Legislature(2005 - 2006)CAPITOL 106

03/31/2005 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 225 MEDICAL EXAMINERS & AUTOPSIES TELECONFERENCED
Moved Out of Committee
+= HB 53 CHILDREN IN NEED OF AID/REVIEW PANELS TELECONFERENCED
Moved CSHB 53(HES) Out of Committee
*+ HB 111 MEDICAID COVERAGE FOR BIRTHING CENTERS TELECONFERENCED
Moved CSHB 111(HES) Out of Committee
*+ HB 220 MENTAL HEALTH PATIENT RIGHTS:STAFF GENDER TELECONFERENCED
Moved CSHB 220(HES) Out of Committee
*+ HB 14 DISCLOSURES BY FOSTER PARENTS TELECONFERENCED
Scheduled But Not Heard
Bills Previously Heard/Scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                         March 31, 2005                                                                                         
                           3:07 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                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Berta Gardner                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
HOUSE BILL NO. 225                                                                                                              
"An  Act   relating  to  medical  examiners   and  medical  death                                                               
examinations."                                                                                                                  
                                                                                                                                
     - MOVED HB 225 OUT OF COMMITTEE                                                                                            
                                                                                                                                
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 53                                                                                        
"An  Act relating  to child-in-need-of-aid  proceedings; amending                                                               
the construction  of statutes pertaining  to children in  need of                                                               
aid; relating  to a  duty and  standard of  care for  services to                                                               
children and families, to  the confidentiality of investigations,                                                               
court  hearings, and  public agency  records  and information  in                                                               
child-in-need-of-aid   matters  and   certain  child   protection                                                               
matters,  to  immunity  regarding disclosure  of  information  in                                                               
child-in-  need-of-aid  matters   and  certain  child  protection                                                               
matters, to the retention of certain  privileges of a parent in a                                                               
relinquishment   and   termination   of  a   parent   and   child                                                               
relationship  proceeding,  to   eligibility  for  permanent  fund                                                               
dividends for certain  children in the custody of  the state, and                                                               
to juvenile delinquency  proceedings and placements; establishing                                                               
a right  to a  trial by  jury in  termination of  parental rights                                                               
proceedings;  reestablishing  and  relating  to  state  citizens'                                                               
review panels  for certain child protection  and custody matters;                                                               
amending the duty  to disclose information pertaining  to a child                                                               
in need of aid; authorizing  additional family members to consent                                                               
to  disclosure of  confidential or  privileged information  about                                                               
children and  families involved  with children's  services within                                                               
the Department  of Health  and Social  Services to  officials for                                                               
review  or use  in official  capacities; relating  to reports  of                                                               
harm and  to adoptions  and foster  care; mandating  reporting of                                                               
the  medication of  children in  state  custody; prescribing  the                                                               
rights of grandparents related  to child-in-need-of-aid cases and                                                               
establishing  a  grandparent  priority for  adoption  in  certain                                                               
child-in-need-of-aid  cases;  modifying  adoption  and  placement                                                               
procedures  in   certain  child-in-need-of-aid   cases;  amending                                                               
treatment service requirements for  parents involved in child-in-                                                               
need-of-aid  proceedings;   amending  Rules  9  and   13,  Alaska                                                               
Adoption Rules;  amending Rules  3, 18, and  22, Alaska  Child in                                                               
Need of  Aid Rules of  Procedure; and providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
     - MOVED CSSSHB 53(HES) OUT OF COMMITTEE                                                                                    
                                                                                                                                
HOUSE BILL NO. 111                                                                                                              
"An Act adding birthing centers  to the list of health facilities                                                               
eligible for payment of medical assistance for needy persons."                                                                  
                                                                                                                                
     - MOVED CSHB 111(HES) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 220                                                                                                              
"An  Act  relating to  mental  health  patient  rights and  to  a                                                               
hospital's duty to  provide choice of the sex  of staff providing                                                               
intimate care to a mental health patient."                                                                                      
                                                                                                                                
     - MOVED CSHB 220(HES) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 14                                                                                                               
"An Act relating to disclosure of  information about a child or a                                                               
child's  family to  a legislator  or a  member of  a legislator's                                                               
staff; and making conforming changes."                                                                                          
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 225                                                                                                                  
SHORT TITLE: MEDICAL EXAMINERS & AUTOPSIES                                                                                      
SPONSOR(S): REPRESENTATIVE(S) MCGUIRE                                                                                           
                                                                                                                                
03/18/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/18/05       (H)       HES, FIN                                                                                               
03/31/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB  53                                                                                                                  
SHORT TITLE: CHILDREN IN NEED OF AID/REVIEW PANELS                                                                              
SPONSOR(S): REPRESENTATIVE(S) COGHILL                                                                                           
                                                                                                                                
01/10/05       (H)       PREFILE RELEASED 1/7/05                                                                                
01/10/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/10/05       (H)       HES, JUD, FIN                                                                                          
03/02/05       (H)       SPONSOR SUBSTITUTE INTRODUCED                                                                          
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)       Heard & Held                                                                                           
03/15/05       (H)       MINUTE(HES)                                                                                            
03/22/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/22/05       (H)       <subcommittee meeting>                                                                                 
03/31/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 111                                                                                                                  
SHORT TITLE: MEDICAID COVERAGE FOR BIRTHING CENTERS                                                                             
SPONSOR(S): REPRESENTATIVE(S) CRAWFORD                                                                                          
                                                                                                                                
01/26/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/26/05       (H)       HES, FIN                                                                                               
03/31/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 220                                                                                                                  
SHORT TITLE: MENTAL HEALTH PATIENT RIGHTS:STAFF GENDER                                                                          
SPONSOR(S): REPRESENTATIVE(S) GARA                                                                                              
                                                                                                                                
03/16/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/16/05       (H)       HES, FIN                                                                                               
03/31/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB  14                                                                                                                  
SHORT TITLE: DISCLOSURES BY FOSTER PARENTS                                                                                      
SPONSOR(S): REPRESENTATIVE(S) ROKEBERG                                                                                          
                                                                                                                                
01/10/05       (H)       PREFILE RELEASED 12/30/04                                                                              
01/10/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/10/05       (H)       HES, JUD                                                                                               
03/31/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
DR. ROGERS                                                                                                                      
(No address provided)                                                                                                           
POSITION STATEMENT:  Speaking as a former state medical examiner                                                                
in Juneau,                                                                                                                      
                                                                                                                                
RYNNIEVA MOSS, Staff                                                                                                            
to Representative John Coghill                                                                                                  
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 53 on behalf of Representative                                                                
Coghill, sponsor.                                                                                                               
                                                                                                                                
REPRESENTATIVE JOHN COGHILL                                                                                                     
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions regarding HB 53 as                                                                      
sponsor.                                                                                                                        
                                                                                                                                
SCOTT TRAFFORD CALDER                                                                                                           
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 53.                                                                             
                                                                                                                                
REPRESENTATIVE HARRY CRAWFORD                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 111 as sponsor.                                                                               
                                                                                                                                
BARBARA NORTON, Certified Nurse Midwife (CNM); Part Owner                                                                       
Geneva Woods Birth Center                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 111.                                                                            
                                                                                                                                
MARIBETH GARDNER, Family Nurse Practitioner; Nurse Midwife                                                                      
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  During hearing on HB 111, testified in                                                                     
support of Medicaid reimbursing birthing facilities.                                                                            
                                                                                                                                
JACK NIELSON, Executive Director                                                                                                
Rate Review                                                                                                                     
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Provided comments on HB 111.                                                                               
                                                                                                                                
TORA GERRICK, Part Owner                                                                                                        
Midwives Birth Center                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  During the hearing of HB 111, provided                                                                     
information she has garnered from her own birthing center.                                                                      
                                                                                                                                
KITTY ERNST                                                                                                                     
(No address provided)                                                                                                           
POSITION STATEMENT:   During the  hearing of HB 111,  opined that                                                               
birthing centers are safe.                                                                                                      
                                                                                                                                
KAYE KANNE, CDM, Executive Director                                                                                             
Juneau Family Birth Center                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  During the  hearing of HB 111, expressed the                                                               
need  to support  birth centers  in Alaska  and place  them on  a                                                               
level  playing   field  with  hospitals,   as  far   as  Medicaid                                                               
reimbursement.                                                                                                                  
                                                                                                                                
REPRESENTATIVE LES GARA                                                                                                         
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 220 as bill sponsor.                                                                          
                                                                                                                                
PATRICK HIGGINS                                                                                                                 
North Star Behavioral Health System                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   During hearing of HB 220,  related that the                                                               
organization's issues and concerns have been addressed.                                                                         
                                                                                                                                
HOLLY GLAESER, Director                                                                                                         
Behavioral Health Unit                                                                                                          
Fairbanks Memorial Hospital                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:   During  hearing of  HB 220,  testified that                                                               
this  issue  should   be  an  organizational  issue   and  not  a                                                               
legislation issue.                                                                                                              
                                                                                                                                
KARL SANFORD, Chief Nursing Officer                                                                                             
and Associate Administrator                                                                                                     
Fairbanks Memorial Hospital                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 220.                                                                         
                                                                                                                                
DORRANCE COLLINS                                                                                                                
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Testified  in support  of  the  committee                                                               
substitute for HB 220.                                                                                                          
                                                                                                                                
FAITH MYERS                                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Testified  in support  of  the  committee                                                               
substitute for HB 220.                                                                                                          
                                                                                                                                
RON ADLER, CEO                                                                                                                  
Alaska Psychiatric Institute (API)                                                                                              
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 220.                                                                         
                                                                                                                                
RICHARD RAINERY, Executive Director                                                                                             
Alaska Mental Health Board                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified that  the Board has requested that                                                               
the appropriate policies  be revised to reflect the  intent of HB                                                               
220.                                                                                                                            
                                                                                                                                
ROD BETIT, President                                                                                                            
Alaska State Hospital Nursing Home Association (ASHNHA)                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in opposition to HB 220.                                                                         
                                                                                                                                
BILL HOGAN, Director                                                                                                            
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions from the committee.                                                                     
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 3:07:59  PM.                                                             
Representatives Kohring, Seaton, and  McGuire were present at the                                                               
call to  order.  Representative  Anderson arrived as  the meeting                                                               
was  in   progress.    Representative  Cissna   was  present  via                                                               
teleconference.                                                                                                                 
                                                                                                                                
HB 225-MEDICAL EXAMINERS & AUTOPSIES                                                                                          
                                                                                                                                
3:09:17 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE BILL  NO. 225,  "An Act relating  to medical  examiners and                                                               
medical death examinations."                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE,  speaking as  the sponsor,  expressed her                                                               
belief that the duty of the  state medical examiner is of immense                                                               
responsibility and  importance to  the citizens  of Alaska.   She                                                               
explained that autopsies  are performed by the  state coroner for                                                               
various   reasons,  including   suspicious  death   and  possible                                                               
communicable  disease  outbreaks.   There  is  one state  medical                                                               
examiner  in  Alaska,  she related,  manages  over  1,000  cases,                                                               
annually.    She  further  explained   that  Alaska  law  divides                                                               
autopsies   into   two   different  categories,   which   include                                                               
suspicious, unusual or public health  related deaths in the first                                                               
category and leaves other cases  to the discretion of the medical                                                               
examiner.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  MCGUIRE said  that HB  225 would  require that  a                                                               
deputy medical examiner be appointed  to assist the state medical                                                               
examiner  in  Alaska.    She explained  that  the  state  medical                                                               
examiner has been  so overworked in past years,  that some deaths                                                               
have  not  been  properly  investigated,   due  to  the  lack  of                                                               
resources.   She  pointed out  that the  deputy medical  examiner                                                               
would provide  respite for the  state medical examiner  and allow                                                               
for the development  and training of the position.   If the state                                                               
medical examiner became ill, needed  to take time off, or decided                                                               
to leave the  position, there would be someone to  take over, she                                                               
related.                                                                                                                        
                                                                                                                                
REPRESENTATIVE MCGUIRE  stated that there  is a zero  fiscal note                                                               
attached to HB 225 because  the governor's office decided to fund                                                               
the  [deputy commissioner]  position.   She  explained that  this                                                               
position was funded in recognition  that this is a critical state                                                               
responsibility, and a matter of public trust.                                                                                   
                                                                                                                                
3:14:37 PM                                                                                                                    
                                                                                                                                
DR. ROGERS  said that he  was the  state medical examiner  for 27                                                               
years in Alaska.  He explained  that he resigned and retired when                                                               
the policy  in Juneau  shifted requirements  to complete  only 25                                                               
percent of  deaths reported  to the state  medical examiner.   He                                                               
continued:                                                                                                                      
                                                                                                                                
     I couldn't  see doing  that because we  have to  sign a                                                                    
     death  certificate, we  have to  certify that  somebody                                                                    
     died  of  something.   And  the  word certify,  I  take                                                                    
     seriously, ... the word certify  is equivalent to being                                                                    
     under oath.   So, I didn't want to do  what they call a                                                                    
     walk by autopsy  and just make a guess at  the cause of                                                                    
     death and  sign it out  ....   One of the  reasons that                                                                    
     the  present  situation  is unsatisfactory  is  nothing                                                                    
     more   that   death   certificate  statistics.      The                                                                    
     Department  of   Epidemiology  ...  thought   that  our                                                                    
     autopsy records  were the best  in the  country because                                                                    
     we  did  autopsies  on  about 98  percent  of  all  the                                                                    
     coroner's  cases  and   that  includes  the  unattended                                                                    
     natural deaths,  and there are  a lot of things  to die                                                                    
     of besides a  coronary, which is what most  of them get                                                                    
     signed out  as now.   Our death  certificate statistics                                                                    
     have  become relatively  worthless ...  for people  who                                                                    
     die outside of the hospital ....   I was at a meeting a                                                                    
     while  back  where a  group  from  Pittsburgh tried  an                                                                    
     experiment,  they  would  bring  a body  in,  the  duty                                                                    
     pathologist  would  decide  whether  or not  to  do  an                                                                    
     autopsy and  write down what  he would sign it  out as;                                                                    
     ... if  he decided he didn't  need to do one,  then one                                                                    
     of  the other  pathologists in  the group  would do  an                                                                    
     autopsy ....   And they  found that they were  wrong 25                                                                    
     percent  of the  time and  I  think that  a 25  percent                                                                    
     error rate is really not very acceptable.                                                                                  
                                                                                                                                
     I  think it's  a responsibility  of the  state to  know                                                                    
     what its  citizens die of,  and therefore I  think this                                                                    
     bill will at  least provide more people for  them to do                                                                    
     the work.   Right now, one guy just simply  can't do it                                                                    
     all ... my partner and I,  used to do about 1,000 cases                                                                    
     a  year and  it can  be done  if the  time is  utilized                                                                    
     efficiently ....   I really applaud this  bill and hope                                                                    
     that it  will make  a difference  in the  policies that                                                                    
     come out of  the "department"; I assume  that they come                                                                    
     from the  commissioner ....   When they made  us change                                                                    
     it  came   through  Dr.  Nakamura,   I  think   is  Dr.                                                                    
     Mandsager's predecessor,  and it  was his view  that we                                                                    
     should do only  an average job compared to  the rest of                                                                    
     the country.  And I wanted  to do a better job than the                                                                    
     rest of  the country, not  because we're any  better at                                                                    
     it,  but because  there are  few enough  cases that  we                                                                    
     could do  them all.  So,  I think we should  go back to                                                                    
     doing them all, again.                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON  moved to  report HB  225 out  of committee                                                               
with individual recommendations and  the accompanying zero fiscal                                                               
note.   There being no  objection, HB  225 was reported  from the                                                               
House Health, Education and Social Services Standing Committee.                                                                 
                                                                                                                                
HB  53-CHILDREN IN NEED OF AID/REVIEW PANELS                                                                                  
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE  BILL  NO. 53,  "An  Act  relating to  child-in-need-of-aid                                                               
proceedings; amending the construction  of statutes pertaining to                                                               
children in need of aid; relating  to a duty and standard of care                                                               
for  services to  children and  families; amending  court hearing                                                               
procedures  to allow  public  attendance at  child-in-need-of-aid                                                               
proceedings;  establishing  a  right  to   a  trial  by  jury  in                                                               
termination  of parental  rights proceedings;  reestablishing and                                                               
relating to state  and local citizens' review  panels for certain                                                               
child custody matters; amending  the duty to disclose information                                                               
pertaining  to   a  child   in  need   of  aid;   establishing  a                                                               
distribution age for  permanent fund dividends held  in trust for                                                               
a child committed to the custody  of the Department of Health and                                                               
Social  Services;  mandating  reporting   of  the  medication  of                                                               
children   in   state   custody;  prescribing   the   rights   of                                                               
grandparents   related  to   child-in-   need-of-aid  cases   and                                                               
establishing  a  grandparent  priority for  adoption  in  certain                                                               
child-in-need-of-aid  cases;  modifying  adoption  and  placement                                                               
procedures  in  certain  child-in-  need-of-aid  cases;  amending                                                               
treatment service requirements for  parents involved in child-in-                                                               
need-of-aid proceedings;  amending Rules  3 and 18,  Alaska Child                                                               
in  Need  of  Aid  Rules  of  Procedure;  and  providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
3:19:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to adopt  the  proposed  committee                                                               
substitute  (CS)  for  SSHB  53,  labeled  24-LS0251\X,  Mischel,                                                               
3/30/05,  as the  working document.   There  being no  objection,                                                               
Version X was before the committee.                                                                                             
                                                                                                                                
3:20:07 PM                                                                                                                    
                                                                                                                                
RYNNIEVA  MOSS,  Staff  to Representative  John  Coghill,  Alaska                                                               
State  Legislature,  explained  the  changes made  to  HB  53  in                                                               
Version  Y.   She noted  that the  amendments recommended  by the                                                               
Department  of  Law  [DOL]  had  been  incorporated  with  a  few                                                               
exceptions.   She  explained that  Section 1  was split  into two                                                               
sections, and these sections build  a bridge between the guardian                                                               
statutes, the  adoption statutes,  and the Child  in Need  of Aid                                                               
(CINA)  statutes  as  they  pertain to  an  adult  family  member                                                               
getting guardianship.   She noted that Section  4 originally said                                                               
that if  an adult  family member  had cared for  a child  for two                                                               
years he/she  would get preference  in an adoption,  however this                                                               
has been changed to 12 consecutive months.                                                                                      
                                                                                                                                
MS. MOSS  turned to Section 5  and explained that it  mirrors the                                                               
language  [HB  114]  dealing  with  voluntary  relinquishment  of                                                               
parental  rights.    She  said,   "On  behalf  of  Representative                                                               
Coghill, I  would really  like to express  our gratitude  to [the                                                               
House State  Affairs Standing  Committee] and  all the  work they                                                               
put  into  HB 114.    That  bill is  folded  into  HB 53  in  its                                                               
entirety, with no  changes."  Section 10, at the  request of DOL,                                                               
tightens up the  provisions for a jury trial,  which she remarked                                                               
would ensure that  jury trials were available  for termination of                                                               
parental rights, and  "another section of [AS  47.10] which makes                                                               
the  determination   of  incarceration  is  grounds   enough  for                                                               
termination of parental rights."                                                                                                
                                                                                                                                
MS.  MOSS turned  to  Section  15 and  noted  that that  language                                                               
"interested person"  has been changed to  "non-party adult family                                                               
member" in order  to make it clear that parties  to the CINA case                                                               
are eligible  for public counsel,  but non-party adults  are not.                                                               
Section  16 was  changed  such that  the  mandatory language  for                                                               
foster parents being  mentors was altered to  language that would                                                               
merely encourage  it.  She explained  that in the original  HB 53                                                               
there was  a separate subsection  for parental consent  for drugs                                                               
to treat mental  health disorders; the new Section  17 folds this                                                               
in to  the original major  medical provision that  already exists                                                               
in statute.                                                                                                                     
                                                                                                                                
MS. MOSS pointed out that  DOL recommended that those entities to                                                               
which confidential information can  be disclosed should include a                                                               
review  panel  that  might  be  created  by  a  governor  or  the                                                               
legislature,  which was  added to  Section 26.   She  stated that                                                               
Section  31   provides  for  a  grievance   system  in  statutory                                                               
language;  it  allows  for the  regulatory  process  to  actually                                                               
design the nuts and bolts of  the system.  She surmised that this                                                               
would allow  for more public  input, public hearings,  and public                                                               
comment.   She turned to Section  36 and explained that  it would                                                               
cleanup awkward  language dealing with foster  homes, foster home                                                               
licensing, and family  homes who become foster  homes; she opined                                                               
that this would  make sure that family members  who became foster                                                               
parents would still have a priority for placement.                                                                              
                                                                                                                                
MS. MOSS said  that Section 50 changes the age  group for which a                                                               
transition plan would be prepared;  currently it's 16-21 years of                                                               
age  and, at  the request  of DOL,  the bill  would change  it to                                                               
cover people  ages 16-23 years of  age.  She continued,  "The two                                                               
areas  of  contention  that  will  be  discussed  in  [the  House                                                               
Judiciary Standing  Committee] ... [are]  the jury trial  and the                                                               
construction language. ...  I think we're one step  closer to the                                                               
possibility of having at least  some jury trials."  She remarked,                                                               
"What we may discuss in  [the House Judiciary Standing Committee]                                                               
is when a judge terminates  parental rights on a preponderance of                                                               
evidence, the parents would have a right to a jury trial."                                                                      
                                                                                                                                
3:25:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  stated that she saw  a typographical error                                                               
on one of  the handouts she had from a  previous meeting, and she                                                               
asked if that had been remedied in Version X.                                                                                   
                                                                                                                                
MS.  MOSS  replied  that  both  Legislative  Legal  and  Research                                                               
Services and  DOL had gone over  Version X, so she  was sure that                                                               
the typo had been fixed.                                                                                                        
                                                                                                                                
CHAIR WILSON pointed  out that the typo had indeed  been fixed in                                                               
Version X.                                                                                                                      
                                                                                                                                
3:27:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHN  COGHILL, Alaska State  Legislature, sponsor,                                                               
commented that  he is  willing to pull  the jury  trial provision                                                               
out of the bill, and stated that  he is open to making changes as                                                               
the bill  progresses.  He  noted, "There  are some things  in the                                                               
bill  that  I think  already  give  us  some comfort  level,  for                                                               
example:  we have  opened up  some  of the  court proceedings,  I                                                               
think, and given some guidelines to  that.  And we're allowing an                                                               
oversight board ... that will be formulated under regulations."                                                                 
                                                                                                                                
CHAIR WILSON stated that one of  her concerns is that if everyone                                                               
got  a jury  trial it  would cost  the state  a lot  of time  and                                                               
expense.                                                                                                                        
                                                                                                                                
REPRESENTATIVE COGHILL  said that it wasn't  his expectation that                                                               
every parental right termination would go to a jury trial.                                                                      
                                                                                                                                
3:29:51 PM                                                                                                                    
                                                                                                                                
MS.  MOSS  commented  that  one  of  the  things  that  has  been                                                               
discussed over  a number  of years is  the disparity  between the                                                               
Indian Child  Welfare Act (ICWA)  and CINA.   She said,  "ICWA is                                                               
clear and convincing evidence to  terminate parental rights; CINA                                                               
is  preponderance of  the evidence.  ... Discussing  this trigger                                                               
point  would be  one way  to bring  that level  of proof  on CINA                                                               
equal with ICWA."                                                                                                               
                                                                                                                                
3:30:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCGUIRE said  that  one of  the  things that  has                                                               
happened as a result of ICWA  and that high standard is that more                                                               
and more  Indian and Native  Alaskan children are  staying within                                                               
their  original   family  unit,  including  aunts,   uncles,  and                                                               
grandparents.  She said:                                                                                                        
                                                                                                                                
     That was  the policy reason  behind ICWA and  that high                                                                    
     standard  of  clear  and convincing  evidence,  and  in                                                                    
     point of  fact, it's worked.  ... You want to  get kids                                                                    
     out  of places  where  they're not  safe, but  wherever                                                                    
     possible,  ... try  to  keep them  placed  as close  as                                                                    
     possible to that family unit  that they're connected to                                                                    
     in some way.                                                                                                               
                                                                                                                                
REPRESENTATIVE  COGHILL responded,  "That is  exactly the  point,                                                               
plus  many of  the  things  that we're  doing  in  this bill  are                                                               
creating a  more open process,  a clearer line of  authority, ...                                                               
but also recognition that the  family needs to be more thoroughly                                                               
involved."                                                                                                                      
                                                                                                                                
3:32:32 PM                                                                                                                    
                                                                                                                                
SCOTT TRAFFORD CALDER commented that  he is a parent in Fairbanks                                                               
and has  been interested in these  issues for the last  12 years,                                                               
since  his son  was "essentially  kidnapped and  tortured by  the                                                               
Department of Health and Social Services."  He continued:                                                                       
                                                                                                                                
     So obviously  I'm very  interested in  this legislation                                                                    
     and  I  think  I've  established my  credibility  as  a                                                                    
     careful reader.  And I have  to say that there were two                                                                    
     other  people here  earlier who  were so  upset by  the                                                                    
     chair's  decision not  to hear  public testimony  today                                                                    
     that they left,  so I think there might  be some people                                                                    
     expecting 'nasty grams' for that.                                                                                          
                                                                                                                                
     I  have not  previously testified  on this  bill, so  I                                                                    
     think  that  it's  appropriate  that  I  be  given  the                                                                    
     opportunity to  speak to the  committee.  And  I regret                                                                    
     that more  public process and more  discussion and more                                                                    
     involvement with the people who  are most interested in                                                                    
     this  has  not  taken  place.   At  the  same  time,  I                                                                    
     certainly   appreciate   Representative   Coghill   and                                                                    
     Rynnieva Moss for their diligence  in this subject area                                                                    
     over most  of the  years that I  have been  diligent in                                                                    
     this subject area.  And so  I have a lot of respect and                                                                    
     appreciation for them bringing this forward.                                                                               
                                                                                                                                
MR. CALDER continued:                                                                                                           
                                                                                                                                
     So I'm for this  bill.  I have to say  though that as a                                                                    
     somewhat more  than casual observer and  a minor expert                                                                    
     on this  subject, I'm completely  baffled by the  20 or                                                                    
     so pages  of amendments  this time, plus  the 10  or so                                                                    
     pages of amendments  the last time, and a new  CS.  But                                                                    
     I appreciate  that the process isn't  always simple and                                                                    
     easy, so  I'm willing  to go  with that.   And  I think                                                                    
     that   it's  very   appropriate   that  the   committee                                                                    
     favorably  consider this  bill and  pass it  along with                                                                    
     excellent recommendations.                                                                                                 
                                                                                                                                
MR. CALDER continued:                                                                                                           
                                                                                                                                
     At  every  possible   opportunity,  I  would  encourage                                                                    
     members  of the  legislature generally  to regard  this                                                                    
     subject  area  as a  matter  of  human rights  for  the                                                                    
     people who  have been harmed,  or who may be  harmed in                                                                    
     the future,  by improper actions by  the administration                                                                    
     of  state government.   This  is the  highest order  of                                                                    
     responsibility and authority,  and potential danger for                                                                    
     citizens  that can  be  manifested  by government:  the                                                                    
     interference with  parent-child relationships.   And so                                                                    
     if there  is ever any  doubt in your mind  or confusion                                                                    
     about which  way to  go on any  principle, I  would ask                                                                    
     you  to err  on the  side of  human rights  and to  not                                                                    
     shield   yourself,  or   ...   negligently  avoid   the                                                                    
     historical facts of this situation.   I would encourage                                                                    
     you to become more informed about these subjects.                                                                          
                                                                                                                                
3:36:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON commented that  oral testimony is no more                                                               
compelling than a  letter, email, or public opinion  message.  He                                                               
then defended  the chair  by saying that  she has  provided ample                                                               
time [for  public testimony].   He noted  that the  House Health,                                                               
Education  and Social  Services Standing  Committee is  the first                                                               
committee of referral for HB 53.   He highlighted that the public                                                               
can track legislation and scheduled  hearings through their local                                                               
newspaper and  the legislature's  Bill Action and  Status Inquiry                                                               
System  (BASIS) on  the Internet.   He  encouraged people  not to                                                               
wait until the last minute to become involved.                                                                                  
                                                                                                                                
CHAIR WILSON closed public testimony.                                                                                           
                                                                                                                                
3:37:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  moved to  report the  proposed committee                                                               
substitute for  SSHB 53,  labeled 24-LS0251\X,  Mischel, 3/30/05,                                                               
out  of   committee  with  individual  recommendations   and  the                                                               
accompanying  fiscal notes.   There  being  no objection,  CSSSHB                                                               
53(HES) was reported from the  House Health, Education and Social                                                               
Services Standing Committee.                                                                                                    
                                                                                                                                
HB 111-MEDICAID COVERAGE FOR BIRTHING CENTERS                                                                                 
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE BILL NO.  111, "An Act adding birthing centers  to the list                                                               
of health  facilities eligible for payment  of medical assistance                                                               
for needy persons."                                                                                                             
                                                                                                                                
3:38:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HARRY  CRAWFORD,  Alaska  State  Legislature,  as                                                               
sponsor, explained  that HB  111 would  give uninsured  women the                                                               
same choice as  insured women to have their babies  at a birthing                                                               
center, attended  by a midwife.    He pointed out  that presently                                                               
Medicaid pays  for hospital  births and  doctors; the  bill would                                                               
allow Medicaid  to pay  for births at  birthing centers  as well.                                                               
He  commented that  the bill  would save  Medicaid money  because                                                               
doctors and hospitals cost more than birthing centers.                                                                          
                                                                                                                                
3:41:30 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  asked whether the department  estimated any savings                                                               
from this.  She noted that there was a zero fiscal note.                                                                        
                                                                                                                                
REPRESENTATIVE CRAWFORD replied that  the state has no experience                                                               
to  draw on  and thus  can't estimate  any savings.   However,  a                                                               
study in California showed a 22 percent savings rate.                                                                           
                                                                                                                                
3:42:39 PM                                                                                                                    
                                                                                                                                
BARBARA  NORTON,  Certified  Nurse  Midwife  (CNM);  Part  Owner,                                                               
Geneva  Woods  Birth Center,  clarified  that  Medicaid pays  for                                                               
midwife services, but does not pay the facility fee.  She said:                                                                 
                                                                                                                                
     We  really need  to encourage  the use  of midwives  in                                                                    
     this  state.    The  State of  Florida  passed  a  bill                                                                    
     several years ago  to say that by 2005,  they wanted 25                                                                    
     percent of  their births  attended by  midwives because                                                                    
     there  was significant  cost savings.    And I  believe                                                                    
     that they  have instituted that. ...  Approximately 14-                                                                    
     15  percent of  births in  this state  are attended  by                                                                    
     midwives.    And just  to  compare  a Cesarean  section                                                                    
     rate:  ...  the  Cesarean  section rate  right  now  at                                                                    
     Providence Hospital  is 33 percent and  growing because                                                                    
     doctors as refusing  to do a vaginal  birth for someone                                                                    
     who's  had a  Cesarean section  once.   So  now all  of                                                                    
     those women  are becoming  repeat Cesarean  sections at                                                                    
     twice the cost  to Medicaid.  Midwives  have a Cesarean                                                                    
     section  rate in  this state  of between  3-10 percent,                                                                    
     and   physicians   average  probably   20-50   percent,                                                                    
     depending  upon which  physician you're  talking about.                                                                    
     So  preventing that  first Cesarean  section is  a huge                                                                    
     savings.  And using midwives  is a very significant way                                                                    
     to prevent that first Cesarean section.                                                                                    
                                                                                                                                
MS. NORTON continued, "The other  issue is just offering families                                                               
choice:  we're not  bringing  high risk  people  to the  birthing                                                               
center;  we're  only bringing  low-risk  people  to the  birthing                                                               
center."                                                                                                                        
                                                                                                                                
MARIBETH  GARDNER,  Family  Nurse  Practitioner;  Nurse  Midwife,                                                               
testified   in   support   of   Medicaid   reimbursing   birthing                                                               
facilities.  She stated that she  has attended births at home, at                                                               
birth  centers, and  in  hospitals.   She  commented that  births                                                               
attended in  nationally certified birth centers  or birth centers                                                               
that  meet  the  National Association  of  Childbirthing  Centers                                                               
(NACC) are a nice alternative for low-risk women.                                                                               
                                                                                                                                
JACK  NIELSON, Executive  Director,  Rate Review,  Office of  the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
stated that  he works  for the  DHSS Medicaid  program.   He said                                                               
that DHSS is neutral  on the bill, but would like  to raise a few                                                               
points.  He said:                                                                                                               
                                                                                                                                
     The bill as  it's written now adds  birthing centers to                                                                    
     the  list of  facilities whose  Medicaid payment  rates                                                                    
     are  required by  statute to  be  established based  on                                                                    
     reasonable  costs incurred  by the  facility.   But ...                                                                    
     the  way  it's written  right  now  doesn't really  add                                                                    
     birthing centers  as a  Medicaid service  authorized by                                                                    
     state  law  to  be   offered  in  the  Alaska  Medicaid                                                                    
     program.   The  list of  authorized services  is in  AS                                                                    
     47.07.030.  Adding the birthing  centers to the list of                                                                    
     authorized  services  in   [AS  47.07.030]  would  make                                                                    
     legislative  intent   absolutely  clear   and  possibly                                                                    
     assist  the department  in  dealing  with getting  this                                                                    
     type of  service approved by the  federal government as                                                                    
     a  Medicaid   service  so  we   can  get   the  federal                                                                    
     government to share in the cost.                                                                                           
                                                                                                                                
MR. NIELSON continued:                                                                                                          
                                                                                                                                
     There  is a  question whether  birthing centers  are an                                                                    
     allowable Medicaid service  that the federal government                                                                    
     will  participate in  financially.   A few  states have                                                                    
     obtained  federal participation  in  the  past but  the                                                                    
     federal  criteria really  aren't clear.   And  recently                                                                    
     it's  become more  and more  difficult to  gain federal                                                                    
     approval for  provider types that are  not specifically                                                                    
     defined  in  federal  statutes and  regulations.    The                                                                    
     department would, of course,  make every effort to gain                                                                    
     federal approval.  However, if  we were not successful,                                                                    
     payments  to birthing  centers would  be state  general                                                                    
     fund only payments rather than  payments matched by the                                                                    
     federal Medicaid  program. ... [In 2006]  that match is                                                                    
     going to  be around  50 percent.   The type  of federal                                                                    
     approval that  we're able to  gain could  also somewhat                                                                    
     drive  the methodology  for  calculating payment  rates                                                                    
     that we would  end up using for birthing  centers.  So,                                                                    
     until  we  have a  written  approval  from the  federal                                                                    
     agency, we won't know for  sure what they would have to                                                                    
     say about that.                                                                                                            
                                                                                                                                
     In 2004  there were close  to 10,000 births  in Alaska;                                                                    
     approximately  50  percent   of  those  were  Medicaid.                                                                    
     Overall in the state,  ... historically about 3 percent                                                                    
     of births  are in birthing  centers. ... In  some areas                                                                    
     where there  are birthing centers, the  birthing center                                                                    
     rates  are  much  higher.  ...   Just  looking  at  the                                                                    
     statewide statistic  though, we'd  be looking  at maybe                                                                    
     150 or so Medicaid births  per year in birthing centers                                                                    
     if this provider type were adopted by Medicaid.                                                                            
                                                                                                                                
MR. NIELSON continued:                                                                                                          
                                                                                                                                
     Some  of the  factors to  consider in  estimating costs                                                                    
     and savings  on adding this  new provider type:  on the                                                                    
     savings  side, we  did find  a study  that was  done in                                                                    
     California  ... where  paying for  these facility  fees                                                                    
     for birthing  centers instead of hospitals  resulted in                                                                    
     a  22 percent  savings  overall in  facility fees,  and                                                                    
     overall  to the  ...  California  Medicaid program,  it                                                                    
     basically  resulted  in a  7  percent  savings, if  you                                                                    
     include doctor  fees versus midwife fees....   So there                                                                    
     are  studies out  there that  show  some savings  along                                                                    
     those  lines.   Certainly the  facilities would  have a                                                                    
     lower cost;  the space, the staff,  the supplies, would                                                                    
     be  lower cost.   As  was mentioned  earlier, fewer  C-                                                                    
     sections  would   likely  happen  using   the  birthing                                                                    
     centers.   Probably less  epidural anesthesia  would be                                                                    
     used, and  so all of  these things  are sort of  on the                                                                    
     savings side of the equation.                                                                                              
                                                                                                                                
MR. NIELSON continued:                                                                                                          
                                                                                                                                
     On the cost  side of the equation we  have things like:                                                                    
     we  would  have  to   change  our  Medicaid  management                                                                    
     information system; that costs  about $130,000 to put a                                                                    
     new provider  type in.   We could have some  births now                                                                    
     that  are happening  at  home that  would  move to  the                                                                    
     birthing center;  we would have increased  costs there.                                                                    
     In the  case where we  have hospital transfers,  we may                                                                    
     end  up  paying  both  the   birthing  center  and  the                                                                    
     hospital  for  those  situations,  and  Medicaid  would                                                                    
     likely  have to  pay transportation  costs between  the                                                                    
     two....   Hospital costs, of  course, are  different by                                                                    
     different  area of  the  state.   There  is always  the                                                                    
     potential of  a slight  chance of  a bad  outcome where                                                                    
     the patient isn't in the  hospital while they're giving                                                                    
     birth and  so they're  not right  on site  if something                                                                    
     bad  were  to  happen.   In  the  hospital  study,  the                                                                    
     birthing  centers  that were  studied  were  part of  a                                                                    
     large health  network, either owned by  an organization                                                                    
     that had a  hospital and various levels  of care within                                                                    
     it, or ...  the hospital is a member of  a network with                                                                    
     a firmly established referral process....                                                                                  
                                                                                                                                
     This  regulation would  require the  department to  set                                                                    
     the  rates for  the  birthing centers  based on  actual                                                                    
     birthing center  costs.   We don't  know for  sure what                                                                    
     those costs  are at this  point; we would have  to find                                                                    
     out and set the rates  accordingly.  But that's sort of                                                                    
     an unknown at this point.   Presumably it would be less                                                                    
     than a hospital cost, but  we just don't know how much.                                                                    
     ...                                                                                                                        
                                                                                                                                
     The federal  government may have  a say in the  type of                                                                    
     reimbursement system  we use.   The  federal government                                                                    
     may not  participate, although we would  work certainly                                                                    
     very  hard  to try  to  make  sure that  happened.  ...                                                                    
     Alaska Medicaid  babies may  be more  at risk  than the                                                                    
     California study;  you know, we've  got a lot  of rural                                                                    
     communities....                                                                                                            
                                                                                                                                
CHAIR WILSON  inquired as  to the number  of birthing  centers in                                                               
the state.                                                                                                                      
                                                                                                                                
MR. NIELSON  replied that there  are eight.  In  further response                                                               
to Chair Wilson, Mr. Nielson  specified that most of the birthing                                                               
centers  are located  around population  centers.   Upon  further                                                               
questioning,  Mr. Nielson  said  that there  are  at least  three                                                               
states for which birthing centers are covered by Medicaid.                                                                      
                                                                                                                                
CHAIR WILSON  surmised that  if there  are at  least a  few other                                                               
states,  the federal  government would  probably cover  Alaska as                                                               
well.                                                                                                                           
                                                                                                                                
3:57:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CRAWFORD expressed his  willingness to address any                                                               
problems or concerns with the bill through amendments.                                                                          
                                                                                                                                
3:59:32 PM                                                                                                                    
                                                                                                                                
TORA  GERRICK,  Part  Owner, Midwives  Birth  Center,  commented,                                                               
"Without this  bill we're definitely  sending a  negative message                                                               
to our working class and underinsured  people in Alaska.  I think                                                               
that we're  telling them  where they have  to have  their babies,                                                               
and  frankly,  I think  it's  a  subtle form  of  discrimination,                                                               
economic  discrimination  at best."    She  highlighted that  her                                                               
facility  participates in  the community  in a  variety of  ways,                                                               
including  the YWCA  Early Breast  and Cervical  Cancer Screening                                                               
program that offers  early cancer screening for  low income women                                                               
in  Alaska.   She  also  highlighted that,  to  the  best of  her                                                               
knowledge,  all of  the  birth  centers in  Alaska  are owned  by                                                               
Alaskan women.   Therefore, by supporting this  bill, the [state]                                                               
would  also be  supporting  locally owned  businesses, and  would                                                               
keep Medicaid  monies in the  state.   In response to  an earlier                                                               
statement  by Mr.  Neilson, she  clarified that  women who  can't                                                               
afford  the   birth  center  facility  fees   aren't  necessarily                                                               
choosing home births.  In fact, she  said she has seen them go to                                                               
the  hospital  instead.    She also  reiterated  that  the  birth                                                               
centers only offer  services to low-risk women,  and so high-risk                                                               
women would already be birthing in hospitals.                                                                                   
                                                                                                                                
4:02:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  commented that there  is no one  on Prince                                                               
of Wales Island to deliver  babies, and therefore the women there                                                               
have to  travel to Ketchikan about  two weeks prior to  their due                                                               
date to deliver.  She asked if those costs wouldn't be cut as                                                                   
well if there were birthing centers in rural areas.                                                                             
                                                                                                                                
CHAIR WILSON replied that she wasn't sure that Medicaid covered                                                                 
those costs.  She noted that no babies are delivered in Wrangell                                                                
anymore due to insurance costs.                                                                                                 
                                                                                                                                
4:04:27 PM                                                                                                                    
                                                                                                                                
KITTY ERNST commented  that she is not an Alaskan,  but is in the                                                               
state  for a  meeting being  conducted on  women's health  by the                                                               
local chapter  of the  American College of  Nurse Midwives.   She                                                               
stated:                                                                                                                         
                                                                                                                                
     [House Bill 111] speaks primarily  to a cost savings of                                                                    
     only $40,000 for 100 births  in the birth center, which                                                                    
     ... it is  alleged could easily be offset  by one birth                                                                    
     center  with  serious  complications.    This  sort  of                                                                    
     infers  that  serious   complications  don't  occur  in                                                                    
     hospitals, and they do, and  they also have added costs                                                                    
     when  serious complications  occur.   Cesarean sections                                                                    
     ...  result  from  a serious  complication.    Neonatal                                                                    
     intensive    care    units    result    from    serious                                                                    
     complications.    Both   of  these  complications,  for                                                                    
     example,  are  far  less  ...  in  a  birthing  center,                                                                    
     because  you're  dealing  with a  low-risk  population.                                                                    
     But it is  significant that in a  national birth center                                                                    
     study,  the Cesarean  rate was  4 percent  among 17,000                                                                    
     birth  center  women.    I   think  that  represents  a                                                                    
     significant cost  savings.   When we  look at  the fact                                                                    
     that the Cesarean section rate  in this country in 2003                                                                    
     has climbed to an all-time  high of 28 percent and much                                                                    
     higher  in certain  locales.   And the  prognosticators                                                                    
     are telling  us it's  going to be  50 percent  by 2010.                                                                    
     And   that's  attributed   to  ...   elective  Cesarean                                                                    
     sections, which means it does  not have to be a medical                                                                    
     indication to  have this  major surgery,  and secondly,                                                                    
     the virtual  national shutdown of  any place to  have a                                                                    
     VBAC, which is a  vaginal birth after Cesarean section.                                                                    
     And both ... the  American College of Obstetricians and                                                                    
     Gynecologists  and   the  American  College   of  Nurse                                                                    
     Midwives have strongly stated that  the solution to the                                                                    
     problem is  to reduce  the number of  primary Caesarian                                                                    
     sections.  And  that is exactly what  the birth centers                                                                    
     do. ...                                                                                                                    
                                                                                                                                
MS. ERNST continued:                                                                                                            
                                                                                                                                
     I really urge  you not to take a short  sighted look in                                                                    
     your  decision on  whether or  not  to reimburse  birth                                                                    
     centers  because my  30 year  experience in  working to                                                                    
     establish and demonstrate  and evaluate this innovation                                                                    
     in the  delivery of health care  ... is that we  need a                                                                    
     lot  more evidence  before we  shut these  places down.                                                                    
     And if you don't pay  a facility for its services, it's                                                                    
     going to shut  down. ... All the other  things are also                                                                    
     important, such  as giving choice to  Medicaid mothers.                                                                    
     ...  We  have the  experience  ...  that the  time  and                                                                    
     education  and  intensive  care given  by  midwives  in                                                                    
     birthing centers  empower these  women to  take control                                                                    
     of their lives.                                                                                                            
                                                                                                                                
MS. ERNST shared  a few anecdotes regarding  empowerment of women                                                               
at birth  centers.   She concluded by  saying that  birth centers                                                               
are safe  and there is a  97 percent satisfaction rate  among the                                                               
women who use birth centers.                                                                                                    
                                                                                                                                
4:13:22 PM                                                                                                                    
                                                                                                                                
KAYE KANNE, CDM, Executive Director,  Juneau Family Birth Center,                                                               
pointed  out  that she  recently  calculated  that on  average  a                                                               
hospital facility  fee is about  $2,500 more than a  birth center                                                               
facility fee,  not counting  any additional  services.   She also                                                               
noted  that in  2004, an  estimated 186  women on  Denali KidCare                                                               
have  had babies  at Alaskan  birth centers.   She  said that  an                                                               
additional 85 women  were not able to pay the  facility fee.  She                                                               
calculated  that  the state  paid  over  $200,000 additional  for                                                               
those  85 women  to  go  to the  hospital  instead  of the  birth                                                               
center.   Noting  that  the  hospital in  Juneau  has a  Cesarean                                                               
section rate  of 40 percent while  the local birth center  has an                                                               
eight percent  rate, she  commented that many  of those  85 women                                                               
probably ended up  having Cesarean section, which  cost the state                                                               
tens of thousands of additional dollars.                                                                                        
                                                                                                                                
MS.  KANNE stated  that even  if the  federal government  did not                                                               
support this, the cost to the  state of paying 100 percent of the                                                               
birth center facility  fees is still less than  paying 50 percent                                                               
of the  hospital facility  fees.   In response  to Representative                                                               
Cissna's  earlier  question, she  replied  that  many women  from                                                               
rural areas come  to Juneau to deliver their babies,  and if they                                                               
have Denali  KidCare coverage, this  will pay for the  travel and                                                               
lodging  expenses, whether  the women  have their  babies at  the                                                               
birth  center  or at  the  hospital.    However,  if there  is  a                                                               
hospital in the rural area,  Denali KidCare will cover the mother                                                               
at  that hospital,  but  not cover  her to  travel  to Juneau  to                                                               
deliver her baby.                                                                                                               
                                                                                                                                
MS. KANNE replied to an earlier remark by Mr. Nielson:                                                                          
                                                                                                                                
     I have  never seen anybody  have a home birth  and then                                                                    
     go to  a birth  center birth; once  they've had  a home                                                                    
     birth,  they're  always going  to  have  a home  birth.                                                                    
     What I  do see is women  who choose to have  a hospital                                                                    
     birth because they can't afford  the facility fee.  One                                                                    
     thing we  do at a  nonprofit birth center is  we donate                                                                    
     that facility  fee if people  cannot afford to  pay, or                                                                    
     we offer  them a sliding  scale.   And it does  make it                                                                    
     hard  for our  ... nonprofit  birth center  to pay  the                                                                    
     bills.  And  I think it is really  important to support                                                                    
     our birth  centers and  to keep our  doors open;  we do                                                                    
     need to be on an  even playing field with the hospitals                                                                    
     as far as getting reimbursement from Medicaid.                                                                             
                                                                                                                                
CHAIR  WILSON remarked  that she  assumes that  midwives' charges                                                               
are less than the doctors' charges.                                                                                             
                                                                                                                                
MS.   KANNE  replied,   "Midwives   charges  are   less  than   a                                                               
physicians',  and Medicaid  pays midwives  at a  lower rate  than                                                               
they  pay  physicians.  ...  We  do get  paid  by  Medicaid,  but                                                               
probably we get ... 60 percent of what physicians get."                                                                         
                                                                                                                                
4:19:44 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON closed public testimony.                                                                                           
                                                                                                                                
4:19:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON moved  to  adopt  Conceptual Amendment  1,                                                               
which  would make  the provisions  of Section  1 contingent  upon                                                               
approval of  matching funding from  the federal Medicaid.   There                                                               
being no objection, Conceptual Amendment 1 was adopted.                                                                         
                                                                                                                                
4:20:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KOHRING  commented that  he thinks  it is  good to                                                               
encourage people to attend birthing  centers, however, he stated,                                                               
"From a philosophical  standpoint, I just am  concerned about the                                                               
fact that we're  encouraging use of Medicaid monies  for what you                                                               
had described  as not a  sickness...."  He questioned  the wisdom                                                               
of  using Medicaid  dollars when  "if they're  young, capable  of                                                               
producing children and they're healthy,  they ought to figure out                                                               
a way to  pay their own bills."   He said, "I  think that perhaps                                                               
we ought  to go  the other direction  and not  encourage Medicaid                                                               
payments  either  in these  kind  of  facilities or  in  hospital                                                               
situations, and  perhaps that will  be an incentive for  women to                                                               
go to  these kind  of facilities."   He  continued, "My  point is                                                               
that maybe we ought to discourage  the use of Medicaid monies and                                                               
not encourage the use of Medicaid monies."                                                                                      
                                                                                                                                
4:22:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CRAWFORD  clarified  that  this bill  is  not  to                                                               
encourage more people to use  Medicaid, but to allow those people                                                               
who are already on Medicaid to use a lower cost facility.                                                                       
                                                                                                                                
4:23:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON moved to report  HB 111, as amended, out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSHB  111(HES)  was                                                               
reported  from the  House Health,  Education and  Social Services                                                               
Standing Committee.                                                                                                             
                                                                                                                                
HB 220-MENTAL HEALTH PATIENT RIGHTS:STAFF GENDER                                                                              
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 220,  "An Act relating  to mental  health patient                                                               
rights and to  a hospital's duty to provide choice  of the sex of                                                               
staff providing intimate care to a mental health patient."                                                                      
                                                                                                                                
4:24:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to adopt  the  proposed  committee                                                               
substitute  (CS)  for  HB   220,  labeled  24-LS0667\Y,  Mischel,                                                               
3/31/05,  as  the  working  draft.   There  being  no  objection,                                                               
Version Y was before the committee.                                                                                             
                                                                                                                                
4:25:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LES  GARA,  Alaska  State  Legislature,  sponsor,                                                               
said,  "House Bill  220 is  about the  basic rights  of our  most                                                               
vulnerable patients  to be treated  with dignity."   He explained                                                               
that the bill would require  that mental health patients have the                                                               
opportunity  to  choose the  gender  of  the person  who  bathes,                                                               
dresses, or  otherwise cares  for them  in an  intimate way.   He                                                               
presented  examples  of  particular  instances  in  which  female                                                               
patients have expressed  discomfort in being cared for  by a male                                                               
staff member.  He pointed out that there are news articles                                                                      
regarding this issue in the committee packets.                                                                                  
                                                                                                                                
REPRESENTATIVE GARA said that a  number of mental health advocacy                                                               
groups have  read the  bill.  In  fact, the  National Association                                                               
for the  Mentally Ill has said,  "The right to choose  a same-sex                                                               
care  provider while  in a  vulnerable mental  state should  be a                                                               
state mandated right."  He continued:                                                                                           
                                                                                                                                
     The Mental Health Consumer Web  supports the bill.  The                                                                    
     Law   Project   for   Psychiatric  Rights   [and]   the                                                                    
     Disability Law Center  support the bill.   And the bill                                                                    
     essentially parallels  a policy  that has  been adopted                                                                    
     at  a  facility  in  Maine, the  Bangor  Mental  Health                                                                    
     Facility; they  have a provision  like this.   A number                                                                    
     of concerns have been raised  by some of the facilities                                                                    
     in  the state.    We've satisfied  I  believe about  98                                                                    
     percent   of  the   concerns.     [Alaska   Psychiatric                                                                    
     Institute  (API)] still  has  some  concerns about  the                                                                    
     bill that,  frankly, you'll either support  the bill or                                                                    
     you'll support API's position that  we shouldn't have a                                                                    
     bill like this, and we can't get past API's concerns.                                                                      
                                                                                                                                
     We've tried  to make  the bill  flexible so  it doesn't                                                                    
     require that  any facility  hire any  additional staff.                                                                    
     If a ... female patient  asks for a female provider and                                                                    
     no female  provider is available,  that just has  to be                                                                    
     documented on the chart.   We've tried to put as little                                                                    
     burden  as  possible  on professional  staff  so  if  a                                                                    
     female  patient  ... wants  a  female  staff member  to                                                                    
     bathe  that person,  the  female  staff member  doesn't                                                                    
     have  to  be  of  a particular  license  or  particular                                                                    
     profession; it's up to the facility.                                                                                       
                                                                                                                                
REPRESENTATIVE GARA continued:                                                                                                  
                                                                                                                                
     If  [the  facility] can't  provide  a  provider of  the                                                                    
     appropriate gender, then  all they have to do  is get a                                                                    
     licensed staff  member of  the other  gender to  do the                                                                    
     bathing;  just  so you  have  a  licensed staff  member                                                                    
     there in  that case.  But  then even ... if  there's no                                                                    
     staff member  that's available to satisfy  the concerns                                                                    
     of the patient,  ... then all you have to  do is say in                                                                    
     the chart,  "We had  no female staff  members available                                                                    
     that  day."  ... So  you  don't  have to  hire  anybody                                                                    
     additionally; you just  have to put it in  the chart as                                                                    
     to why you couldn't comply.                                                                                                
                                                                                                                                
     One of the mental  health facilities raised the concern                                                                    
     that  sometimes you  have a  mental health  patient who                                                                    
     would inappropriately  ask for  a particular  gender of                                                                    
     provider,  maybe somebody  with  a sexually  aggressive                                                                    
     condition or something  like that, and so  we've put in                                                                    
     the  bill that  if it  would be  inappropriate for  the                                                                    
     patient's  treatment to  let  them  choose what  gender                                                                    
     person  treats  them then  that's  fine  too; then  you                                                                    
     don't have to comply with the provisions of the bill.                                                                      
                                                                                                                                
REPRESENTATIVE GARA continued:                                                                                                  
                                                                                                                                
     [In Version  Y] we  made about  six changes  to address                                                                    
     the  concerns that  came in.  ...   We don't  want this                                                                    
     bill  to  apply  to   small  facilities  because  small                                                                    
     facilities  don't have  enough staff,  frankly, to  let                                                                    
     people  choose the  gender of  who treat  them.   So it                                                                    
     only applies  to facilities where  you have 10  or more                                                                    
     staff  members on  duty providing  mental health  care,                                                                    
     and  still they  have an  out even  then if  they don't                                                                    
     have  enough  women  or  enough   men  available  on  a                                                                    
     particular day.                                                                                                            
                                                                                                                                
REPRESENTATIVE GARA said that the  original intention of the bill                                                               
was  to require  that  the provider  be the  same  gender as  the                                                               
patient,  but it  was changed  to  allow the  patient to  decide.                                                               
However, he  noted that if  the committee preferred, he  would be                                                               
willing to  allow a  conceptual amendment to  return the  bill to                                                               
its original state, requiring the  provider to be the same gender                                                               
as  the patient.   He  commented,  "I think  we've satisfied  the                                                               
concerns  of every  mental health  facility  that's contacted  us                                                               
except for API."                                                                                                                
                                                                                                                                
4:32:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE remarked  that she thinks this  is a great                                                               
bill and  she applauds the efforts  involved.  She said  that she                                                               
prefers to  leave the  bill as is.   She inquired  as to  why the                                                               
bill only applies to patients 18 years of age or older.                                                                         
                                                                                                                                
REPRESENTATIVE GARA noted  that Alaska law says  that parents get                                                               
to make  medical care choices for  people under 18 years  of age.                                                               
He said  that the original  version applied to all  patients, and                                                               
provided  that  the parent  would  have  the  right to  make  the                                                               
request for anyone under 18.  He commented:                                                                                     
                                                                                                                                
     One of the facilities  in Anchorage made an interesting                                                                    
     point;  they  stated that  there  is  sometimes a  link                                                                    
     between  a child  who has  mental  health problems  and                                                                    
     parents  who have  mental health  problems.   And  [the                                                                    
     facility] saw a  problem with allowing a  parent with a                                                                    
     mental health problem to make  a choice like that for a                                                                    
     child with a mental health  problem.  I don't know what                                                                    
     to think  about that concern.   The majority  of mental                                                                    
     health  patients  are  adults,  and I  suppose  it's  a                                                                    
     policy  call  for  the committee.    We  were  somewhat                                                                    
     sympathetic  to the  concerns of  the  folks at  [North                                                                    
     Star Behavioral  Health System] in Anchorage  about the                                                                    
     difficulty of  dealing with the concerns  from a parent                                                                    
     for a  child who's in a  facility.  We could  go either                                                                    
     way; I  suppose we prefer  the CS  the way it  is right                                                                    
     now.                                                                                                                       
                                                                                                                                
CHAIR  WILSON pointed  out that  a spokesperson  from North  Star                                                               
Behavioral Health System was on the teleconference.                                                                             
                                                                                                                                
4:36:06 PM                                                                                                                    
                                                                                                                                
PATRICK HIGGINS,  North Star Behavioral  Health System,  began by                                                               
relating  that the  current version  of HB  220 does  address the                                                               
organization's  issues.   He  explained  that  his agency  serves                                                               
children ages  3-17, and  many of  them have  disorders involving                                                               
sexual contact issues.  He said  that the agency attempts to take                                                               
a great  deal of care  with these  issues and thus  have policies                                                               
dealing with the same-gender issue.                                                                                             
                                                                                                                                
REPRESENTATIVE MCGUIRE commented:                                                                                               
                                                                                                                                
     What  we're  dealing  with  here  then  is  probably  a                                                                    
     drafting  issue and  a legal  issue,  because ...  [it]                                                                    
     sounds  like there  aren't  any problems  accommodating                                                                    
     the  basic policy  that's contained  in  the bill,  but                                                                    
     rather  because of  an issue  of  capacity, not  having                                                                    
     achieved the age  of majority that then  you would have                                                                    
     to provide  for that  parent to  have that  choice, and                                                                    
     that's where the problem comes about.                                                                                      
                                                                                                                                
REPRESENTATIVE  MCGUIRE suggested  that  perhaps intent  language                                                               
could be included in the bill.                                                                                                  
                                                                                                                                
4:38:47 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON  stated that  sometimes  [the  gender of  the  care                                                               
provider] is  part of the  treatment plan.   She said  that there                                                               
are  instances of  children  who "like  to act  out  in front  of                                                               
somebody of the opposite sex."                                                                                                  
                                                                                                                                
REPRESENTATIVE SEATON noted  that many times children  are in the                                                               
custody of the state, and he  questioned how the state would deal                                                               
with these issues.                                                                                                              
                                                                                                                                
4:40:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  commented, "I  give great  deference and                                                               
credence to  the opinions of  like associations....  I  also give                                                               
great deference  to Providence Hospital  because of its  size and                                                               
probably  impact in  the bill  affecting it  more than  any other                                                               
facility. ... Have they talked to [Representative Gara]?"                                                                       
                                                                                                                                
REPRESENTATIVE GARA  replied that he  had been in contact  with a                                                               
number of  facilities and "we  were able  to satisfy ...  what we                                                               
considered to be  the valid concerns of many  of the facilities."                                                               
He offered  his belief that  every member [excluding API]  of the                                                               
Nursing Home  Association either  has no concerns,  hasn't stated                                                               
concerns,  or thinks  the  bill is  okay.   He  noted, "The  bill                                                               
doesn't  require  that you  ask  the  patient  what gender  of  a                                                               
provider they would like.  It would  only be if they bring it up;                                                               
they have the right to request it."   He said that if the patient                                                               
is a child  in the custody of the state,  the original bill would                                                               
have allowed the state to decide.  He further commented:                                                                        
                                                                                                                                
     Sometimes  people   are  being  treated   for  sexually                                                                    
     inappropriate conduct,  and so  the bill  provides that                                                                    
     if  it  would not  be  in  the  best interests  of  the                                                                    
     patient's treatment  ... to allow  the patient  to make                                                                    
     that  choice, ...  then the  bill  just doesn't  apply;                                                                    
     we're not going  to give people the  right to undermine                                                                    
     their own treatment.                                                                                                       
                                                                                                                                
REPRESENTATIVE ANDERSON  remarked that he would  be interested in                                                               
any  studies suggesting  that male  to male  or female  to female                                                               
staff care would  reduce abuse, "unless your intent  here is just                                                               
for the  comfort of the patient."   He then stated  that the bill                                                               
concerns  him as  a possible  "haven for  lawsuits."   Lastly, he                                                               
commented,  "[It  is intriguing],  if  you're  looking at  mental                                                               
capacity, and in this case  very diminished, I'm intrigued at how                                                               
they can have the capacity to choose gender."                                                                                   
                                                                                                                                
REPRESENTATIVE   GARA   replied  that   if   a   patient  is   so                                                               
incapacitated  that he/she  needs to  have a  guardian, then  the                                                               
guardian would make  the request.  But, he noted,  "If you're not                                                               
so incapacitated, you  just have mental health  problems, but you                                                               
don't  have a  guardian,  then you  have the  right  to make  the                                                               
request."   Regarding  Representative  Anderson's question  about                                                               
possible studies,  Representative Gara  answered that  he doesn't                                                               
think there are  any such studies.  He reiterated  that this bill                                                               
is  dealing  with "a  comfort  issue,  a  privacy issue,  it's  a                                                               
dignity  issue."    Regarding  liabilities,  Representative  Gara                                                               
responded  that the  bill doesn't  provide for  penalties or  any                                                               
specific cause of action or damages.   He again explained that if                                                               
a facility is unable to provide  the requested gender of the care                                                               
provider, the facility only needs to document this.                                                                             
                                                                                                                                
4:46:35 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  commented that nurses  and care providers  are very                                                               
aware of the importance of documentation.                                                                                       
                                                                                                                                
4:47:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  commented that  some children  have become                                                               
inappropriately sexualized by  manipulative adults, and therefore                                                               
it's best to leave  the power in the hands of  the parent and the                                                               
therapist to develop the best plan  for a child under 18 years of                                                               
age.   Having  worked as  a mental  health therapist,  she stated                                                               
that when  the state has  custody of  a child, the  state usually                                                               
listens to the advice of the professionals.                                                                                     
                                                                                                                                
4:49:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON pointed out  that subsection (c) is putting                                                               
a new  duty on the  facilities, and he  asked if the  sponsor had                                                               
spoken with  the facilities about  the bill's requirement  that a                                                               
notice be  posted in the patient  rooms.  He commented  that if a                                                               
notice  was posted  in every  room it  would probably  cause more                                                               
casual requests rather  than requests in order  to remedy genuine                                                               
problems.                                                                                                                       
                                                                                                                                
REPRESENTATIVE GARA said that no  one has raised a question about                                                               
posting the notice.  He said:                                                                                                   
                                                                                                                                
     This  is  almost a  catch-22;  if  you don't  post  the                                                                    
     notice you'll have  some patients who are  too timid to                                                                    
     request  to be  treated appropriately,  and the  notice                                                                    
     would  ...  let them  know  they  have  a right  to  be                                                                    
     treated appropriately.   On the  other hand, if  you do                                                                    
     post  the notice,  you might  have more  people request                                                                    
     them than is necessary.                                                                                                    
                                                                                                                                
4:52:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON asked if Mr. Higgins supported the bill.                                                                
                                                                                                                                
MR. HIGGINS said that North Star's issues and concerns have been                                                                
addressed by the sponsor.                                                                                                       
                                                                                                                                
HOLLY GLAESER, Director, Behavioral Health Unit, Fairbanks                                                                      
Memorial Hospital, testified that this issue should be an                                                                       
organizational issue and not a legislation issue.                                                                               
                                                                                                                                
KARL SANFORD, Chief Nursing Officer and Associate Administrator,                                                                
Fairbanks Memorial Hospital, testified in opposition to HB 220.                                                                 
He stated his belief that this is an unnecessary bill.  He said:                                                                
                                                                                                                                
     Currently all  hospitals of  any size  in the  state, I                                                                    
     believe,  are accredited  by the  Joint Commission  for                                                                    
     Hospitals nationally.   Accrediting bodies such  as the                                                                    
     [Joint Commission for Hospitals],  the state itself, as                                                                    
     well as  the mental health board,  are oversight bodies                                                                    
     which  really  are  intended  to  prevent  issues  that                                                                    
     Representative  Gara, I  believe,  has introduced  this                                                                    
     bill  to address.   Those  bodies frequently  and on  a                                                                    
     regular basis  ensure that facilities abide  by patient                                                                    
     rights, policies  within the facilities. ...  I have an                                                                    
     overall concern  about legislating response  to patient                                                                    
     complaints; I think it's a bad policy to follow. ...                                                                       
                                                                                                                                
     This   bill  overrides   my  nursing   judgment  as   a                                                                    
     professional nurse.   I'm offended  by this  because it                                                                    
     is my job as a  nurse to make an appropriate assessment                                                                    
     of the  patient upon admission  into a facility  and to                                                                    
     make  sure that  that patient's  issues are  dealt with                                                                    
     appropriately.  I believe I  have the capability, as do                                                                    
     every other  registered nurse in  the state  that takes                                                                    
     care of mental health patients.                                                                                            
                                                                                                                                
CHAIR WILSON asked Mr. Sanford if the bill would prevent him                                                                    
from conducting any services that he now gives.                                                                                 
                                                                                                                                
MR. SANFORD replied that it would not.                                                                                          
                                                                                                                                
4:56:01 PM                                                                                                                    
                                                                                                                                
DORRANCE COLLINS stated:                                                                                                        
                                                                                                                                
     I support  the passing of the  committee substitute for                                                                    
     HB 220.   I also ask that the committee  read the seven                                                                    
     support letters submitted.  House  Bill 220 is based on                                                                    
     a  Bangor, Maine  policy which  uses words  like "must"                                                                    
     and  "will."   It's  a strong  policy  and very  clear.                                                                    
     House  Bill 220  is also  very  strong.   In a  perfect                                                                    
     world we  could just send everybody  involved an e-mail                                                                    
     or a letter  and tell them to handle it.  ... It is not                                                                    
     a perfect world;  everyone has an axe to  grind.  Laws,                                                                    
     regulations,  and  guidelines  are  necessary  on  this                                                                    
     issue.                                                                                                                     
                                                                                                                                
     House  Bill 220  is fair  to the  psychiatric patients,                                                                    
     many of which have been  sexually abused, not always by                                                                    
     the  opposite gender,  which is  why gender  choice for                                                                    
     intimate care  is very  important.   House Bill  220 is                                                                    
     fair to  the institutions;  it gives them  an out.   On                                                                    
     page 2 of  the bill it says the  institutions only have                                                                    
     to  make a  good  faith effort,  then  document in  the                                                                    
     patient's records  why gender choice was  not provided.                                                                    
     That is  a huge  loophole for  any contingency  for the                                                                    
     institutions.                                                                                                              
                                                                                                                                
     Defeating this bill is only  a matter of convenience to                                                                    
     the mental  institutions.  What the  last hundred years                                                                    
     has  taught  us  is  the institutions  will  fight  for                                                                    
     convenience.   It is  much more to  the patient;  it is                                                                    
     about   not   being   degraded   or   humiliated,   and                                                                    
     maintaining some control over  your life and your body.                                                                    
     It is important  and it is doable.  We  ask that HB 220                                                                    
     be passed.                                                                                                                 
                                                                                                                                
4:58:21 PM                                                                                                                    
                                                                                                                                
FAITH MYERS testified in support of the committee substitute for                                                                
HB 220.  She stated that she is a former psychiatric patient.                                                                   
She said:                                                                                                                       
                                                                                                                                
     Over the last four years  I have testified on the issue                                                                    
     of  psychiatric  patients  not   having  the  right  to                                                                    
     gender-choice  for  hands-on  intimate care.    I  have                                                                    
     traveled  to Fairbanks,  Juneau, and  in Anchorage.   I                                                                    
     have  testified in  front of  all  relevant boards  and                                                                    
     committees.    House Bill  220  is  a patients'  rights                                                                    
     bill;  it  is necessary.    A  high percentage  of  the                                                                    
     psychiatric patients in  Alaska's mental hospitals have                                                                    
     been  sexually  abused as  children  or  adults; it  is                                                                    
     difficult to  know which gender  abused them,  which is                                                                    
     why  it is  important  to let  the  patient choose  the                                                                    
     gender   of  the   staff  they   feel  most   safe  and                                                                    
     comfortable with.   This is why gender  choice of staff                                                                    
     is   more  preferable   than  same-sex   of  staff   in                                                                    
     legislative wording of the bill.                                                                                           
                                                                                                                                
     There is an  out for the institutions: on  page 2, line                                                                    
     2, of HB 220 it  states the institutions must only make                                                                    
     a  reasonable and  good faith  effort.   On  line 4  it                                                                    
     simply  says  that  the  institution  document  in  the                                                                    
     patient's record  the reason why they  couldn't provide                                                                    
     the requested  gender.  That  gives the  institution an                                                                    
     out for  any contingency.   Some  of the  seven support                                                                    
     letters submitted in favor of  a bill have been written                                                                    
     by people who either had  the experience of being in an                                                                    
     Alaskan  psychiatric  institution  or have  had  family                                                                    
     members in  an Alaskan psychiatric institution.   House                                                                    
     Bill 220  is based  on a Bangor,  Maine policy  and has                                                                    
     proven that it  is doable.  I support CSHB  220 and ask                                                                    
     that it be passed.                                                                                                         
                                                                                                                                
5:00:32 PM                                                                                                                    
                                                                                                                                
RON ADLER, CEO, Alaska Psychiatric Institute (API), Division of                                                                 
Behavioral Health, Department of Health and Social Services,                                                                    
testified in opposition to HB 220.  He said:                                                                                    
                                                                                                                                
     We  believe  this  is  a  policy  issue  and  want  the                                                                    
     opportunity to  address these  issues in  policy rather                                                                    
     than  legislation, especially  since  there's only  one                                                                    
     situation  that we're  aware of  that raises  a concern                                                                    
     over this issue in the entire  system of care.  We have                                                                    
     no reports of this whatsoever....                                                                                          
                                                                                                                                
MR. ADLER continued:                                                                                                            
                                                                                                                                
     I'm seeing this  bill as the API bill,  not a patients'                                                                    
     rights  bill. ...  Some of  the negotiations  that have                                                                    
     already occurred really exempt  every other hospital in                                                                    
     the State  of Alaska but API,  so it really is  the API                                                                    
     bill.     Let   me  tell   you  why   I  think   that's                                                                    
     inappropriate.  ... On  [July 1,  2003], API  requested                                                                    
     from  the [Assistant  Commissioner of  the Division  of                                                                    
     Finance  and Management  Service, Department  of Health                                                                    
     and Social Services] Janet Clarke  [to find] funding to                                                                    
     create a  consumer and family specialist  position with                                                                    
     a specified  program.  This  was granted and  with this                                                                    
     new  program  at  API,  on  a daily  basis  we  have  a                                                                    
     consumer and family specialist that  surveys all of our                                                                    
     guests at  the hospital to assure  that appropriate and                                                                    
     quality treatment  services happen.   Results  of these                                                                    
     daily surveys are tabulated each  month and reviewed by                                                                    
     the API governing  board.  On [July 1,  2003] there was                                                                    
     no incentive  for us to do  this; we did it  because it                                                                    
     was the right thing to do.                                                                                                 
                                                                                                                                
     On  [October  1,  2004],   API  established  a  gender-                                                                    
     sensitivity  policy  which  already provides  a  person                                                                    
     receiving  services at  the hospital  everything that's                                                                    
     being  requested.    We  have  gone  to  the  point  of                                                                    
     training  all of  our staff  on this  competency that's                                                                    
     all recorded  in personnel documents.   On  [October 1,                                                                    
     2004]  there was  no legislative  incentive or  mandate                                                                    
     for us  to do this;  we did  it because we  listened to                                                                    
     input  and  feedback at  our  various  meetings in  the                                                                    
     community and we did it  because it was the right thing                                                                    
     to do. ...                                                                                                                 
                                                                                                                                
     This  issue  came  before   the  Alaska  Mental  Health                                                                    
     Board's  legislative committee  who refused  to support                                                                    
     legislative intent  on this issue.   Rather,  the board                                                                    
     decided   to    assert   its   influence    by   making                                                                    
     recommendations to  [Bill Hogan, Director,  Division of                                                                    
     Behavioral    Health],   and    specifically   requests                                                                    
     [Bartlett Hospital] and  Fairbanks Memorial Hospital to                                                                    
     comport to the  same standards as API.   The department                                                                    
     supports this  position: allowing the division  to make                                                                    
     reasonable  changes to  advance health  care in  policy                                                                    
     rather than legislation. ...                                                                                               
                                                                                                                                
MR. ADLER continued:                                                                                                            
                                                                                                                                
     This  legislation  is  framed  within  the  context  of                                                                    
     patients'  rights.   API  provides  an  office for  the                                                                    
     Disability  Law  Center  in the  hospital;  what  other                                                                    
     hospital  in Alaska  makes such  a provision  to ensure                                                                    
     excellence  in  patients' rights?    One  of the  other                                                                    
     changes  that happened  here  is, ...  if  there is  no                                                                    
     unlicensed  individual on  staff,  you're allowing  the                                                                    
     hospital or  institution to redirect a  licensed person                                                                    
     from another unit - this  is a problem with [registered                                                                    
     nurses  (RN)];  we  have a  recruitment  and  retention                                                                    
     issue with RNs not only at  API but statewide.  We know                                                                    
     from an  operating perspective  when you  ask an  RN to                                                                    
     step outside their prescribed duties  and tasks for the                                                                    
     evening and go do  another task, medication error rates                                                                    
     go up.   And  actually that  is one  of the  number one                                                                    
     issues  ...   all  hospitals  face  in   our  regularly                                                                    
     scheduled joint commission site  reviews.  We've looked                                                                    
     every  month  at  our  medication  error  rates;  we're                                                                    
     keeping  them very  low at  API, but  we know  the more                                                                    
     extraneous demands we make on  RNs, the more difficulty                                                                    
     we have in managing this. ...                                                                                              
                                                                                                                                
     The  Mental Health  Board  has asked  us  to make  some                                                                    
     language  changes in  our existing  policy  so that  it                                                                    
     will  exactly  mirror  the   policy  of  Bangor  Mental                                                                    
     Institute.    We agreed  to  do  that.   So  our  basic                                                                    
     position is that this is unnecessary at this time.                                                                         
                                                                                                                                
CHAIR WILSON asked Mr. Adler if  this bill would prevent API from                                                               
conducting the services that it now gives.                                                                                      
                                                                                                                                
MR. ADLER replied that it would not.                                                                                            
                                                                                                                                
5:06:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON said  that he had some  concerns and they                                                               
coincided  with Dr.  Adler's.   He remarked  that the  witnesses'                                                               
comments that patients are being  degraded and humiliated "rubbed                                                               
me wrong  because it suggests  that when it's  a male to  male or                                                               
female to  female there's degrading  and humiliation."   He asked                                                               
Mr.  Adler to  respond  to  this, and  commented,  "I assume  the                                                               
current system  is working  fine other  than the,  again, comfort                                                               
level of some mentally disabled folks."                                                                                         
                                                                                                                                
MR. ADLER replied:                                                                                                              
                                                                                                                                
     This brings up  a very sensitive point.   I just really                                                                    
     dislike talking about  acute psychiatric and behavioral                                                                    
     disorders  in  public  because  it's  just  a  terrible                                                                    
     disorder that people  have.  And what  is degrading and                                                                    
     erodes  dignity and  respect for  the person  receiving                                                                    
     services is  when they have  to do something  that they                                                                    
     are forced to do on an  involuntary basis.  Yet that is                                                                    
     the reality  that we're faced with.   People frequently                                                                    
     are  admitted to  API not  of  choice, but  on a  legal                                                                    
     basis and frequently we have  to do things to stabilize                                                                    
     people.  And  while we make every attempt  in the world                                                                    
     to do  that in  a respectful  and dignified  way, there                                                                    
     are  times  we  have  to prevent  people  from  hurting                                                                    
     themselves  or  others and  that  requires  us to  make                                                                    
     certain accommodations in terms of these issues.                                                                           
                                                                                                                                
REPRESENTATIVE  ANDERSON said  that some  say the  theme of  this                                                               
bill is about "comfort level."   He asked if most of the patients                                                               
in API are there because they have been sexually abused.                                                                        
                                                                                                                                
MR.  ADLER  answered  that  this  is an  emerging  concern  on  a                                                               
nationwide level.  He said:                                                                                                     
                                                                                                                                
     We believe in  this field that we  are finding evidence                                                                    
     of trauma more  and more often, and we  believe that we                                                                    
     have to  do a reasonable  trauma screen  and evaluation                                                                    
     to make sure we don't  help people relive past traumas.                                                                    
     ... Whether  that's a child  watching a  violent family                                                                    
     interaction,  which  is   a  traumatic  experience,  or                                                                    
     somebody  being  sexually  abused,  or  somebody  being                                                                    
     witness to  a friend's suicide,  we know that  this has                                                                    
     an impact, and we know that  if we don't deal with this                                                                    
     in  an  appropriate way,  especially  in  an acute  in-                                                                    
     patient setting  that ... we're  not doing  what's best                                                                    
     for the individual.                                                                                                        
                                                                                                                                
REPRESENTATIVE  MCGUIRE  commented  that  if it  is  already  the                                                               
policy  at API  to do  all that  is necessary  for the  patients'                                                               
comfort, then she  fails to understand why Mr.  Adler opposes the                                                               
bill.    She  said,  "All  the   bill  does  is  put  into  place                                                               
statutorily the policy that ... you have in place at API."                                                                      
                                                                                                                                
5:11:36 PM                                                                                                                    
                                                                                                                                
MR.  ADLER  said that  API  makes  that accommodation  currently,                                                               
while the  bill exempts  all the  other hospitals  within Alaska.                                                               
He said, "Why legislate something that's happening?"                                                                            
                                                                                                                                
CHAIR  WILSON  asked  if  Mr.  Adler was  saying  that  no  other                                                               
hospitals have a staff of over 10 people.                                                                                       
                                                                                                                                
MR. ADLER  replied, "On any  given shift, if  you were to  take a                                                               
survey of the other hospitals today, that's correct."                                                                           
                                                                                                                                
5:13:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON said:                                                                                                     
                                                                                                                                
     That  doesn't mean  that if  you don't  have 10  [staff                                                                    
     members on duty] you shouldn't  do it."  He stated that                                                                    
     he is a  little concerned that page  1, subsection (b),                                                                    
     and said, "If somebody's  incapacitated, then we put in                                                                    
     an immediate burden that it  has to be the same-sex ...                                                                    
     nurse, and I'm  wondering why we're doing  that. ... We                                                                    
     don't  have a  request,  but all  of  the sudden  we're                                                                    
     putting   this   blanket    duty   on   if   somebody's                                                                    
     incapacitated; now  we're presuming that there  is this                                                                    
     request that it's  going to be the  same-sex person and                                                                    
     it seems to me that possibly  even if you have 10 staff                                                                    
     members on duty, that could be a burden.                                                                                   
                                                                                                                                
5:14:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA said that according  to the bill, if a person                                                               
is  incapacitated and  there isn't  same-gender staff  available,                                                               
then the  exceptions would apply;  it just  has to be  written in                                                               
the  chart.    He  agreed  that the  bill  would  be  creating  a                                                               
presumption in the cases where a person is incapacitated.                                                                       
                                                                                                                                
5:16:17 PM                                                                                                                    
                                                                                                                                
RICHARD RAINERY, Executive Director,  Alaska Mental Health Board,                                                               
said  that  the board  supports  the  intent of  the  legislation                                                               
however,  "we  felt the  most  direct  approach  was to  ask  the                                                               
Division  of  Behavioral Health  and  [API]  to institute  policy                                                               
changes that  reflect these concerns."   He noted that  there are                                                               
some  differences  between  the  board's policy  and  the  policy                                                               
followed in Bangor, Maine; the  board would ask that the hospital                                                               
honor the patient choice of gender.                                                                                             
                                                                                                                                
The committee took an at-ease from 5:18:12 PM to 5:18:25 PM.                                                                    
                                                                                                                                
5:18:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked Mr.  Rainery if removal of subsection                                                               
(b) from the bill would influence the board one way or another.                                                                 
                                                                                                                                
MR. RAINERY  replied, "I don't believe  so, no."  He  pointed out                                                               
that the majority  of the members of the Mental  Health Board are                                                               
consumers of mental health services or their families.                                                                          
                                                                                                                                
5:20:00 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON said,  "So basically what you're telling  us is that                                                               
because  this has  come up,  the Mental  Health Board  itself has                                                               
decided to  put a policy  in place that  would take care  of this                                                               
concern."                                                                                                                       
                                                                                                                                
MR.  RAINERY  responded,  "We  have  formerly  requested  of  the                                                               
Division  of  Behavior Health  and  [API]  that they  revise  the                                                               
appropriate  policies to  reflect the  intent of  what this  bill                                                               
asks for,  yes.   And we intend  to work with  them to  make sure                                                               
that those revisions do that."                                                                                                  
                                                                                                                                
5:20:50 PM                                                                                                                    
                                                                                                                                
ROD  BETIT,   President,  Alaska  State  Hospital   Nursing  Home                                                               
Association  (ASHNHA), testified  in opposition  to HB  220.   He                                                               
said:                                                                                                                           
                                                                                                                                
     We don't support the bill,  and not because of what the                                                                    
     sponsors  are  attempting to  do,  but  because of  the                                                                    
     scope  of what  the  bill  would set  in  motion and  a                                                                    
     solution for  a problem that  really has only  been one                                                                    
     incident,  to  our  knowledge, and  that  it  would  go                                                                    
     beyond what's  necessary to address  the concerns.   We                                                                    
     think  that the  professional practice  expectations of                                                                    
     the  medical   staff  that   are  working   with  these                                                                    
     patients,  each  facility's  commitment to  meet  those                                                                    
     kinds  of  intimate   care  expectations  when  someone                                                                    
     requests them and  policies that they have  in place to                                                                    
     do  that  have  been  affective.   To  their  knowledge                                                                    
     there's  been  no  surveys   or  reviews  by  licensing                                                                    
     organizations to indicate there's  any failure in those                                                                    
     policies.  And  that would be the best place  for us to                                                                    
     put our trust in terms of  what needs to happen next to                                                                    
     fix the one  incident that occurred.  And  so, we would                                                                    
     agree with the Mental Health Board on that.                                                                                
                                                                                                                                
MR. BETIT  applauded Representative Gara's efforts  and said that                                                               
at this point this bill would  not impact all five members of the                                                               
ASHNHA with mental  health units, but would  primarily affect API                                                               
and occasionally Providence Hospital as well.                                                                                   
                                                                                                                                
5:22:52 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON  asked  that  the   director  of  the  Division  of                                                               
Behavioral Health  come forward,  and she asked  him how  be felt                                                               
about the bill.                                                                                                                 
                                                                                                                                
BILL HOGAN,  Director, Division of Behavioral  Health, Department                                                               
of  Health and  Social  Services, commended  the bill's  sponsors                                                               
because "we  think what is being  considered in the bill  is very                                                               
important to the people that we serve."  However, he continued:                                                                 
                                                                                                                                
     We feel as though we  can accommodate the concerns that                                                                    
     are being raised  through policy changes at  [API].  In                                                                    
     fact, we  have ...  over the  last year  and a  half or                                                                    
     more,  tried   to  change  policy  based   on  consumer                                                                    
     concerns  to ensure  that clients  or patients  do have                                                                    
     ... gender choice when  there's intimate care involved.                                                                    
     We also recognize the concerns  expressed by the Mental                                                                    
     Health Board....   We have  every intention  of working                                                                    
     with the  Mental Health Board with  the [API] governing                                                                    
     body  to implement  those policy  changes as  well. ...                                                                    
     Our feeling is  that we can make the  changes that need                                                                    
     to   occur   through   policy  and   through   practice                                                                    
     standards, and not through legislation.                                                                                    
                                                                                                                                
CHAIR WILSON said,  "If you're going to do that,  ... what is the                                                               
objection of having it in statute?"                                                                                             
                                                                                                                                
MR. HOGAN  responded, "Perhaps  it's philosophical.   We  feel as                                                               
though we can do what needs  to be done without statutory change,                                                               
and if there  was a need for statutory change,  I believe I would                                                               
be up here supporting [it]."                                                                                                    
                                                                                                                                
5:25:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE responded to Mr. Hogan:                                                                                  
                                                                                                                                
     I might  trust you now  and the  people who are  in the                                                                    
     position  of policymaking  right  now,  and five  years                                                                    
     from now  I may  not.   And I think  that's one  of the                                                                    
     most  important  things   about  considering  statutory                                                                    
     changes versus  allowing your policies  to govern.   If                                                                    
     the issue  is important  enough, we put  it in  the law                                                                    
     books, and  that way it's  there for all time  to come.                                                                    
     And if a future  legislature decides for policy reasons                                                                    
     to remove that, then the  debate will occur in a public                                                                    
     setting;  the public  will be  aware of  it, and  there                                                                    
     will  be an  opportunity  for folks  to  testify.   The                                                                    
     concern about  making these really  important decisions                                                                    
     on  a policy  level is,  oftentimes, many  people don't                                                                    
     even know  that they're  taking place; they  don't know                                                                    
     the policy is  in place, they don't know  the policy is                                                                    
     being  changed.   So there  isn't that  opportunity for                                                                    
     people  to weigh  in  on  it.   And  so,  with all  due                                                                    
     respect, I think that's why  it is appropriately placed                                                                    
     in Alaska state law.                                                                                                       
                                                                                                                                
REPRESENTATIVE SEATON  said that  he is uncomfortable  with parts                                                               
of  the bill.    He moved  to adopt  Conceptual  Amendment 1,  as                                                               
follows:                                                                                                                        
                                                                                                                                
     Page 1, lines 11-14                                                                                                        
     Delete subsection (b)                                                                                                      
                                                                                                                                
REPRESENTATIVE SEATON  stated that the requirement  in subsection                                                               
(b) could be quite burdensome [to the treatment center].                                                                        
                                                                                                                                
REPRESENTATIVE  ANDERSON objected  for discussion  purposes.   He                                                               
asked if Representative Seaton would  object to the addition of a                                                               
friendly amendment to the conceptual  amendment, or if perhaps he                                                               
should make  his own  amendment to  change line 10  on page  1 to                                                               
read, "is the opposite sex."                                                                                                    
                                                                                                                                
CHAIR  WILSON recommended  that  Representative  Anderson make  a                                                               
separate amendment to address this concern.                                                                                     
                                                                                                                                
REPRESENTATIVE ANDERSON removed his objection.                                                                                  
                                                                                                                                
REPRESENTATIVE MCGUIRE asked for  clarification of the definition                                                               
of  "incapacitated,"   and  wondered   what  percentage   of  the                                                               
population   in   a   mental   hospital   would   be   considered                                                               
incapacitated.  She commented that  her only concern is that [the                                                               
deletion of the word "incapacitated"] would gut the bill.                                                                       
                                                                                                                                
REPRESENTATIVE SEATON replied  that he didn't think  it would gut                                                               
the bill.  He explained:                                                                                                        
                                                                                                                                
     If you're  saying that anybody in  a mental institution                                                                    
     is incapacitated,  what we're really saying  is there's                                                                    
     an automatic  no-request; everybody in  the institution                                                                    
     must  be treated  as if  they did  make a  request. ...                                                                    
     What I'm trying  to do is get it so  if anybody makes a                                                                    
     request,  or   their  guardian  or  whoever   [makes  a                                                                    
     request], then  that request  would be  honored through                                                                    
     [subsection  (a)], but  that we  would get  rid of  the                                                                    
     automaticity of ... if somebody's incapacitated.                                                                           
                                                                                                                                
REPRESENTATIVE  MCGUIRE responded,  "So  then it  would speak  to                                                               
nothing on incapacity; there would be no policy."                                                                               
                                                                                                                                
5:30:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA said:                                                                                                       
                                                                                                                                
     I  think that's  right. ...  By taking  out [subsection                                                                    
     (b)] you now make the law  say, "If you're 18 or older,                                                                    
     you get to make the choice."   And I think it's implied                                                                    
     that if  you're 18 or  older and can't make  the choice                                                                    
     and  you  have  a  personal  representative,  then  the                                                                    
     personal  representative can  make  the  request.   You                                                                    
     might want  to make clear  that [the bill  is referring                                                                    
     to]   a  person   18  or   older   or  their   personal                                                                    
     representative, just  to make  that clear, but  I think                                                                    
     that would be  implied.  So I think you  could take out                                                                    
     [subsection (b)] and you would  still protect people or                                                                    
     their  personal representatives  who want  to make  the                                                                    
     request.                                                                                                                   
                                                                                                                                
[There being no objection, Conceptual Amendment 1 was adopted.]                                                                 
                                                                                                                                
5:31:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  moved to adopt Conceptual  Amendment 2, as                                                               
follows:                                                                                                                        
                                                                                                                                
     Page 2, line 3, after "place"                                                                                              
     Delete "in patient rooms"                                                                                                  
                                                                                                                                
REPRESENTATIVE ANDERSON objected for discussion purposes.                                                                       
                                                                                                                                
REPRESENTATIVE SEATON explained, "This is  a lot of signage going                                                               
up around; all we need is notification in the hospital."                                                                        
                                                                                                                                
REPRESENTATIVE ANDERSON removed his objection.                                                                                  
                                                                                                                                
[There being no objection, Conceptual Amendment 2 was adopted.]                                                                 
                                                                                                                                
REPRESENTATIVE MCGUIRE  moved to report the  committee substitute                                                               
for HB  220, labeled 24-LS0667\Y,  Mischel, 3/31/05,  as amended,                                                               
out  of   committee  with  individual  recommendations   and  the                                                               
accompanying fiscal notes.                                                                                                      
                                                                                                                                
REPRESENTATIVE  ANDERSON objected  for discussion  purposes.   He                                                               
recounted that many  of the treatment centers  that testified are                                                               
opposed to  the bill, which  is of concern  for him.   He removed                                                               
his objection.                                                                                                                  
                                                                                                                                
CHAIR WILSON stated her concern [that the treatment centers are                                                                 
opposed to the bill].                                                                                                           
                                                                                                                                
There being no objection, CSHB 220(HES) was reported from the                                                                   
House Health, Education and Social Services Standing Committee.                                                                 
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 5:34:02 PM.                                                                                                  

Document Name Date/Time Subjects