and offered relevant information pertaining to HB 151.                                                                          
                                                                                                                                
BOB FORD, M.D.                                                                                                                  
Chehalis, WA                                                                                                                    
POSITION STATEMENT:  Testified in opposition to HB 151.                                                                         
                                                                                                                                
SAM TRIVETTE                                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 151.                                                                         
                                                                                                                                
FRANK BICKFORD                                                                                                                  
Alaska Society of Eye Physicians Surgery                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 151.                                                                            
                                                                                                                                
MICHAEL BENNETT, O.D.                                                                                                           
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 151.                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 3:04:42  PM.                                                             
Representatives Kohring,  Anderson, and  Gardner were  present at                                                               
the call to  order.  Representatives Seaton,  Cissna, and McGuire                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
HB 193-LICENSING MEDICAL OR CARE FACILITIES                                                                                   
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE  BILL   NO.  193  "An   Act  relating  to   the  licensing,                                                               
regulation,   enforcement,  and   appeal  rights   of  ambulatory                                                               
surgical centers,  assisted living homes, child  care facilities,                                                               
child  placement  agencies,  foster  homes,  free-standing  birth                                                               
centers,  home health  agencies, hospices  or agencies  providing                                                               
hospice  services, hospitals,  intermediate  care facilities  for                                                               
the  mentally  retarded,  maternity  homes,  nursing  facilities,                                                               
residential  child   care  facilities,   residential  psychiatric                                                               
treatment  centers,   and  rural  health  clinics;   relating  to                                                               
criminal history requirements, and  a registry, regarding certain                                                               
licenses,  certifications, approvals,  and authorizations  by the                                                               
Department  of  Health  and Social  Services;  making  conforming                                                               
amendments; and providing for an effective date."                                                                               
                                                                                                                                
3:06:02 PM                                                                                                                    
                                                                                                                                
RICHARD  MANDSAGER, M.D.,  Director, Division  of Public  Health,                                                               
Department   of  Health   and   Social  Services,   (Department),                                                               
introduced  the slide  entitled, "PUBLIC  HEALTH: Protecting  and                                                               
Promoting  the  Health  of  All  Alaskans,  HB  193,  a  Bill  to                                                               
Consolidate DHSS  Licensing, Certification, and  Background Check                                                               
Functions."  He showed slide number 2 and explained:                                                                            
                                                                                                                                
     The existing  statutory and regulatory  environment ...                                                                    
     that the  Department deals with  all kinds  of programs                                                                    
     and   facilities  that   range  in   size  from   major                                                                    
     hospitals,  like  Providence,  to  small  family  owned                                                                    
     assisted living  homes, to  hospice, to  ambulatory ...                                                                    
     surgery  centers, to  foster  families  - there's  this                                                                    
     whole range  of licensing and  certification activities                                                                    
     that  the Department  does.   And,  two  years ago  the                                                                    
     Governor with "administrative order  108" ... began the                                                                    
     centralization  process of  bringing the  certification                                                                    
     and licensing  activities together  into one  place and                                                                    
     separating them  from the parts of  the Department that                                                                    
     pay  for   services  ...  there   is  some   degree  of                                                                    
     separation  of the  licensing and  certifying from  the                                                                    
     paying  part of  the  organization.   As we've  started                                                                    
     down  that journey,  it has  become very  apparent that                                                                    
     these  programs have  all  grown  up independently  ...                                                                    
     with  their own  sets of  statutes ...  regulations ...                                                                    
     appeal  processes and  they are  sometimes similar  ...                                                                    
     many times  with different steps.   So, the  first real                                                                    
     purpose  here is  an administrative  simplification and                                                                    
     cohesion question  about what  makes sense ...  for the                                                                    
     Department across  all of these  entities to  make them                                                                    
     as  similar  as  possible  ...  in  terms  of  cost  of                                                                    
     certification and  licensing ... even though  there's a                                                                    
     theory that  we can bring together  and centralize this                                                                    
     licensing  function ...  the training  of  staff to  be                                                                    
     able to interact with more  than one type of program is                                                                    
     really markedly  decreased ... We're  aiming for  a day                                                                    
     ...  when one  person could  go prepared  to do  two or                                                                    
     three  activities  rather  than three  separate  people                                                                    
     going  in  on  three  separate plane  trips  into  that                                                                    
     [rural] community.   To get  there, requires us  ... to                                                                    
     try  to get  to much  more standardized  and simplified                                                                    
     rules on the state side  ... on the provider side, many                                                                    
     providers have multiple types of  programs and for them                                                                    
     to  keep track  of  separate program  rules  ... is  an                                                                    
     administrative cost ...                                                                                                    
                                                                                                                                
DR. MANDSAGER  described a past  situation where a provider  in a                                                               
supported living  home was misappropriating funds  collected from                                                               
a  resident.   He  explained that  the state  does  not demand  a                                                               
license  or background  check for  [supported  living homes]  and                                                               
there was  little that the state  could do in terms  of recourse.                                                               
He said that in Alaska there  is a "nurse aid registry" and three                                                               
nurse   aids  were   found  by   investigative  agencies   to  be                                                               
mistreating  residents  in a  nine  month  period and  after  the                                                               
mandatory reporting  period, two  had not  been entered  into the                                                               
registry; one  case had involved  physical violence.   He pointed                                                               
out  that timeliness  issues in  the current  process need  to be                                                               
improved.  He  added that many personal care  attendants work for                                                               
more  than  one   agency  and  are  required   to  have  separate                                                               
background checks with  each agency.  He offered  that doing this                                                               
once for  all agencies  could be more  efficient.   Dr. Mandsager                                                               
reviewed which  department divisions and service  providers would                                                               
be affected, and what would be standardized by HB 193.                                                                          
                                                                                                                                
3:18:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER stated  that  Representative Kohring  and                                                               
she have constituents that are  involved in the health care field                                                               
and provide  services to people  at home, and they  have inquired                                                               
as to  the development  of a  database that  would allow  for the                                                               
detection of people who have  been accused of fraud with Medicare                                                               
billing.   She explained  that there  is no  legal way  to inform                                                               
other agencies that this has occurred  with a past employee.  She                                                               
asked if the registry [mentioned  by Dr. Mandsager] would include                                                               
fraud allegations.                                                                                                              
                                                                                                                                
STACIE  KRALY,   Senior  Assistant   to  the   Attorney  General,                                                               
Department  of  Law, said  that  she  understood the  theoretical                                                               
concept behind the  abuse registry to include a  finding of fraud                                                               
in that context  if the individual had, in  fact, been terminated                                                               
for fraudulent billing  activities.  She explained  that the idea                                                               
[for  the abuse  registry] is  to  create a  civil registry  that                                                               
would include all types of  instances that a prospective employer                                                               
would want to know about, before hiring.                                                                                        
                                                                                                                                
REPRESENTATIVE GARDNER said that there  are gray areas that would                                                               
include there being no record  of offensive behavior.  She opined                                                               
that many employees [in assisted  living homes, or acting as care                                                               
providers] are minimally  skilled and move from  agency to agency                                                               
for a variety of reasons; it  seems that there is the possibility                                                               
for  "low-grade"   violations  to  escape  prosecution   in  many                                                               
instances, which  would provide little  or no information  on the                                                               
registry.                                                                                                                       
                                                                                                                                
3:21:31 PM                                                                                                                    
                                                                                                                                
MS.  KRALY said  that Representative  Gardner brought  up a  good                                                               
point and that ultimately, what  is envisioned is a mechanism, to                                                               
notify the  state for  the basis of  the termination  and provide                                                               
them with some  type of hearing.  She highlighted  that this is a                                                               
process that  benefits both parties  so that one cannot  be taken                                                               
advantage of.                                                                                                                   
                                                                                                                                
3:23:42 PM                                                                                                                    
                                                                                                                                
DR.  MANDSAGER  said that  the  [Division  of Public  Health]  is                                                               
looking for  ideas of how to  make this [registry] have  the best                                                               
value  at a  reasonable cost  and  accomplish all  of the  things                                                               
mentioned.                                                                                                                      
                                                                                                                                
REPRESENTATIVE   GARDNER   inquired    as   to   care   providers                                                               
participating in  the process [of  using the registry]  and asked                                                               
whom they should contact for more information.                                                                                  
                                                                                                                                
DR. MANDSAGER offered himself as a contact.                                                                                     
                                                                                                                                
3:24:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  opined that  there  should  be a  hearing                                                               
process  that defines  limitation on  liability for  the employer                                                               
and provides  information on past employees  [that have committed                                                               
offenses of some kind].  He  said that there may be difficulty in                                                               
the creation of a registry  if employers could face lawsuits from                                                               
past employees.                                                                                                                 
                                                                                                                                
3:26:22 PM                                                                                                                    
                                                                                                                                
MS. KRALY referred to HB 193 and said:                                                                                          
                                                                                                                                
     On  page 13,  section  47.32.170,  there's an  immunity                                                                    
     section, subparagraph C,  which addresses the liability                                                                    
     and the  criminal history check but  we should probably                                                                    
     look at that  with respect to the  abuse registries, as                                                                    
     well ... We  appreciate that comment, and  we'll take a                                                                    
     look at that.                                                                                                              
                                                                                                                                
REPRESENTATIVE  KOHRING inquired  as to  the description  of this                                                               
legislation as an "efficiency measure."                                                                                         
                                                                                                                                
DR. MANDSAGER  said that  he hopes that  as the  population grows                                                               
and more providers come online,  that the staff required to serve                                                               
will remain the same and demonstrate efficiencies over time.                                                                    
                                                                                                                                
3:28:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KOHRING inquired as  to Dr. Mandsager's perception                                                               
of  the  medical industry  in  terms  of streamlining  regulatory                                                               
processes.                                                                                                                      
                                                                                                                                
DR.   MANDSAGER  said   that   he  is   also   troubled  by   the                                                               
aforementioned     question     which     concerns     regulatory                                                               
simplifications in a heavily regulated industry.                                                                                
                                                                                                                                
REPRESENTATIVE MCGUIRE asked, "are  there any new categories that                                                               
did not previously require licensure?"                                                                                          
                                                                                                                                
DR.  MANDSAGER said  that one  of  the amendments  that is  being                                                               
worked  on  relates to  the  list  on page  2,  of  HB 193.    He                                                               
explained:                                                                                                                      
                                                                                                                                
     I  have  a concern  ...  as  the medical  industry  ...                                                                    
     evolves ...  and develops  more free  standing services                                                                    
     outside  of  hospitals, how  do  we  have a  list  that                                                                    
     includes some kind  of a statement that  there could be                                                                    
     developed a  checklist or  criteria against  which when                                                                    
     the risks  of a  population is  high enough,  that they                                                                    
     would  then be  brought into  a licensed  and regulated                                                                    
     environment  ... more  and  more  services are  leaving                                                                    
     hospitals and  going into stand alone  types of service                                                                    
     delivery.  At the other  end of the extreme ... there's                                                                    
     ... "supported living homes"  that aren't regulated ...                                                                    
     "assisted living home" starts  at [page] 25 and there's                                                                    
     a set of  criteria that are listed ...   if a person is                                                                    
     ... providing  housing and  food services  or assisting                                                                    
     with  activities of  daily living,  this would  ... say                                                                    
     that  you need  to be  licensed as  an assisted  living                                                                    
     home.  Right  now, there are ... places  out there that                                                                    
     are choosing not  to be licensed ... this  will try and                                                                    
     make it  more clear  what the break  point is  at which                                                                    
     you need  licensure or don't  ... the staff  would need                                                                    
     the background check, as minimum,  as this bill were to                                                                    
     go into place ...                                                                                                          
                                                                                                                                
3:32:26 PM                                                                                                                    
                                                                                                                                
DR. MANDSAGER said that the  Division of Public Health is working                                                               
on a series of amendments [for HB 193].                                                                                         
                                                                                                                                
REPRESENTATIVE  GARDNER inquired  as to  the issue  of employment                                                               
and  a record  of termination  [within the  registry].   She then                                                               
asked if [Alaskan Statute] "47.05.20" is part of HB 193.                                                                        
                                                                                                                                
MS.   KRALY  explained   that  the   first   statutory  cite   in                                                               
subparagraph  C  should be  "47.05.310"  and  then it  should  be                                                               
"47.05.320" and those  are the statutes of reference  on page 27,                                                               
of  HB 193.   Under  "Article 3"  of the  bill, the  new sections                                                               
under  "47.05", which  creates the  "Criminal History;  Registry"                                                               
process and how the background check can occur.                                                                                 
                                                                                                                                
3:36:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON mentioned  the testimony  from the  Alaska                                                               
State Hospital  and Nursing Home  Association, (ASHNHA),  and its                                                               
liability concerns.   He  inquired as  to what  has been  done to                                                               
prevent  liability  issues  and   if  these  concerns  have  been                                                               
addressed, overall.                                                                                                             
                                                                                                                                
DR. MANDSAGER  said, "  ... as  we envision  this in  statute, we                                                               
need  to make  sure  that  there are  steps  in  place either  in                                                               
statute  or  ...  in  regulation   to  make  it  clear  that  the                                                               
Department is  ready to do  such an  action ... you  can't expose                                                               
frail elderly  ... to risk,  before they're moved out  to another                                                               
facility  ... or  another provider  is brought  in to  manage the                                                               
facility."                                                                                                                      
                                                                                                                                
MS. KRALY  clarified that the  bill was  drafted in an  effort to                                                               
bring the 12  statutory provisions into one  umbrella process, in                                                               
an effort  to serve a wide  spectrum of entities.   Currently, if                                                               
there  is a  situation of  immediate risk  in a  nursing home,  a                                                               
temporary manager  must be  contacted to go  through a  series of                                                               
court processes, she  related.  When there is  an assisted living                                                               
home with an  individual at risk, she said,  the individual would                                                               
be removed  and the due-process  hearing would occur later.   She                                                               
clarified that  the instances that  ASHNA had mentioned  in their                                                               
letter  would be  dealt  with using  the  temporary manager,  and                                                               
court process,  because from a  legal and  management standpoint,                                                               
it would not be plausible to take over a large institution.                                                                     
                                                                                                                                
3:40:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  inquired  as  to  the  "taking  over"  of                                                               
smaller assisted living  homes if they are found to  be "at risk"                                                               
situations.                                                                                                                     
                                                                                                                                
MS. KRALY it  would all be laid out through  regulation, and more                                                               
often than not,  a resident would be removed before  a "home" was                                                               
"taken over."                                                                                                                   
                                                                                                                                
CHAIR  WILSON mentioned  the "Position  Paper on  House Bill  193                                                               
Offered by  Rod Betit, President  of ASHNHA," and inquired  as to                                                               
the Department addressing the concerns that were listed.                                                                        
                                                                                                                                
DR.  MANDSAGER  said  that  the  current  regulations  allow  for                                                               
gradation  within the  assisted living  situations.   The balance                                                               
point between a  nursing home and a "level 3"  in a pioneer home,                                                               
for example, is  the discussion point.  In light  of the function                                                               
pioneer  homes have,  he opined  that in  order to  continue that                                                               
level of  home-based, social service,  kind of care,  rather than                                                               
medical care, regulation opportunities will have to be created.                                                                 
                                                                                                                                
CHAIR  WILSON commented  on the  slow  physical deterioration  of                                                               
individuals  within   care  facilities  and  the   adaptation  of                                                               
different forms of care that evolve.                                                                                            
                                                                                                                                
DR.  MANDSAGER   stated  that  one  major   issue  concerns  fire                                                               
marshals.  In  a pioneer home, a fire marshal  would require that                                                               
people be able  to readily get out and if  someone had physically                                                               
deteriorated to  a certain  level [where  they could  not readily                                                               
get  out],  then  that  person  would have  to  move  to  another                                                               
facility.                                                                                                                       
                                                                                                                                
3:45:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  commented that  she  would  like to  stay                                                               
informed  as Dr.  Mandsager and  others make  more decisions  and                                                               
modifications on HB 193.                                                                                                        
                                                                                                                                
DR. MANDSAGER opined that in reality,  HB 193 is unlikely to pass                                                               
this legislative  session.  He  advocated for moving  through the                                                               
process, making modifications, hearing  concerns, and coming back                                                               
next year with a clearer version of HB 193.                                                                                     
                                                                                                                                
REPRESENTATIVE MCGUIRE  opined that, in many  instances, language                                                               
within HB 193 is unqualified.   She referred to page 14, line 22,                                                               
and  said  that  this  section   was  a  very  broad  "access  to                                                               
information" clause.  She encouraged  Dr. Mandsager to spend time                                                               
looking  at  HB 193  and  qualifying  sections that  are  lacking                                                               
specific information.                                                                                                           
                                                                                                                                
DR. MANDSAGER  explained that the advantage  of having introduced                                                               
the  bill is  it is  now public  and can  be inspected  from many                                                               
points of  view.   He said  he hopes that  there will  be meeting                                                               
over the summer  and fall and then,  HB 193 can be  acted on next                                                               
winter.                                                                                                                         
                                                                                                                                
MS. KRALY clarified:                                                                                                            
                                                                                                                                
     The genesis of  this section 1, which  is a centralized                                                                    
     licensing  and  related administrative  procedures,  99                                                                    
     percent of  that is  current law.   It's just  been cut                                                                    
     and  pasted   and  cleaned  up   ...  to   create  one,                                                                    
     centralized licensing statute.  If  you look at most of                                                                    
     it, it's  not pulled  out of  the pie  in the  sky type                                                                    
     thoughts,  we're currently  using these  statutes -  it                                                                    
     just pulls  it into  one ...  we took  the best  of the                                                                    
     best, we  felt and we  cleaned up the problems  that we                                                                    
     see  we've envisioned  in  enforcing  and advising  the                                                                    
     department  and created  this centralized  panel, there                                                                    
     are questions and  issues and we knew there  would be -                                                                    
     but just  so that's  clear, we tried  to take  what was                                                                    
     good and make it a little bit better.                                                                                      
                                                                                                                                
[HB 193 was held over.]                                                                                                         
                                                                                                                                
HB 185-POSTSECONDARY STUDENT IMMUNIZATION                                                                                     
                                                                                                                                
3:52:53 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE  BILL  NO.   185  "An  Act  relating   to  immunization  of                                                               
postsecondary  students  for  meningitis; and  providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
ERIC  DELAND, Staff  to Representative  Mike Chenault,  presented                                                               
the  sponsor statement  for HB  185 on  behalf of  Representative                                                               
Chenault.   He described how a  man in Alaska, age  nineteen, was                                                               
overcome  with  a meningococcal  disease  and  became brain  dead                                                               
within several hours of the onset  of symptoms.  He informed that                                                               
meningococcal  disease has  a 15  percent mortality  rate.   What                                                               
this bill  tries to do,  he related,  is remove the  exemption so                                                               
that post-secondary institutions  shall provide information about                                                               
viral and  bacterial meningococcal diseases  and their risk.   He                                                               
said that  the students shall  also sign a document  stating that                                                               
they have  received this information  and can have the  option of                                                               
immunization.   He emphasized  that there  is no  requirement for                                                               
immunization in  HB 185.   He  said that  the Center  for Disease                                                               
Control,  the American  Academy of  Physicians, and  the American                                                               
Academy of Pediatrics  recommend immunizations for post-secondary                                                               
students.                                                                                                                       
                                                                                                                                
CHAIR WILSON commented  that immunization requirements concerning                                                               
meningococcal disease are required for  some groups of people but                                                               
that there are  known exemptions.  She  offered religious beliefs                                                               
as an example of an exemption.                                                                                                  
                                                                                                                                
MR.  DELAND explained  that the  passage  of HB  185 will  enable                                                               
post-secondary    students   to    receive   information    about                                                               
meningococcal  disease.   He  said  that post-secondary  students                                                               
live in  high-risk environments for  the spread  of meningococcal                                                               
disease                                                                                                                         
                                                                                                                                
CHAIR  WILSON   clarified  that   this  bill  does   not  require                                                               
immunization of students.                                                                                                       
                                                                                                                                
MR.  DELAND stated  that it  requires  post-secondary schools  to                                                               
provide  information  pertaining  to  meningococcal  disease  and                                                               
information about immunization.                                                                                                 
                                                                                                                                
REPRESENTATIVE  GARDNER  asked  if  there are  various  types  of                                                               
meningococcal disease.                                                                                                          
                                                                                                                                
MR.  DELAND  said that  meningococcal  disease  can be  viral  or                                                               
bacterial.  He informed that there are many different strains.                                                                  
                                                                                                                                
REPRESENTATIVE GARDNER  inquired as  to the effectiveness  of the                                                               
immunization for all of the types of meningococcal disease.                                                                     
                                                                                                                                
MR. DELAND stated that the  immunization is effective, regardless                                                               
of the strain of meningococcal disease.                                                                                         
                                                                                                                                
REPRESENTATIVE KOHRING  inquired as  to the necessity  of passing                                                               
HB  185 and  creating statute  around this  issue.   He asked  if                                                               
schools are informed about meningococcal disease.                                                                               
                                                                                                                                
MR.  DELAND  said  that  most  schools  around  the  country  are                                                               
requiring immunizations but it is not required in Alaska.                                                                       
                                                                                                                                
REPRESENTATIVE  KOHRING  asked if  schools  in  Alaska know  that                                                               
meningococcal disease is a problem.                                                                                             
                                                                                                                                
MR. DELAND  opined that schools should  know [about meningococcal                                                               
disease]  and the  purpose  of  HB 185  is  to provide  necessary                                                               
information  so  that  students can  make  a  decision  regarding                                                               
immunization.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  KOHRING  inquired  as   to  the  distribution  of                                                               
letters  to  schools as  an  attempt  to  inform, as  opposed  to                                                               
creating legislation.                                                                                                           
                                                                                                                                
MR. DELAND  clarified that  HB 185  is related  to post-secondary                                                               
schools.                                                                                                                        
                                                                                                                                
REPRESENTATIVE KOHRING  offered that  the letters  be distributed                                                               
to  post-secondary  schools.   He  expressed  his uncertainty  of                                                               
creating a bill to inform students of a disease.                                                                                
                                                                                                                                
MR.   DELAND  restated   that   not   all  institutions   provide                                                               
information on meningococcal disease.                                                                                           
                                                                                                                                
REPRESENTATIVE KOHRING  inquired as  to the cost  associated with                                                               
the distribution of information.                                                                                                
                                                                                                                                
MR. DELAND explained  that there is a [health]  packet handed out                                                               
to new  students at post-secondary  schools and  this information                                                               
would be included in that packet.                                                                                               
                                                                                                                                
3:59:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCGUIRE said,  "We're requiring  that information                                                               
be given but we're not requiring immunization?"                                                                                 
                                                                                                                                
MR. DELAND said that is correct.                                                                                                
                                                                                                                                
REPRESENTATIVE MCGUIRE asked why immunization is not required.                                                                  
                                                                                                                                
MR. DELAND said that the reasons  are similar to those brought up                                                               
by Chair  Wilson.  He  described the issues  concerning religious                                                               
beliefs, and  opined that each  individual should make  their own                                                               
decisions [to immunize].                                                                                                        
                                                                                                                                
REPRESENTATIVE   MCGUIRE  related   that,   in  her   experience,                                                               
immunizations were required when attending school.                                                                              
                                                                                                                                
CHAIR  WILSON clarified  that there  are other  exemptions.   She                                                               
commented  that some  people don't  believe  in immunizing  their                                                               
children, and  that, based  on her experience  as a  school nurse                                                               
for many years,  there are many reasons why people  choose not to                                                               
be immunized.                                                                                                                   
                                                                                                                                
4:00:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE inquired  as to the number  of states that                                                               
require immunization [of meningococcal disease].                                                                                
                                                                                                                                
RICHARD  MANDSAGER, M.D.,  Director, Division  of Public  Health,                                                               
Department of Health  and Social Services, stated  that there are                                                               
two  varieties of  meningococcal vaccine  for this  organism, for                                                               
Neiserria meningitidis.   He explained  that this is the  kind of                                                               
meningitis that makes people fearful.  He said:                                                                                 
                                                                                                                                
     somebody gets  sick with flu  symptoms and can  be dead                                                                    
     in a few hours.  Thankfully,  it's very rare.  There is                                                                    
     a  small, increased  risk if  you are  a freshman  in a                                                                    
     college dorm or  in the military, and  that's where the                                                                    
     epidemics back ... during  WWII, were first recognized.                                                                    
     A couple things have  changed this winter, the American                                                                    
     Council on  Infectious Practices  has just  changed its                                                                    
     recommendations   about  the   vaccine  for   Neiserria                                                                    
     meningitidis  ...  and  is  now  recommending,  because                                                                    
     there is a new vaccine  available this winter, that all                                                                    
     people  ... get  it ...  within  a few  years, this  is                                                                    
     going  to be  common  practice for  most kids  entering                                                                    
     post-secondary   institutions   ...  colleges   already                                                                    
     include  it   in  their  information  ...   we  in  the                                                                    
     [Department of  Health and Social Services]  are fairly                                                                    
     neutral  on this  bill  for some  of  the reasons  that                                                                    
     Representative Kohring just stated  ... there's a small                                                                    
     number  of post-graduate  colleges  in  this state  and                                                                    
     couldn't  we persuade  them to  voluntarily include  [a                                                                    
     letter]  rather than  have a  statute,  given the  fact                                                                    
     that immunization  practices over the next  five years,                                                                    
     most  kids, by  the time  they go  off to  college, are                                                                    
     going  to  be immunized  already  with  a new  vaccine.                                                                    
     Your  question is  specifically  how  many states  have                                                                    
     requirements for  either information or  vaccination or                                                                    
     nothing,  most  have moved  to  ...   either  requiring                                                                    
     information  or requiring  immunization  and there's  a                                                                    
     mixture  across the  country but  it's going  to change                                                                    
     fairly  quickly now  with  the  change in  immunization                                                                    
     practices.   We are a universal  immunization state and                                                                    
     we don't  have to include  this vaccine because  of the                                                                    
     vaccine for  kids which is  the federal program  ... as                                                                    
     long as  we remain  a universal  vaccine state,  all of                                                                    
     our kids  in this state  will be offered, and  the only                                                                    
     kids that won't be immunized  will be the families that                                                                    
     choose not  to get vaccinated,  but it will  get joined                                                                    
     into the  requirement for  school attendance  over this                                                                    
     next  year ...  I  recognize the  ...  interest in  the                                                                    
     bill, but  the timing  is interesting given  the change                                                                    
     in vaccine as to how  necessary it is, given it's going                                                                    
     to happen, anyhow.                                                                                                         
                                                                                                                                
4:04:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCGUIRE   expressed  her  belief  that   if  [the                                                               
legislature]  makes   a  fundamental  policy  shift   to  require                                                               
immunizations,  then  that  should  be  the  law  created.    She                                                               
inquired as  to the  requirements of  immunizations at  the local                                                               
level for students, before entering school.                                                                                     
                                                                                                                                
DR. MANDSAGER said that over this  next year, because Alaska is a                                                               
"universal  vaccine state",  the  Department will  be putting  up                                                               
proposed  regulations that  [meningococcal disease  vaccine] will                                                               
get added to the schools for  students in grades K-12.  He opined                                                               
that  over  the  next  six   months  the  [meningococcal  disease                                                               
vaccine] will be  added in; the [Department of  Health and Social                                                               
Services] will  have to  put out  regulations proposing  to amend                                                               
the mandatory vaccine policies for  schools and, if that happens,                                                               
over the  next few years  all of the  teenagers are going  to get                                                               
vaccinated.                                                                                                                     
                                                                                                                                
REPRESENTATIVE MCGUIRE clarified  that the [meningococcal disease                                                               
vaccine] will be a requirement for students in grades K-12.                                                                     
                                                                                                                                
REPRESENTATIVE SEATON stated that  HB 185 deals specifically with                                                               
post-secondary  students.   He asked  if regulations  proposed by                                                               
the state will apply for post-secondary schools.                                                                                
                                                                                                                                
DR. MANDSAGER  said that the  state has no authority  to regulate                                                               
immunization in post-secondary schools.                                                                                         
                                                                                                                                
REPRESENTATIVE GARDNER  inquired as to the  document mentioned in                                                               
HB 185 where the student's  immunization status is recorded.  She                                                               
asked how long this document would be kept and by whom.                                                                         
                                                                                                                                
MR.  DELAND  said that  the  document  would  be kept  while  the                                                               
student was attending that institution, by the institution.                                                                     
                                                                                                                                
4:07:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE  moved to report  HB 185 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.                                                                                                                          
                                                                                                                                
REPRESENTATIVE  GARDNER objected.   She  said that  if this  bill                                                               
were to pass,  she anticipates repealing it  when regulations are                                                               
revised.   She said that  she is not in  favor of passing  a bill                                                               
that may not be needed.                                                                                                         
                                                                                                                                
CHAIR  WILSON  reminded  Representative   Gardner  that  the  new                                                               
regulations would  apply to  grades K-12, and  HB 185  is dealing                                                               
with post-secondary schools.                                                                                                    
                                                                                                                                
A roll call  vote was taken.   Representatives Anderson, McGuire,                                                               
Seaton, Cissna,  and Wilson  voted in favor  of reporting  HB 185                                                               
out  of  committee.   Representative  Gardner  voted against  it.                                                               
Representative Kohring  was absent for  the vote.   Therefore, HB
185  was reported  from the  House Health,  Education and  Social                                                               
Services Standing Committee by a vote of 5-1.                                                                                   
                                                                                                                                
4:09:52 PM                                                                                                                    
                                                                                                                                
HB 156-COMMISSION ON AGING                                                                                                    
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 156  "An Act  relating to  the membership  of the                                                               
Alaska  Commission  on  Aging; and  providing  for  an  effective                                                               
date."                                                                                                                          
                                                                                                                                
BARBARA COTTING,  Staff to Representative Jim  Holm, presented HB
156 on behalf of Representative  Holm.  She explained that within                                                               
the committee packet, the  sponsor statement, sectional analysis,                                                               
and  her  comments  are addressed  to  the  committee  substitute                                                               
because the original bill had suggested changes.                                                                                
                                                                                                                                
4:11:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to adopt  the  proposed  committee                                                               
substitute  (CS)  for  HB   156,  Version  24-LS0615\F,  Mischel,                                                               
3/2/05, as  a work draft.   There  being no objection,  Version F                                                               
was adopted.                                                                                                                    
                                                                                                                                
MS. COTTING explained that in  2003, Governor Murkowski issued an                                                               
executive order that transferred  the Alaska Commission on Aging,                                                               
(ACoA), from  the Department of Administration  to the Department                                                               
of  Health   and  Social  Services.     In  2004,   she  related,                                                               
Representative Holm sponsored  HB 394 which put  that change into                                                               
statute; it  also changed  the "sunset" date  from 2004  to 2008.                                                               
She  said that  HB  156 makes  a change  in  compliance with  the                                                               
wishes of  the ACoA.  She  pointed out that at  the ACoA February                                                               
2005 quarterly meeting, what was  requested was that a vacancy be                                                               
filled  by a  senior services  provider, regardless  of age,  and                                                               
that the  provider be  a recipient  of a  division of  senior and                                                               
disabilities grant  under the  senior grant  program.   She added                                                               
that  the ACoA  felt strongly  that the  expertise that  would be                                                               
provided would be a good thing  for the ACoA.  She requested that                                                               
the committee insert  the phrase, "regardless of age"  in HB 156,                                                               
on page 1, line 11, after "senior services provider."                                                                           
                                                                                                                                
REPRESENTATIVE GARDNER  inquired as to  who would be  included in                                                               
the pool of "grant recipients" mentioned.                                                                                       
                                                                                                                                
4:14:13 PM                                                                                                                    
                                                                                                                                
LINDA GOHL, executive director,  Alaska Commission on Aging, said                                                               
there's a  variety of  services under  the senior  grant program,                                                               
including  nutrition,  transportation support  services,  in-home                                                               
services for  home and community  based care, chore  respite, and                                                               
Alzheimer's support services.                                                                                                   
                                                                                                                                
REPRESENTATIVE  GARDNER asked  if the  people who  administer the                                                               
aforementioned programs obtain the grants.                                                                                      
                                                                                                                                
MS. GOHL said  grant recipients could be  project coordinators or                                                               
a board  member for  a non-profit  organization; they  are people                                                               
providing direct  services as part  of an agency.   She explained                                                               
that the ACoA  was asked, prior to the meeting,  to consider this                                                               
seat  being  a  provider  seat  and  they  thought  it  would  be                                                               
beneficial  to  the  community,  as well  as  to  the  providers,                                                               
beneficiaries, and stakeholders.                                                                                                
                                                                                                                                
4:15:53 PM                                                                                                                    
                                                                                                                                
STEVE  ASHMAN,  Director,  Division   of  Senior  and  Disability                                                               
Services, said that under statute,  the recipients of grants have                                                               
to  be   a  501(c)3,  a   municipal  government,  or   a  "tribal                                                               
government."                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER inquired as to the "ethics act."                                                                         
                                                                                                                                
MS.  GOHL  said  that  the  ACoA is  no  longer  receiving  grant                                                               
proposals, reviewing grant  proposals, making recommendations for                                                               
grant  awards,  nor  involved  in  any way  in  the  grant  award                                                               
process.                                                                                                                        
                                                                                                                                
REPRESENTATIVE  GARDNER  clarified  that there  aren't  conflicts                                                               
with grant recipients.                                                                                                          
                                                                                                                                
MS. GOHL said that is correct.  She continued:                                                                                  
                                                                                                                                
     The   Department  has   essentially  taken   over  that                                                                    
     function, within the Division  of Senior and Disability                                                                    
     Services  and  the  centralized  grants  and  contracts                                                                    
     administration unit, and then  the Commissioner [of the                                                                    
     Department] or his designee is  the only individual who                                                                    
     is actually signing  grant awards ... there  could be a                                                                    
     potential  conflict ...  when the  [ACoA] works  on the                                                                    
     state plan  of services that  has to be  produced every                                                                    
     two  to  three  years  and  submitted  to  the  federal                                                                    
     government in  order to receive continuing  funds under                                                                    
     the  Older  Americans Act,  we  have  to do  a  formula                                                                    
     allocation  which is  a geographic  allocation for  how                                                                    
     the  grant awards  will be  distributed throughout  the                                                                    
     state and  there's different criteria and  elements and                                                                    
     factors that make  up this chart of how  the awards and                                                                    
     the total funds  will be allocated, and  there could be                                                                    
     a potential conflict  if this provider were  in an area                                                                    
     that was  going to see  a loss,  perhaps, or a  gain in                                                                    
     funding  in their  geographic area  ... the  commission                                                                    
     discussed any  potential ... conflicts of  interest ...                                                                    
     and they decided during the  February meeting that they                                                                    
     would ask the individual to refrain from voting.                                                                           
                                                                                                                                
4:19:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER moved to adopt Amendment 1, as follows:                                                                  
                                                                                                                                
     Page 1, line 11, following "senior services provider"                                                                      
     Insert "regardless of age"                                                                                                 
                                                                                                                                
There being no objection, it was so ordered.                                                                                    
                                                                                                                                
REPRESENTATIVE KOHRING moved to report  CSHB 156, as amended, out                                                               
of   committee   with    individual   recommendations   and   the                                                               
accompanying  fiscal  notes.   There  being  no  objection,  CSHB
156(HES)  was  reported  from the  House  Health,  Education  and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
HB 151-RESPONSIBILITY FOR CARE AFTER EYE SURGERY                                                                              
                                                                                                                                
CHAIR WILSON announced that the next order of business would be                                                                 
HOUSE BILL  NO. 151 "An  Act relating to  provider responsibility                                                               
for  ocular postoperative  care; and  providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
4:21:38 PM                                                                                                                    
                                                                                                                                
WAYNE HAGERMAN,  O.D., explained that  he has been  practicing as                                                               
a private  optometrist in  Sitka, Alaska since  1984.   He stated                                                               
his opposition  to HB  151 and  that it  will have  a detrimental                                                               
effect to the community of Sitka.   In Sitka, he described, there                                                               
is a community  hospital and a visiting  ophthalmologist that has                                                               
provided service since 1997 and  provides cataract surgery to the                                                               
community members.   He  said that  the ophthalmologist,  Dr. Tim                                                               
Gard, is  from the Hillsboro  Eye clinic  in Oregon.   He pointed                                                               
out that [Dr. Gard] has  provided these services to the community                                                               
hospital as  a benefit  to the  community, especially  the senior                                                               
citizens  who  are  unable  to travel  elsewhere  to  have  these                                                               
surgical  procedures attended  to.   He  emphasized  that he  has                                                               
worked  closely with  Dr.  Gard for  seven  years and  co-managed                                                               
these  patients without  difficulty.   He  opined  that it  would                                                               
cause undue hardship for Dr. Gard  to have to remain in Sitka for                                                               
five days  following eye surgery  and wishes the  committee would                                                               
reconsider the passing of HB 151.                                                                                               
                                                                                                                                
4:23:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  inquired as  to Dr.  Hagerman's position                                                               
if  the bill  were amended  to require  a two-day  stay following                                                               
post-operative  surgery,  as  opposed to  the  original  five-day                                                               
stay.                                                                                                                           
                                                                                                                                
DR. HAGERMAN stated that there  is not a resident ophthalmologist                                                               
in Sitka so there is no  possibility to refer patients to another                                                               
surgeon.  He said that the 48-hour change is amenable.                                                                          
                                                                                                                                
REPRESENTATIVE ANDERSON  asked if Dr. Hagerman  preferred the two                                                               
day  amendment  as opposed  to  the  5  day stay  [following  eye                                                               
surgery].                                                                                                                       
                                                                                                                                
DR. HAGERMAN  said that  he preferred  a two-day  requirement but                                                               
that a  24-hour requirement would  be more than adequate  [for an                                                               
ophthalmologist to stay in the area following eye surgery].                                                                     
                                                                                                                                
REPRESENTATIVE GARDNER  inquired as to patients  in Sitka needing                                                               
the services of an ophthalmologist when one was not available.                                                                  
                                                                                                                                
DR. HAGERMAN said that there  is an understanding between himself                                                               
and  the ophthalmologist  that when  there  is some  complication                                                               
that goes  beyond the  level of  expertise [of  the optometrist],                                                               
the visiting ophthalmologist would stay and deal with it.                                                                       
                                                                                                                                
REPRESENTATIVE   GARDNER  asked   what   would   happen  if   the                                                               
complication arose after the ophthalmologist left [Sitka].                                                                      
                                                                                                                                
DR.  HAGERMAN  stated that  he  and  the ophthalmologist  are  in                                                               
constant  communication   about  the  follow-up  care   of  these                                                               
patients and the situation described has not yet arisen.                                                                        
                                                                                                                                
REPRESENTATIVE SEATON inquired as  to the practicality of setting                                                               
the   two-day  [ophthalmologist]   stay  requirement   after  eye                                                               
surgery.  He  asked Dr. Hagerman what his  opinion was concerning                                                               
this stay requirement.                                                                                                          
                                                                                                                                
DR. HAGERMAN said that generally, it  is within a day or two days                                                               
after the surgery.                                                                                                              
                                                                                                                                
4:26:17 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON stated that HB 151  has been difficult [for her] and                                                               
that she has been indecisive.   She explained that she called Dr.                                                               
Gard [the  ophthalmologist serving  Sitka] and learned  that many                                                               
of his  patients are residents of  the pioneer home and  would be                                                               
unable to  leave [Sitka]  for surgical  procedures.   She related                                                               
that Dr. Gard informs his patients  that they will have to fly to                                                               
Seattle if  there are complications  after he leaves Sitka.   She                                                               
reported that Dr.  Gard said that he could deal  with the two-day                                                               
stay requirement  after surgery,  and that  he would  still serve                                                               
Sitka's  needs.    She  stated  that  Dr.  Gard  had  a  question                                                               
concerning the stay requirement and  it extending to the patient.                                                               
She  said that  he asked  if  the legislation  would require  the                                                               
patient to stay two extra  days after surgery, because many times                                                               
they do not.                                                                                                                    
                                                                                                                                
REPRESENTATIVE   ANDERSON   interjected   that   there   are   no                                                               
requirements related  to the  patient staying  in the  area where                                                               
the surgery occurred.                                                                                                           
                                                                                                                                
CHAIR WILSON explained that Dr. Gard  had said that many times he                                                               
has stayed  to make sure  that every  patient was taken  care of.                                                               
She said  that she had asked  if there was any  time when someone                                                               
had to  fly to Seattle  [for emergency  care] and [Dr.  Gard] had                                                               
said, "No, that  has never happened."  She opined  that the 5-day                                                               
requirement [for  the ophthalmologist to  stay in the  area where                                                               
surgery occurred] is  too much.  She mentioned a  letter from the                                                               
Medical  Association which  promoted the  5-day stay  requirement                                                               
for ophthalmologists, but acquiesced to the 2-day amendment.                                                                    
                                                                                                                                
REPRESENTATIVE  ANDERSON stated  that in  the packet,  the Alaska                                                               
State Medical  Association sent a  letter on March 4,  2005 which                                                               
stated that they  represent physicians across the  state and they                                                               
support HB 151.  He said  that they didn't reference the 2 versus                                                               
5 days  [stay requirement] and  there may be a  discrepancy about                                                               
which association is being discussed.                                                                                           
                                                                                                                                
The committee took an at-ease from 4:30:32 PM to 4:30:55 PM.                                                                    
                                                                                                                                
4:30:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ANDERSON   clarified  that  a  letter   from  the                                                               
American Academy  of Ophthalmology,  dated March 15,  2005 stated                                                               
support of HB 151.  He  explained that this letter was an attempt                                                               
to  indicate  the  areas of  concern  regarding  common  surgical                                                               
complications and they  reference that within the  first 48 hours                                                               
certain complications can occur.                                                                                                
                                                                                                                                
CHAIR  responded that  Dr. Gard  teaches future  ophthalmologists                                                               
and  optometrists  and  he  said that  his  concerns  [for  post-                                                               
operative care] included increased pressure or infection.                                                                       
                                                                                                                                
REPRESENTATIVE  SEATON  stated  that   in  the  letter  from  the                                                               
American Academy  of Ophthalmology, the listed  complications are                                                               
those that  can occur in the  first 48 hours [after  surgery] but                                                               
it is  not clear that  they support the 48-hour  stay requirement                                                               
as opposed to the original 5-day stay requirement.                                                                              
                                                                                                                                
4:33:15 PM                                                                                                                    
                                                                                                                                
CARL  ROSEN, M.D.,  clarified  that 48  hours  will cover  common                                                               
complications  and 5  days  is  preferred as  it  will cover  all                                                               
aspects  of  possible  patient complications  after  cataract  or                                                               
interocular surgery.   He stated that, "two days,  if that's what                                                               
it takes  to get improved  patient quality  of care, then  we can                                                               
accept that."                                                                                                                   
                                                                                                                                
CHAIR WILSON stated that if there  is no amendment there could be                                                               
the  risk  of  ophthalmologists refraining  from  serving  remote                                                               
areas within Alaska.                                                                                                            
                                                                                                                                
REPRESENTATIVE ANDERSON  noted that the letter  from the American                                                               
Academy of  Ophthalmology states,  "The enactment  of HB  151 ...                                                               
will insure that patients have access  to a surgeon within the 48                                                               
hour window  in which  the complications  from eye  surgery could                                                               
occur."                                                                                                                         
                                                                                                                                
REPRESENTATIVE SEATON said  that as he reads the  letter, it does                                                               
not say that  they are revising their recommendation  from 5 days                                                               
to  48 hours.   He  pointed out  that the  letter is  saying that                                                               
certain complications can occur within 48 hours.                                                                                
                                                                                                                                
4:35:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ANDERSON  stated  that the  American  Academy  of                                                               
Ophthalmology  encompasses  all  of the  medical  physicians  who                                                               
practice  ophthalmology and  they recommend  [the ophthalmologist                                                               
to remain after surgery] 5 days.   He said that the House Health,                                                               
Education  and Social  Services  Standing  Committee prefers  the                                                               
amended 2 day stay requirement.                                                                                                 
                                                                                                                                
CHAIR WILSON  said that  it is obvious  that American  Academy of                                                               
Ophthalmology is aware of the  amendment and that they endorse HB
151 with the 2-day amendment.                                                                                                   
                                                                                                                                
4:36:32 PM                                                                                                                    
                                                                                                                                
ERIC CHRISTIANSON, O.D., said that  he has been an optometrist in                                                               
Ketchikan   since  1990,   and   there  is   not   a  full   time                                                               
ophthalmologist.   He  explained that  there is  an ophthalmology                                                               
group that  rotates through Ketchikan  one week a month  and they                                                               
perform surgeries.   He  mentioned that since  1990, he  has been                                                               
involved  with 3  or 4  eye  care emergencies  and most  occurred                                                               
within a  few days  after surgery.   He  said that  in Ketchikan,                                                               
older  surgical techniques  are used  and the  results aren't  as                                                               
good.  He said that he refers his patients to Seattle.  He said:                                                                
                                                                                                                                
     When I refer  to a surgeon, I am counting  on the skill                                                                    
     of the surgeon  and the ability of  his particular team                                                                    
     that he  has put together  to take care of  the patient                                                                    
     ... the  outcomes of surgery  are much better  when you                                                                    
     have a team and that  includes the surgeon, but it also                                                                    
     includes  the  other  staff   members  in  the  office,                                                                    
     including  optometrists  to   manage  the  patient  and                                                                    
     return  them at  an appropriate  time.   The opposition                                                                    
     that  I  have  to  this bill  is  ...  the  legislature                                                                    
     shouldn't  be regulating  comanagement.   It should  be                                                                    
     regulated by the boards.  I  was a board member ... for                                                                    
     eight years  ... I have  never heard one peep  from the                                                                    
     Medical Board regarding  any problems with comanagement                                                                    
     with optometrists ...                                                                                                      
                                                                                                                                
4:39:54 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  stated that she  called the Medical Board  and they                                                               
don't  meet until  next  month.   She  said  that she  considered                                                               
holding this  bill until next month  to give the Medical  Board a                                                               
chance to respond to the issues related to HB 151.                                                                              
                                                                                                                                
DR. CHRISTIANSON stated  that his concern is that  passing HB 151                                                               
is opening  a "huge  can of  worms."  He  said that  passing this                                                               
legislation would  affect comanagement  decisions of  health care                                                               
professionals  in rural  communities.   He  emphasized that  when                                                               
referring for surgery, health care  providers are counting on the                                                               
clinical judgment of the surgeon that is being referred to.                                                                     
                                                                                                                                
REPRESENTATIVE GARDNER  asked how  long patients stay  in Seattle                                                               
after their surgery is complete.                                                                                                
                                                                                                                                
DR. CHRISTIANSON  said that,  typically, a  patient will  see the                                                               
surgeon,  have the  surgery completed,  and see  the surgeon  the                                                               
following  day.   Depending on  the  procedure, if  a patient  is                                                               
stable enough  there is no  reason for them  to stay longer.   He                                                               
related that  he then  sees the  patient for a  follow up  7 days                                                               
after the  surgery.  He  pointed out that his  responsibility for                                                               
the  patient  occurs  as  soon  as they  are  released  from  the                                                               
surgical facility.                                                                                                              
                                                                                                                                
REPRESENTATIVE GARDNER asked if it  was accurate to say, assuming                                                               
there are no problems, that after  a patient has surgery they are                                                               
seen by the surgeon the following day and then can return home.                                                                 
                                                                                                                                
DR. CHRISTIANSON replied that is correct.                                                                                       
                                                                                                                                
4:42:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  stated that he  has had a problem  with HB
151 in that there  is a "board process."  He  said that with [Dr.                                                               
Christianson's]  testimony, as  the  Chair of  the State  Medical                                                               
Board, it  is clear  that this  issue has  not been  addressed by                                                               
ophthalmologists.                                                                                                               
                                                                                                                                
DR. CHRISTIANSON  clarified that he  is a part of  the "Optometry                                                               
Board."                                                                                                                         
                                                                                                                                
REPRESENTATIVE SEATON said  that the HESS committee  is trying to                                                               
get information from  the State Medical Board  because the issues                                                               
surrounding  HB  151  are  within  the  Board's  jurisdiction  to                                                               
regulate.    He pointed  out  that  there  is no  information  on                                                               
ophthalmologists appealing to the State  Medical Board and asking                                                               
for  assistance with  this  issue.   He added  that  he has  real                                                               
concern about legislating particular  medical procedures in place                                                               
of the State Medical Board.                                                                                                     
                                                                                                                                
4:44:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE referred to HB 151 and said:                                                                             
                                                                                                                                
     on page 2, line 13 ...  my understanding is that if the                                                                    
     distance  the  patient  would have  to  travel  to  the                                                                    
     regular office  of the  operating surgeon  would result                                                                    
     in an  unreasonable hardship of  the patient ...  it is                                                                    
     an exception.                                                                                                              
                                                                                                                                
DR.  CHRISTIANSON  pointed  out  that   HB  151  states  that  co                                                               
management  agreements  may  occur  only when  the  patient  must                                                               
endure  an  unreasonable  hardship  to travel  to  the  operating                                                               
surgeon.                                                                                                                        
                                                                                                                                
REPRESENTATIVE MCGUIRE  said that in  many places in  Alaska, the                                                               
situation of  "unreasonable hardship" would apply.   She inquired                                                               
as to medical malpractice insurance requirements.                                                                               
                                                                                                                                
DR.  CHRISTIANSON   replied  that   he  carries  $3   million  in                                                               
malpractice insurance.                                                                                                          
                                                                                                                                
REPRESENTATIVE MCGUIRE inquired as to the amount of malpractice                                                                 
insurance that the ophthalmologist that Dr. Christianson works                                                                  
with carries.                                                                                                                   
                                                                                                                                
DR. CHRISTIANSON clarified that he does not work with the                                                                       
ophthalmologist; he refers patients to an ophthalmologist.  He                                                                  
said that there is no financial connection.                                                                                     
                                                                                                                                
4:47:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE said:                                                                                                    
                                                                                                                                
     please  understand that  the  sponsor's intentions  are                                                                    
     not to be disrespectful to you,  nor are mine ... I got                                                                    
     a couple  of emails that said  ... I was saying  that I                                                                    
     didn't think optometrists  were valuable, or important,                                                                    
     or professionals and that's  just the absolute opposite                                                                    
     of how  I feel.   I think  that ... your  profession is                                                                    
     extremely  important, valuable,  that the  patient care                                                                    
     is great -  I have an optometrist, I need  them, I have                                                                    
     terrible eyes - so, I just  want to get that on record,                                                                    
     but  back to  the medical  malpractice insurance,  when                                                                    
     you enter into these  comanagement agreements, is there                                                                    
     a direct shift in liability  that occurs ... one of the                                                                    
     things ...  I have a  concern about is, when  things go                                                                    
     well they go  well, and then when they  don't, with the                                                                    
     eyes, it's  a disaster ...  the surgeon comes  in, does                                                                    
     the surgery,  gets on a  plane, leaves, and  now you're                                                                    
     there and  you are dealing  with ... a problem  on your                                                                    
     hands.    In the  co-management  agreement  ... is  the                                                                    
     liability for  medical malpractice then shifted  to you                                                                    
     for the primary act of the surgeon ...                                                                                     
                                                                                                                                
4:48:44 PM                                                                                                                    
                                                                                                                                
DR. CHRISTIANSON stated that he is not well versed in medical                                                                   
malpractice.                                                                                                                    
                                                                                                                                
DR. ROSEN said that malpractice is shared, but the primary                                                                      
responsibility ultimately falls on the surgeon's hands.                                                                         
                                                                                                                                
4:49:34 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON inquired as to when co management occurs.                                                                          
                                                                                                                                
DR.  CHRISTIANSON said  that  he refers  patients  to a  specific                                                               
surgeon after he has diagnosed them.   He said that patients like                                                               
to get back  within a reasonable time frame to  avoid high travel                                                               
costs.   He emphasized that he  trusts the surgeon to  return the                                                               
patient at a time when they feel it is appropriate.                                                                             
                                                                                                                                
CHAIR WILSON  clarified that patients  usually return  home, from                                                               
Seattle, by the second day after surgery.                                                                                       
                                                                                                                                
DR. CHRISTIANSON said  that is correct except if  they have other                                                               
plans in Seattle, as well.                                                                                                      
                                                                                                                                
REPRESENTATIVE ANDERSON  stated his  belief that this  bill isn't                                                               
about comanagement  as much  as it is  about the  surgeon staying                                                               
for  two  days  after  surgery   is  performed.    He  reiterated                                                               
Representative  McGuire's comment  that the  distance an  Alaskan                                                               
patient  would  have  to  travel  for  surgery  would  constitute                                                               
"hardship" and asked for a comment regarding this.                                                                              
                                                                                                                                
DR. CHRISTIANSON  stated that decisions  related to  patient care                                                               
are for  the surgeon to  decide.   He emphasized that  the Alaska                                                               
State Medical Board  should decide if regulations  are needed for                                                               
specific situations  regarding patient  care and management.   He                                                               
opined that regulating patient care  is not up to the legislature                                                               
to  mandate.    He  said  that  attempting  to  pass  HB  151  is                                                               
"precedent setting" legislation.                                                                                                
                                                                                                                                
4:53:02 PM                                                                                                                    
                                                                                                                                
DR.  WILLY   SHIELDS,  ophthalmologist,  informed  that   he  has                                                               
specialty training in retina care.   He said that he has patients                                                               
referred to  him from optometrists and  from ophthalmologists and                                                               
that though the bulk of his  patients are referred from the state                                                               
of Washington, there are some patients  who come from Alaska.  He                                                               
said  that, as  a result,  he  is affected  by the  co-management                                                               
relationship.  He continued:                                                                                                    
                                                                                                                                
     I certainly  have my opinions  about how  co management                                                                    
     can work  ... when  I think about  the state  of Alaska                                                                    
     and how things are spread  out ... I, personally, think                                                                    
     that it's  going to be  very difficult to take  care of                                                                    
     patients  in  the larger  sense  without  having a  co-                                                                    
     management  system.    The  problem  that  I  see  that                                                                    
     surfaces  when there  is an  attempt to  have rules  or                                                                    
     regulations about co management,  obviously you want to                                                                    
     make  sure that  there is  a certain  level of  quality                                                                    
     that  is  adhered   to,  and  I  think   that  that  is                                                                    
     fundamentally      our      responsibility      whether                                                                    
     ophthalmologists   or  optometrists,   but  the   major                                                                    
     problem  ...  is ...  it  is  difficult  to set  up  co                                                                    
     management  ... rules  that forgive  ... co  management                                                                    
     relationships  between rural  settings ...  and ...  co                                                                    
     management  in  a  kind  of urban  ...  setting.    The                                                                    
     challenge is ,  how do you say that it  is okay to have                                                                    
     co management  in one  setting and not  the other.   As                                                                    
     Dr.  Christianson  has said  ...  if  there is  a  good                                                                    
     relationship  and I  know that  kind of  care that  the                                                                    
     optometrist can  provide in their  community then  I am                                                                    
     perfectly okay with the patient going back.                                                                                
                                                                                                                                
CHAIR WILSON inquired  as to Dr. Shields' opinion  on the two-day                                                               
stay requirement issue related to HB 151.                                                                                       
                                                                                                                                
DR.  SHIELDS related  that there  are times  when a  patient will                                                               
undergo  surgery, and  return home  the following  day.   He said                                                               
that,  depending  on the  patient  and  the situation,  the  time                                                               
frames change.  He added  that there are instances where patients                                                               
would be advised to abstain  from travel because of complications                                                               
with healing process.                                                                                                           
                                                                                                                                
REPRESENTATIVE MCGUIRE reminded Dr.  Shields that HB 151 pertains                                                               
to  surgeons performing  eye surgery  in Alaska.   She  explained                                                               
that it  is not  uncommon for the  legislature to  make different                                                               
rules  pertaining to  rural parts  of  the state  than for  urban                                                               
[areas in Alaska].                                                                                                              
                                                                                                                                
DR. SHIELDS  thanked the committee  and all participants  for the                                                               
efforts involved in  understanding HB 151.  He  responded to line                                                               
14,  within  HB  151,  and  inquired  as  to  the  definition  of                                                               
"hardship."                                                                                                                     
                                                                                                                                
CHAIR  WILSON  stated  that  "hardship" can  simply  be  that  an                                                               
individual  would not  be able  to afford  airfare [required  for                                                               
travel related to eye surgery].                                                                                                 
                                                                                                                                
REPRESENTATIVE GARDNER  confirmed that Dr. Shields  advocated for                                                               
the practice of sending a patient home 24 hours after surgery.                                                                  
                                                                                                                                
DR. SHIELDS said  that is appropriate in many  circumstances.  He                                                               
emphasized that follow-up care would be involved after surgery.                                                                 
                                                                                                                                
REPRESENTATIVE  ANDERSON  asked  Dr.  Shields  if  he  understood                                                               
Representative McGuire's  earlier clarification regarding  HB 151                                                               
being applicable  only within  the state of  Alaska; he  asked if                                                               
Dr. Shields  had performed  surgery in Alaska;  he asked  how Dr.                                                               
Shields was contacted to testify before the committee.                                                                          
                                                                                                                                
DR. SHIELDS  said that he understood  the clarification regarding                                                               
HB 151;  he replied  that he had  never performed  surgery within                                                               
Alaska;  he  said  that  he  was contacted  by  Paul  Barney,  an                                                               
optometrist  who   works  for  the  Pacific   Cataract  Group  in                                                               
Anchorage and has received phone calls from Dr. Michael Bennett.                                                                
                                                                                                                                
REPRESENTATIVE GARDNER said,  "Representative Seaton talked about                                                               
a letter  of support [for  HB 151]  from the "medical  board" and                                                               
...  in my  packet I  have a  letter of  support from  the Alaska                                                               
State   Medical  Association,   which   is   an  association   of                                                               
practitioners, not the board; am  I missing something?"  She said                                                               
that  she is  hoping to  clarify as  there is  a big  distinction                                                               
between the "medical board" and the "medical association."                                                                      
                                                                                                                                
REPRESENTATIVE  ANDERSON stated  that  Representative Gardner  is                                                               
correct  and the  Alaska State  Medical  Association endorses  HB
151, not the Alaska Medical Board.                                                                                              
                                                                                                                                
5:05:41 PM                                                                                                                    
                                                                                                                                
BOB  FORD,   M.D.,  ophthalmologist,   said  that  he   lives  in                                                               
Washington  state  but that  he  established  an office  [Pacific                                                               
Cataract and Laser Institute] in  Anchorage, seven years ago.  He                                                               
stated:                                                                                                                         
                                                                                                                                
     I  believe  ... all  of  the  ophthalmologists and  the                                                                    
     optometrists agree  that the surgeon is  the captain of                                                                    
     the  ship  for  post-operative care,  and  the  surgeon                                                                    
     feels that  responsibility and he  is going to  be sure                                                                    
     that it is done and there are  two ways to do that:  he                                                                    
     can do  it himself ... and  that is good ...  but it is                                                                    
     also  very legitimate  to delegate  things  and if  you                                                                    
     have quality  people that you trust,  you can delegate.                                                                    
     I  come  up  typically  on Monday  and  I'll  typically                                                                    
     operate  for  three  days   -  Tuesday,  Wednesday  and                                                                    
     Thursday and  then I  go home ...  the only  reason I'm                                                                    
     comfortable  doing  that  is  because  I  have  a  very                                                                    
     skillful optometrist that's  the full-time doctor there                                                                    
     ...  my office  is open  5 days  a week  ... for  post-                                                                    
     operative care.   I've cared for,  literally, thousands                                                                    
     of patients with Dr. Barney  and I know he's very quick                                                                    
     ...  to  recognize ...  [post-operative  complications]                                                                    
     ...  I've done  approximately  8,000  surgeries in  the                                                                    
     last 7 years,  in Anchorage ... I have  had three cases                                                                    
     that  have needed  my attention  post-operatively, none                                                                    
     of  them  within  the  first  48  hours,  interestingly                                                                    
     enough, and those  3 cases I took care of,  one of them                                                                    
     three  weeks after  surgery ...  so this  bill wouldn't                                                                    
     have  addressed that  ... my  thoughts and  feelings on                                                                    
     this are very colored by  my experience with my father.                                                                    
     My father  was a family  doctor and I watched  him work                                                                    
     with surgeons and  I could tell that  my dad's patients                                                                    
     trusted  my dad  ... and  the surgeons  trusted my  dad                                                                    
     too, and they'd  get the patients right back  to my dad                                                                    
     for  post-operative  care  ...  it  was  good  for  the                                                                    
     patients because  my dad knew them  better than anybody                                                                    
     else did ... I believe  that patients nowadays want the                                                                    
     same thing for  their eye surgery.  If  their doctor is                                                                    
     a surgeon, they'll want their  doctor to do the surgery                                                                    
     and care  for them afterward,  if their doctor  isn't a                                                                    
     surgeon,  which  is  the  case of  80  percent  of  the                                                                    
     patients  in  Alaska  because 80  percent  of  the  eye                                                                    
     doctors are  not surgeons in  Alaska ...  they're going                                                                    
     to ask  their doctor ...  who should do my  surgery and                                                                    
     their doctor  will set that  up and then  they're going                                                                    
     to want  to be right back  in the care of  their doctor                                                                    
     as soon  as possible.  I  don't see that you  can set a                                                                    
     specific time  that works  ... I  haven't had  a single                                                                    
     case, not  one case,  where the fact  that I  went home                                                                    
     Thursday night caused  any harm to any  patients ... if                                                                    
     you  pass  this  legislation,  then  I  will  certainly                                                                    
     cooperate with it,  and I'll spend another  two days up                                                                    
     here at  the end ...  I don't think the  legislation is                                                                    
     needed and it would hamper  the way I practice, which a                                                                    
     lot of patients like and a  lot of doctors like ... but                                                                    
     ... I  trust your  judgment and  ... I'll  cooperate to                                                                    
     the best of my ability.                                                                                                    
                                                                                                                                
5:11:01 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON inquired  as to the costs  associated [for patients]                                                               
if  HB 151  passes and  Dr.  Ford would  be required  to stay  in                                                               
Anchorage for an  additional day; she asked if the  passing of HB
151  would make  Dr.  Ford  hesitate about  coming  to Alaska  to                                                               
perform surgery.                                                                                                                
                                                                                                                                
DR. FORD replied  that if he were required to  stay an additional                                                               
day  after surgery,  he  would  not charge  patients  extra.   He                                                               
clarified  that he  does not  pay optometrists  for comanagement,                                                               
and that  they bill  separately.  In  response to  Chair Wilson's                                                               
second question, Dr. Ford stated  that he might hesitate but that                                                               
he  feels a  strong commitment  to serve  with his  colleagues at                                                               
their practice.                                                                                                                 
                                                                                                                                
REPRESENTATIVE  GARDNER said  that  a surgeon  that performs  eye                                                               
surgery in this state can delegate the responsibility of post-                                                                  
operative care  to another ophthalmologist, according  to HB 151.                                                               
She pointed  out that Dr. Ford  could easily delegate and  one of                                                               
his  partners could  provide post-operative  care,  and that  his                                                               
practice would, in essence, not be affected by HB 151.                                                                          
                                                                                                                                
5:13:00 PM                                                                                                                    
                                                                                                                                
DR. FORD stated:                                                                                                                
                                                                                                                                
     my  partner, the  one  that sees  all  of my  patients,                                                                    
     "post-op" up  here, Dr. Barney,  he is  an optometrist,                                                                    
     not an ophthalmologist.  And  I feel that this bill ...                                                                    
     is  anti-optometry, it  really is,  because the  spirit                                                                    
     behind this  bill is optometrist's  are not  capable of                                                                    
     doing first quality, post-operative  care ... I believe                                                                    
     the way I do it is  first rate ... I believe Dr. Barney                                                                    
     is  just as  able to  screen for  problems, as  anybody                                                                    
     else.    In  fact,  he's probably  seen  more  cataract                                                                    
     surgeries, "post-op"  than the  average ophthalmologist                                                                    
     has.                                                                                                                       
                                                                                                                                
5:13:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ANDERSON  inquired  as   to  Dr.  Ford's  opinion                                                               
regarding  the Academy  of  Ophthalmology's  guidelines on  post-                                                               
operative surgical care.                                                                                                        
                                                                                                                                
DR.  FORD said  that the  typical ophthalmologist  is opposed  to                                                               
comanagement.   He  explained that  there is  a conflict  between                                                               
optometrists and  ophthalmologists because  optometry is  a group                                                               
of forward  looking, ambitious people  and they've  moved forward                                                               
in  their  ability  to  diagnose  and  treat  disease,  which  is                                                               
threatening  to  ophthalmologists.     The  American  Academy  of                                                               
Ophthalmology   is   fundamentally   not   very   supportive   of                                                               
comanagement,  he  related,  and there's  hard  feelings  between                                                               
ophthalmology and  optometry at the leadership  levels because of                                                               
the struggle of  the expansion of practice.  He  added that he is                                                               
more  pro-comanagement  than  the   leadership  of  the  American                                                               
Academy of  Ophthalmology is and respectfully  disagrees with the                                                               
Academy on this subject of comanagement.                                                                                        
                                                                                                                                
REPRESENTATIVE  MCGUIRE inquired  as  to whether  Dr. Ford  takes                                                               
"call."                                                                                                                         
                                                                                                                                
DR. FORD  replied that  he does  not take  "call" [ability  to be                                                               
available  for  of-hours  medical  emergency calls]  and  it  has                                                               
created  negative feelings  between  him and  some  of the  other                                                               
ophthalmologists.   He  explained that  he  has recently  decided                                                               
that it  would be fair  to take "call" and  is in the  process of                                                               
setting the  situation up so that  he can rotate call  with other                                                               
ophthalmologists in his office.                                                                                                 
                                                                                                                                
REPRESENTATIVE MCGUIRE said:                                                                                                    
                                                                                                                                
     at the root  of this bill I think there  are some of us                                                                    
     that are supportive  of it for the reason  that we want                                                                    
     to  attract  ...  retain   ...  more  medical  doctors,                                                                    
     ophthalmologists, to  our community  that are  going to                                                                    
     live in our community and  be here to service the needs                                                                    
     of the people that live in  our state ... I suspect ...                                                                    
     that if I said "Would you  be willing to fly your plane                                                                    
     up  here,  on  a  moment's  notice,  to  take  care  of                                                                    
     somebody  that had  a very  serious eye  emergency that                                                                    
     had not  paid you for  an eye treatment" ...  you would                                                                    
     probably  say no  and that's  kind  of the  point I  am                                                                    
     getting  at  ... it's  an  opportunity  to come  in,  I                                                                    
     understand  ... but  that being  said, you  don't stick                                                                    
     around and  I appreciate  what you  said on  the record                                                                    
     today about the "call."                                                                                                    
                                                                                                                                
CHAIR   WILSON  interrupted   and   stated  that   Representative                                                               
McGuire's comments are not related to HB 151.                                                                                   
                                                                                                                                
REPRESENTATIVE MCGUIRE said:                                                                                                    
                                                                                                                                
     the  point  of  this  is   that  if  we  allow  certain                                                                    
     procedures  to  create a  market,  then  we deter  some                                                                    
     people  from entering  the market  ...  the only  other                                                                    
     final analogy  I have  is, paralegals,  ... I  have met                                                                    
     some  paralegals that  are some  of the  most competent                                                                    
     people ... I have met  paralegals that are smarter than                                                                    
     a  lot of  the  lawyers that  I have  met  and so  life                                                                    
     experience,  and  working  on  the  job  can  make  you                                                                    
     extremely   competent.     So,   this   is  not   about                                                                    
     optometrists not being competent  ... the choice that's                                                                    
     made  at the  outset  is your  own,  about whether  you                                                                    
     choose to  get a medical  degree or whether  you choose                                                                    
     to get an optometry degree ...                                                                                             
                                                                                                                                
5:20:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  inquired as  to Dr. Ford  participating in                                                               
comanagement arrangements.                                                                                                      
                                                                                                                                
DR.  FORD said  that for  the last  20 years,  almost all  of his                                                               
patients have been comanaged.                                                                                                   
                                                                                                                                
SAM TRIVETTE  said that he had  eye surgery in Seattle  and could                                                               
have instead [had eye surgery] in  Anchorage, and if he had, this                                                               
bill would  have had impact.   He explained that he  was referred                                                               
[for surgery] to an ophthalmologist  by his optometrist in Juneau                                                               
and  after the  surgery, was  seen by  his local  optometrist for                                                               
follow-up post-operative  care.   He said  that if  the follow-up                                                               
care had to  have been done by an ophthalmologist,  he would have                                                               
had real difficulty  as there is only one  ophthalmology group in                                                               
Juneau and  he has had negative  past experiences with them.   He                                                               
explained,  "if   I  had  to   stay  for  48  hours   because  an                                                               
ophthalmologist would not do a  comanagement, I would have to eat                                                               
that money  and that's expensive,  hotels are not  cheap anymore,                                                               
and meals are not either.  I  feel this bill is unnecessary and I                                                               
don't  think  the  legislature  should be  forcing  this  on  the                                                               
medical system."   He emphasized  that this  is an issue  that is                                                               
between  him and  his physician  and he  does not  understand why                                                               
statute is necessary.                                                                                                           
                                                                                                                                
5:24:58 PM                                                                                                                    
                                                                                                                                
FRANK  BICKFORD said  that  Dr.  Ford spoke  of  a potential  war                                                               
between optometry  and ophthalmology  in his testimony  and there                                                               
is a  need to clarify this.   He informed that  optometrists do a                                                               
good job  at what  they do and  what they are  trained to  do and                                                               
that optometrists and  ophthalmologists get along in  Alaska.  He                                                               
said:                                                                                                                           
                                                                                                                                
     The frustrating point that I  heard today, was Dr. Ford                                                                    
     stating,  if he  can't  come back  to Anchorage,  he'll                                                                    
     have  his optometrist  come from  Outside.   There  are                                                                    
     ophthalmologists  in  Anchorage,   why  not  add  those                                                                    
     ophthalmologists   as   part    of   the   comanagement                                                                    
     agreement.   It's very simple,  there is no  reason why                                                                    
     the  ophthalmologists in  Anchorage  can't  be part  of                                                                    
     this ...  after 48 hours  the optometrists are  back in                                                                    
     the  system  under this  bill,  so  they're not  taking                                                                    
     optometrists out  of the whole  picture, they  are part                                                                    
     of the  picture but those  first 48 hours  are critical                                                                    
     in  eye care  and that's  why the  American Academy  of                                                                    
     Ophthalmology endorses this bill with that change.                                                                         
                                                                                                                                
CHAIR WILSON  inquired as to  the insurance paying  all involved,                                                               
if in fact  there were situations where  two ophthalmologists and                                                               
an optometrist treated one patient.                                                                                             
                                                                                                                                
CARL  ROSEN replied  yes,  and that  there is  a  fee split  that                                                               
Medicare  and the  "OIG" (Office  of the  Inspector General)  has                                                               
deemed appropriate for appropriate  comanagement that is in place                                                               
and it is usually "80/20" for the typical relationship.                                                                         
                                                                                                                                
5:27:48 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON said  that what she is hearing over  and over is the                                                               
fact that the patient is going  to feel comfortable most with the                                                               
person the  patient knows  the best.   She questioned  whether it                                                               
really makes  a difference   in terms  of who does  the follow-up                                                               
care after eye surgery.                                                                                                         
                                                                                                                                
DR. ROSEN  argued that  the patient  usually does  not understand                                                               
what the comanagement  relationship is and that's  what the "OIG"                                                               
and Medicare expect.  He said:                                                                                                  
                                                                                                                                
     I would  just say  the litmus test  for you  people who                                                                    
     are  making these  decisions ...  would  you prefer  to                                                                    
     have  your physician  take  care of  you,  and to  make                                                                    
     decisions or would you prefer  to have someone who does                                                                    
     not  do  the  cutting,  someone who  does  not  do  the                                                                    
     sewing,  who  does  not make  the  difference  in  your                                                                    
     visual system in the operating  room ... I am not anti-                                                                    
     optometrists.  I think that  we're going to improve eye                                                                    
     care, we're  going to set  a precedent, we're  going to                                                                    
     say look,  you operate, you  need to take care  of that                                                                    
     patient, and after that ,  we can go about our business                                                                    
     as usual.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  ANDERSON added,  "isn't  it true  that a  patient                                                               
after back  surgery might  feel more  comfortable ...  with their                                                               
massage therapist, that doesn't  mean that they're healthier with                                                               
a massage therapist."                                                                                                           
                                                                                                                                
DR. ROSEN  reiterated that the  average person is unaware  of the                                                               
difference between optometrists and  ophthalmologists.  He opined                                                               
that  it  is  the  job  of the  pathologists  to  make  the  best                                                               
decisions  because ophthalmologists  know more  [about eye  care]                                                               
than constituents and patients.                                                                                                 
                                                                                                                                
5:31:58 PM                                                                                                                    
                                                                                                                                
DR. MICHAEL  BENNETT, stated  that throughout  the course  of the                                                               
committee   meeting,   optometrists   have   been   compared   to                                                               
paralegals,  massage  therapists,  and  other  ancillary  medical                                                               
personnel.   He  emphasized that  optometrists are  not ancillary                                                               
medical personnel.  He explained  that optometrists are doctorate                                                               
level physicians and are trained in optometry school to do post-                                                                
operative care.  He said, "the whole  gist seems to be ... are we                                                               
willing to settle  for this ... second standard of  care in post-                                                               
surgical care,  as opposed  to having the  "real" doctor  look at                                                               
the patient,  and ... I don't  know that it's gotten  across very                                                               
well, it's the  whole notion of that, that is  offensive.  I have                                                               
spent  a long  time  doing post-operative  care;  I feel  equally                                                               
qualified to recognize  the problems that are  being talked about                                                               
here, through  the general ophthalmologists.   And, obviously the                                                               
surgeons that I  have referred patients to ...  feel likewise, or                                                               
they would not be sending the patients back to me."                                                                             
                                                                                                                                
REPRESENTATIVE MCGUIRE  said that  a medical degree,  which takes                                                               
about  eight years  to complete,  is different  than a  degree in                                                               
optometry.                                                                                                                      
                                                                                                                                
DR. BENNETT clarified that an  optometry degree takes eight years                                                               
before it is completed.                                                                                                         
                                                                                                                                
REPRESENTATIVE  MCGUIRE inquired  as  to  the difference  between                                                               
optometrists  and  ophthalmologists.   She  said,  "Why not  just                                                               
become a medical doctor?"                                                                                                       
                                                                                                                                
DR.  BENNETT replied  that he  didn't  want to  become a  medical                                                               
doctor.                                                                                                                         
                                                                                                                                
REPRESENTATIVE MCGUIRE opined  that people make a  choice about a                                                               
degree they  want, and  then they come  [to the  legislature] and                                                               
demand additional powers to be granted in their profession.                                                                     
                                                                                                                                
5:36:19 PM                                                                                                                    
                                                                                                                                
DR.  BENNETT  informed  that  optometry  has  grown  and  changed                                                               
considerably   in  the   past  few   decades.     He  said   that                                                               
practitioners  are continually  expanding their  capabilities and                                                               
their level of knowledge.   He explained that medical doctors can                                                               
obtain  training and  determine their  competency to  utilize new                                                               
techniques with patients, while optometrists cannot.                                                                            
                                                                                                                                
REPRESENTATIVE MCGUIRE  said that  people make  a choice  about a                                                               
profession  and  that  the legislature  cannot  grant  additional                                                               
"powers" to suit changing needs.                                                                                                
                                                                                                                                
DR.  BENNETT  said  that comanagement  with  optometry  has  been                                                               
regulated by  the federal government since  1980 and optometrists                                                               
made  the choice  to have  the capability  to comanage  [and have                                                               
been comanaging] for 25 years.   He clarified that [optometrists]                                                               
are not  asking for  an expansion  of authority  in comanagement,                                                               
but  that  [the  legislature] does  not  rescind  [optometrist's]                                                               
authority in comanagement.  He continued:                                                                                       
                                                                                                                                
     to  become  the  only  state   in  the  country,  where                                                                    
     optometrists,    after   25    years   of    successful                                                                    
     comanagement,  are now  prohibited from  doing so,  for                                                                    
     whatever  time  period.   This  is  not something  new,                                                                    
     you're  actually  trying to  turn  the  tables back  25                                                                    
     years ... I'm not here  asking you to give me something                                                                    
     I  don't  already have,  I'm  asking  you not  to  take                                                                    
     something away I've been doing  successfully for a long                                                                    
     time.  There have been a  number of studies, two of the                                                                    
     major  ones, authored  by ophthalmologists,  looking at                                                                    
     comanagement,  looking at  thousands  and thousands  of                                                                    
     retrospective   cases    and   looking    for   outcome                                                                    
     differentials between optometry  comanaged patients and                                                                    
     patients who  are followed by  the surgeon,  they can't                                                                    
     find the problem, there's no difference in outcome.                                                                        
                                                                                                                                
5:40:52 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  asked Dr.  Rosen if  there is  any other  state has                                                               
passed legislation similar to HB 151.                                                                                           
                                                                                                                                
DR.  ROSEN  said   that  four  states  have   looked  at  similar                                                               
legislation.   He  opined that  HB  151 will  benefit people  and                                                               
optometrists will get a chance to participate [in eye care].                                                                    
                                                                                                                                
5:42:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  moved to  adopt a  Conceptual Amendment,                                                               
as follows:                                                                                                                     
                                                                                                                                
     I move  amendment number 1  which would change  on page                                                                    
     1, line 12, 120 hours to  48 hours, and then on page 2,                                                                    
     line 1,  120 hours  to 48  hours.   And have  the legal                                                                    
     services  make  it  a   conceptual  amendment  so  it's                                                                    
     conforming in case I've  missed any applicable language                                                                    
     that  doesn't  reference  48 hours  that  needs  to  be                                                                    
     changed.                                                                                                                   
                                                                                                                                
5:43:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  objects.  He  stated his concern  that the                                                               
48-hour amendment is  arbitrary and that the  testimony has shown                                                               
that most complications  [after eye surgery] do  not occur within                                                               
the 48-hour timeframe.  He opined  that, "we are just changing to                                                               
48 hours because maybe we can pass  the bill with 48 hours and we                                                               
can't  pass   it  with   what  the   ophthalmologists  themselves                                                               
recommend ... and so, I'll withdraw  my objection for that, but I                                                               
have a problem with doing ...".                                                                                                 
                                                                                                                                
REPRESENTATIVE  ANDERSON  said  that   the  American  Academy  of                                                               
Ophthalmology  is stating  that 48  hours is  acceptable and  the                                                               
idea  of  the bill  is  that  doctors  stay  an extra  day  after                                                               
surgery.                                                                                                                        
                                                                                                                                
CHAIR  WILSON noted  that Representative  Seaton's objection  was                                                               
withdrawn.    There  being  no  further  objection,  [Conceptual]                                                               
Amendment 1 was adopted.                                                                                                        
                                                                                                                                
5:45:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KOHRING  offered  that the  committee  hold  this                                                               
legislation over  until the next  meeting because there  seems to                                                               
be  real   hesitation  among  members   and  concerns   from  the                                                               
community.                                                                                                                      
                                                                                                                                
REPRESENTATIVE ANDERSON opined that HB 151 can move.  He said:                                                                  
                                                                                                                                
     We've waited nine  days ... we've had about  5 hours of                                                                    
     testimony    duplicative    for    the    optometrists,                                                                    
     duplicative of  Dr. Rosen,  and have  another committee                                                                    
     of referral.  And, we  also have the ability for people                                                                    
     to allow it  to pass, but vote do not  pass or "no rec"                                                                    
     on the  file and  report if  they're worried  about the                                                                    
     record.                                                                                                                    
                                                                                                                                
The committee took an at-ease from 5:46:21 PM to 5:47:02 PM.                                                                    
                                                                                                                                
5:47:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON moved  to report HB 151  out of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.                                                                                                                          
                                                                                                                                
REPRESENTATIVE SEATON made an objection and stated:                                                                             
                                                                                                                                
     I think that  we've had a lot of testimony  here, and I                                                                    
     think  the  testimony has  come  down  to ...  surgeons                                                                    
     should   use  their   medical   expertise  and   should                                                                    
     determine  when,  within  their  medical  expertise,  a                                                                    
     person should be  able to leave and what  we are trying                                                                    
     to do  is insert ourselves between  the medical doctors                                                                    
     and  their decisions  and say  that the  medical doctor                                                                    
     that says  that his patient is  free to go in  24 hours                                                                    
     is making  a bad  decision, an incorrect  decision, and                                                                    
     we are going  to insert the legislature  into a medical                                                                    
     decision and  say ... that  we know better ...  I think                                                                    
     that that is a very big  mistake.  I also think that on                                                                    
     page 2,  line 12  where we say  "this doesn't  apply to                                                                    
     rural Alaska", [we are saying]  it doesn't matter about                                                                    
     the  care  there,  it only  applies  to  Anchorage  and                                                                    
     Fairbanks,  basically ...  I have  a real  problem with                                                                    
     aspects  if  the  bill   but,  especially,  that  we're                                                                    
     inserting ourselves  ... in  the state  medical board's                                                                    
     place.                                                                                                                     
                                                                                                                                
5:48:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KOHRING  said  that  he has  concerns  about  the                                                               
legislation but that  he will not object to move  the bill to the                                                               
next  committee.   He  explained  that the  bill  will have  more                                                               
opportunities for those that oppose  this legislation to convince                                                               
members  of  other committees  to  prevent  the bill  from  going                                                               
forth.     He   shared   that  his   concerns   are  similar   to                                                               
Representative Seaton's  and he  will vote to  move the  bill but                                                               
mark a "do not pass" recommendation on the "sheet."                                                                             
                                                                                                                                
5:50:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER she  said that it is clear  that this bill                                                               
addresses a problem  that doesn't exist.  She  mentioned that she                                                               
agreed with Representative Seaton's comments.                                                                                   
                                                                                                                                
CHAIR WILSON  noted that she  agreed with  Representatives Seaton                                                               
and  Gardner.     She  highlighted   that  this  is   not  normal                                                               
[legislation] for  Alaska.  She said,  "We try to make  sure that                                                               
what we  do doesn't have any  ramifications in other areas  and I                                                               
... am concerned that this is  setting a precedent and the wishes                                                               
of the  committee is  that we move  this bill and  so we  have an                                                               
objection, so I will go ahead and call the role."                                                                               
                                                                                                                                
5: 51:03 PM                                                                                                                   
                                                                                                                                
A roll  call vote was  taken.  Representatives  Kohring, McGuire,                                                               
Anderson, and Cissna  voted in favor of HB  151.  Representatives                                                               
Seaton, Gardner,  and Wilson voted  against it.   Therefore, CSHB
151(HES)  passed  and  was  reported out  of  the  House  Health,                                                               
Education and Social Services Standing Committee by a vote of 4-                                                                
3.                                                                                                                              
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned around 5:51:42 PM.                                                                                              

Document Name Date/Time Subjects