Legislature(2005 - 2006)Anch LIO Conf Rm

08/29/2005 01:30 PM HEALTH, EDUCATION & SOCIAL SERVICES


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Audio Topic
01:43:05 PM Start
01:44:34 PM Status of Personal Care Attendant Regulations
01:50:16 PM HB303
02:30:44 PM HB271
05:13:48 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 271 LIMIT OVERTIME FOR REGISTERED NURSES TELECONFERENCED
Heard & Held
+= Status of Personal Care Attendant regs TELECONFERENCED
*+ HB 303 ADULT COMPANION SERVICES WAIVER (report) TELECONFERENCED
Heard & Held
+ State of Long-Term Care Study TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       Anchorage, Alaska                                                                                        
                        August 29, 2005                                                                                         
                           1:43 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Tom Anderson                                                                                                     
Representative Lesil McGuire                                                                                                    
Representative Sharon Cissna (via teleconference)                                                                               
Representative Berta Gardner                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Vic Kohring                                                                                                      
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
STATUS OF PERSONAL CARE ATTENDANT REGULATIONS                                                                                   
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 303                                                                                                              
"An  Act expanding  reimbursable waiver  services under  Medicaid                                                               
waivers for older Alaskans and  adults with physical disabilities                                                               
to include adult companion services;  and relating to legislative                                                               
intent  concerning eligibility  and  coverage  for personal  care                                                               
attendant services."                                                                                                            
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
HOUSE BILL NO. 271                                                                                                              
"An Act relating to limitations on overtime for registered                                                                      
nurses in health care facilities; and providing for an effective                                                                
date."                                                                                                                          
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 303                                                                                                                  
SHORT TITLE: ADULT COMPANION SERVICES WAIVER                                                                                    
SPONSOR(S): REPRESENTATIVE(S) WILSON                                                                                            
                                                                                                                                
05/06/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
05/06/05       (H)       HES, FIN                                                                                               
08/29/05       (H)       HES AT 1:30 PM Anch LIO Conf Rm                                                                        
                                                                                                                                
BILL: HB 271                                                                                                                  
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES                                                                               
SPONSOR(S): REPRESENTATIVE(S) WILSON                                                                                            
                                                                                                                                
04/15/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/15/05       (H)       L&C, HES, FIN                                                                                          
04/30/05       (H)       L&C AT 1:00 PM CAPITOL 17                                                                              
04/30/05       (H)       Moved Out of Committee                                                                                 
04/30/05       (H)       MINUTE(L&C)                                                                                            
05/02/05       (H)       L&C RPT 4DP 3NR                                                                                        
05/02/05       (H)       DP:    CRAWFORD,    LYNN,    GUTTENBERG,                                                               
                         ANDERSON;                                                                                              
05/02/05       (H)       NR: LEDOUX, ROKEBERG, KOTT                                                                             
05/03/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
05/03/05       (H)       Heard & Held                                                                                           
05/03/05       (H)       MINUTE(HES)                                                                                            
08/29/05       (H)       HES AT 1:30 PM Anch LIO Conf Rm                                                                        
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JON SHERWOOD, Medical Assistant Administrator IV                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Provided information regarding the status                                                                  
of the personal care attendant regulations and waivers in                                                                       
general.                                                                                                                        
                                                                                                                                
JANET CLARKE, Assistant Commissioner                                                                                            
Finance and Management Services                                                                                                 
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Reviewed HB 303, and related that the                                                                      
department believes it's premature to pass this type of                                                                         
legislation at this point; provided information on HB 271.                                                                      
                                                                                                                                
REBECCA BOLLING, President                                                                                                      
Alaska Nurses Association                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  During hearing of HB 271, expressed                                                                        
concerns with regard to mandatory overtime.                                                                                     
                                                                                                                                
RUSSELL GRANGE, Chief Human Resources Officer                                                                                   
Providence Health System - Alaska                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Expressed concerns with HB 271.                                                                            
                                                                                                                                
DIANE O'CONNELL, Labor Program Director                                                                                         
Alaska Nurses Association                                                                                                       
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on HB 271.                                                                                       
                                                                                                                                
MARCIA COOPER, RN                                                                                                               
Alaska Psychiatric Institute                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 271.                                                                            
                                                                                                                                
J.W. POUND, RN                                                                                                                  
Alaska Psychiatric Institute                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  During hearing of HB 271, related API's                                                                    
wage information.                                                                                                               
                                                                                                                                
MIKE ALEXANDER, RN                                                                                                              
Alaska Psychiatric Institute                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  During hearing of HB 271, expressed                                                                        
concerns with mandatory overtime.                                                                                               
                                                                                                                                
DOROTHY FULTON, Executive Administrator                                                                                         
Alaska Board of Nursing                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 271.                                                                            
                                                                                                                                
SHARA SUTHERLIN, Chief Nurse Executive                                                                                          
Providence Alaska Medical Center                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  During hearing of HB 271, related                                                                          
Providence's work with regard to overtime.                                                                                      
                                                                                                                                
PATRICIA CENTER (PH), Chair                                                                                                     
of the Legislative Committee                                                                                                    
Alaska Nurses Association                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  During hearing of HB 271, related                                                                          
information regarding the nursing shortage.                                                                                     
                                                                                                                                
STACEY ALLEN (ph), RN                                                                                                           
Alaska Regional Hospital                                                                                                        
Laborers' Local 341                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 271.                                                                            
                                                                                                                                
RON ADLER, CEO                                                                                                                  
Alaska Psychiatric Institute                                                                                                    
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:     During  hearing  on   HB  271,  answered                                                               
questions.                                                                                                                      
                                                                                                                                
MILA COSGROVE, Director                                                                                                         
Division of Personnel                                                                                                           
Department of Administration                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   During hearing  on HB 271, related  ways in                                                               
which the division is addressing [the nurse shortage].                                                                          
                                                                                                                                
ROD BEANY (PH)                                                                                                                  
(No address provided)                                                                                                           
POSITION  STATEMENT:   During hearing  on HB  271, expressed  the                                                               
need to  find ways to  address competitive salaries and  have the                                                               
ability to make adjustments when  necessary in order to have some                                                               
parity with the private sector.                                                                                                 
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 1:43:05  PM.                                                             
Representatives  Wilson,   Seaton,  McGuire,  and   Gardner  were                                                               
present  at  the call  to  order.   Representative  Anderson  and                                                               
Cissna  (via  teleconference)  arrived  as  the  meeting  was  in                                                               
progress.                                                                                                                       
                                                                                                                                
^Status of Personal Care Attendant Regulations                                                                                
                                                                                                                                
[Due to technical difficulties, the  beginning of the meeting was                                                               
not recorded.  The recording  begins as the committee was hearing                                                               
the status of personal care attendant regulations.]                                                                             
                                                                                                                                
JON SHERWOOD,  Medical Assistant Administrator IV,  Department of                                                               
Health and  Social Services (DHSS),  informed the  committee that                                                               
currently each  agency uses its  own assessment tool.   The [new]                                                               
assessment  would   be  administered   by  the  state   or  state                                                               
contractor  rather  than by  the  PCA  [personal care  attendant]                                                               
agency  itself.    He  related  the  need  to  implement  clearer                                                               
standards  for providers.   As  a result  of some  of the  public                                                               
comments, some adjustments to the  proposed regulations will have                                                               
to be made,  he said.  He indicated that  those changes should be                                                               
available  for the  commissioner of  DHSS to  adopt some  time in                                                               
September.                                                                                                                      
                                                                                                                                
1:44:34 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON opined that it's good  to know that the system works                                                               
and that  public comments  do make a  difference.   She commended                                                               
the department on that.                                                                                                         
                                                                                                                                
1:44:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  if there was any  particular area of                                                               
the 14  points that received the  most comments and in  most need                                                               
of revision.                                                                                                                    
                                                                                                                                
MR. SHERWOOD noted  that one area that received a  lot of concern                                                               
was  in  regard to  the  standardized  assessment and  having  it                                                               
performed  by the  state.   Although he  attributed some  of that                                                               
concern to  unfamiliarity with the  new assessment tool,  he also                                                               
attributed it to  the state's ability to  perform the assessments                                                               
in a  timely manner.   The regulations  make some  provisions for                                                               
short-term authorization when  there is an urgent  need for care.                                                               
There  may  be   some  further  revisions  to   that,  he  noted.                                                               
Furthermore, the department is  reviewing whether the regulations                                                               
can specify a guaranteed time [for some level of service].                                                                      
                                                                                                                                
MR.  SHERWOOD  identified  the  other  area  that  received  much                                                               
concern  as  the  prior  authorization   for  all  personal  care                                                               
services.  Again, the concern  was that this could complicate the                                                               
administration   and  billing   process  for   providers.     The                                                               
aforementioned requires a bit more  paperwork and management.  If                                                               
the  state doesn't  issue the  prior authorization  numbers in  a                                                               
timely  fashion, it  can slow  down the  payments.   Furthermore,                                                               
there are concerns  with regard to the  [department's] ability to                                                               
do that.                                                                                                                        
                                                                                                                                
1:47:27 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON noted  that due to some abuse of  the program, these                                                               
[regulation changes] are occurring.   Perhaps by the next session                                                               
it will be apparent whether the  changes are helping.  Still, she                                                               
noted, it will be difficult  because people will continue to come                                                               
online.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  SEATON informed  the committee  that the  October                                                               
issue  of  Governing Magazine  includes  an  interview with  U.S.                                                             
Secretary  of  Health and  Human  Services,  Michael Leavitt,  in                                                               
which he  says that states  shouldn't need  a waiver to  use home                                                               
and community care with a long-term  population.  He asked if the                                                               
legislature  has  received  any   indications  from  the  federal                                                               
government that it is implementing  any changes that would impact                                                               
the regulations being modified.                                                                                                 
                                                                                                                                
1:48:50 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD  explained that states  have the ability  to provide                                                               
personal care as  part of the regular state plan,  and outside of                                                               
the  waiver process.   Currently,  Alaska  provides its  personal                                                               
care  services as  a  state plan  service.   Therefore,  proposed                                                               
changes  to  eliminate  the waiver  requirement  wouldn't  impact                                                               
these regulations,  although it would impact  other services that                                                               
[the  state] provides.   Mr.  Sherwood  said he  wasn't aware  of                                                               
anything  proposed   for  federal  Medicaid  reform   that  would                                                               
directly impact these regulations,  although there have been some                                                               
discussions on  generic items such  as the total cap  on Medicaid                                                               
administrative expenses allowed by the state.                                                                                   
                                                                                                                                
HB 303-ADULT COMPANION SERVICES WAIVER                                                                                        
                                                                                                                                
1:50:16 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE  BILL  NO.  303,  "An  Act  expanding  reimbursable  waiver                                                               
services  under Medicaid  waivers for  older Alaskans  and adults                                                               
with physical  disabilities to include adult  companion services;                                                               
and  relating to  legislative intent  concerning eligibility  and                                                               
coverage for personal care attendant services."                                                                                 
                                                                                                                                
1:51:12 PM                                                                                                                    
                                                                                                                                
JON SHERWOOD,  Medical Assistant Administrator IV,  Department of                                                               
Health  and  Social Services  (DHSS),  per  the chair's  request,                                                               
explained that a  Medicaid waiver is a device  allowed by federal                                                               
law to  bypass the normal  limits that federal  regulations would                                                               
impose on a state in operating  a Medicaid program.  Under normal                                                               
federal  law  certain  services   can  and  cannot  be  provided.                                                               
Therefore, a  waiver allows those  services not  normally allowed                                                               
under  federal law  to  be  provided with  some  conditions.   In                                                               
Alaska,  waivers are  usually home-  and community-based  service                                                               
waivers.   Under the home-  and community-based  services waiver,                                                               
the  state  is   allowed  to  provide  certain   services  as  an                                                               
alternative  to  nursing  home  care  and  institutions  for  the                                                               
mentally  retarded and  developmentally disabled.   Mr.  Sherwood                                                               
explained  that under  a  waiver,  the state  has  to define  the                                                               
services it  will offer, which  have to be reasonably  related to                                                               
meeting the needs of the target population.                                                                                     
                                                                                                                                
MR. SHERWOOD, in response to  Chair Wilson, specified that Alaska                                                               
has stayed  with standard  definitions, with  some modifications.                                                               
It's simpler  to use the federal  government's definition because                                                               
there is less review of it, he noted.   As part of the process of                                                               
submitting  a waiver,  the state  has  to specify  the number  of                                                               
people to be  served.  He highlighted that  waivers are different                                                               
from the rest  of Medicaid because under the rest  of Medicaid if                                                               
a  state meets  the basic  eligibility criteria,  the service  is                                                               
provided.  However,  under waivers, once the  state specifies the                                                               
number of  people it  will serve,  no more  people can  be served                                                               
even  if  the  eligibility  criteria is  met  because  the  state                                                               
wouldn't have the authority to add more people to the waiver.                                                                   
                                                                                                                                
1:55:11 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD, in  further response  to Chair  Wilson, said  that                                                               
people [beyond the  specified amount in the waiver]  can be added                                                               
any time during  the year as long as the  department has received                                                               
authority  from  the  federal   government  to  serve  additional                                                               
persons.  He  explained that part of what the  department does to                                                               
get a  waiver approved is  to show that  the waiver will  be cost                                                               
neutral in  that the department  won't spend more  on individuals                                                               
in  a   community  setting  than   it  would  for  those   in  an                                                               
institution.   A complicated formula  is offered as proof  of the                                                               
aforementioned.  Therefore, any time  the number of people served                                                               
is changed, that formula has to be resubmitted.                                                                                 
                                                                                                                                
MR. SHERWOOD specified that Alaska has  four waivers.  There is a                                                               
waiver that serves  older Alaskans, those 65 years  and older who                                                               
meet nursing home level care.   Another waiver serves adults with                                                               
physical disabilities,  those between  the age of  21 and  64 who                                                               
meet  nursing  home  level  care.    Yet  another  waiver  serves                                                               
children  with  complex  medical conditions,  those  children  up                                                               
through the age  of 21 who would  be served by a  nursing home or                                                               
long-term  hospitalization.   Finally,  there  is  a waiver  that                                                               
serves   people  of   all  ages   with   mental  retardation   or                                                               
developmental disabilities which  meet the institutional standard                                                               
for  the Intermediate  Care Facility  for  the Mentally  Retarded                                                               
(ICFMR).  Mr.  Sherwood informed the committee that  at any given                                                               
time,  about 2,800  people on  waivers are  served.   He recalled                                                               
that  in  2005, a  little  under  3,600  people on  waivers  were                                                               
served.   These waivers have  been available since late  1993, he                                                               
noted.  Alaska  obtained waivers to serve people of  all ages for                                                               
both  nursing  home  and  ICFMR levels  of  care.    Furthermore,                                                               
Alaska's breadth  of services  is fairly wide,  he related.   For                                                               
instance, Alaska's  waivers offer care coordination,  payment for                                                               
services in  assisted living facilities, adult  day care, private                                                               
duty  nursing,  respite,  chores, meals,  social  transportation,                                                               
environmental modification,  specialized equipment  and supplies,                                                               
and  a  wide  range  of  habilitative  services  for  those  with                                                               
developmental  disabilities.    Mr.  Sherwood  related  that  the                                                               
companion service is probably the  only service not offered under                                                               
a waiver.                                                                                                                       
                                                                                                                                
2:00:12 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD informed  the committee  that each  waiver requires                                                               
filling  out  a   document  that  is  60-80   pages  with  backup                                                               
materials.  The  initial approval period is three  years, and the                                                               
waivers are renewed every five years.   In fact, this fiscal year                                                               
the  department is  preparing for  renewal  for all  four of  the                                                               
waivers.  He explained that  before the waivers are renewed, they                                                               
must undergo  federal review,  which occurred  about a  year ago.                                                               
Based  on that  review, Mr.  Sherwood said  he expected  that the                                                               
department   will  have   to  provide   additional  documentation                                                               
regarding  the  department's  quality   assurance  methods.    He                                                               
related  that over  $100  million  was spent  on  the waivers  in                                                               
fiscal year  (FY) 05.   In conclusion,  Mr. Sherwood  opined that                                                               
Alaska  has  been  very  successful in  using  waivers  to  avoid                                                               
institutionalization.                                                                                                           
                                                                                                                                
2:02:04 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON requested  a list  detailing the  services provided                                                               
under each waiver.                                                                                                              
                                                                                                                                
MR. SHERWOOD agreed to do so.                                                                                                   
                                                                                                                                
2:03:08 PM                                                                                                                    
                                                                                                                                
JANET  CLARKE,  Assistant  Commissioner, Finance  and  Management                                                               
Services,  Department of  Health  and Social  Services, began  by                                                               
reviewing  HB  303.    Section 1  is  legislative  intent,  which                                                               
basically  addresses the  personal care  attendant program.   She                                                               
then  turned attention  to subsection  (b)  on page  2, line  28,                                                               
which  lays  out  the  intent  to  restore  the  nonmedical  care                                                               
supervision   and   socialization  services   through   companion                                                               
services.  Section 2 outlines  the direction from the legislature                                                               
to  seek assistance  for  an additional  waiver,  referred to  as                                                               
companion care  for services for  older Alaskans and  adults with                                                               
physical disabilities.   She opined  that the  committee probably                                                               
saw this language in legislation such as HB 125 and HB 193.                                                                     
                                                                                                                                
2:04:55 PM                                                                                                                    
                                                                                                                                
MS.  CLARKE  related  that  the  department  believes  that  it's                                                               
premature  to  pass  this  type of  legislation  at  this  point.                                                               
Currently, the  department is performing a  long-term care study,                                                               
which  will help  determine what  services are  necessary in  the                                                               
continuum of care.  To pass  this legislation before the study is                                                               
complete  is  a  bit  premature,  she  reiterated.    Ms.  Clarke                                                               
explained that  merely adding this  additional service on  top of                                                               
the existing  service system without  reviewing all of  the other                                                               
components,  some  inefficiencies  and  costs will  occur.    The                                                               
department has been taking steps  to look forward at the Medicaid                                                               
program, specifically a contractor has  been acquired to help the                                                               
department develop a better long-term  forecast for Medicaid.  As                                                               
part   of  that,   the  contractor   is  reviewing   the  state's                                                               
demographics and  outlining the  services being  used.   Based on                                                               
those demographics,  the contractor is relating  what the service                                                               
array will look like in  the future.  Furthermore, the department                                                               
is embarking on  the long-term care study.  She  opined that both                                                               
studies are  trying to help  the department  get a handle  on the                                                               
Medicaid budget  as well as  the program  itself.  The  hope, she                                                               
further opined, is to obtain advice  on how to best structure the                                                               
state's Medicaid program for the future.                                                                                        
                                                                                                                                
2:08:48 PM                                                                                                                    
                                                                                                                                
MS. CLARK turned attention to the draft fiscal note for HB 303.                                                                 
                                                                                                                                
2:09:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  inquired as to when  the information from                                                               
the two contractors will be available.                                                                                          
                                                                                                                                
MS. CLARKE  answered that there should  definitely be information                                                               
regarding  the  long-term  forecast  for  Medicaid  available  by                                                               
January, but perhaps as early as  November.  In response to Chair                                                               
Wilson, Ms. Clarke agreed to provide  the chair with a summary of                                                               
the information when available.                                                                                                 
                                                                                                                                
MR. SHERWOOD informed the committee  that the notice of intent to                                                               
award the  long-term care  study has been  issued.   He estimated                                                               
that  a contractor  will probably  be officially  on board  about                                                               
September  15th.   According  to  the terms  of  the request  for                                                               
proposals  (RFP),  the  final  report   should  be  available  by                                                               
February 10 although there may  be some interim information prior                                                               
to that.                                                                                                                        
                                                                                                                                
2:11:42 PM                                                                                                                    
                                                                                                                                
MS. CLARKE  referred to  page 1  of the draft  fiscal note.   The                                                               
fiscal  note  projects that  if  HB  303  were  to pass  and  the                                                               
department  implemented regulations  to add  the service  halfway                                                               
through the  fiscal year, in  FY 07  the cost would  be $759,600.                                                               
In FY  08, there would  be a full year  of costs for  the program                                                               
and  the cost  escalates forward  such  that in  2011 adding  the                                                               
service  would cost  over  $31  million.   In  response to  Chair                                                               
Wilson, Ms.  Clarke referred to  page 2  of the fiscal  note that                                                               
attempts to cost out companion services.   Part of the cost model                                                               
was that companion services wouldn't  replace any other services,                                                               
but  would be  in addition  to existing  services.   Furthermore,                                                               
[the  cost model]  would  allow the  primary  caregiver to  sleep                                                               
during normal  night-time hours when  the care recipient  may not                                                               
be left safely  alone.  The aforementioned is  a significant part                                                               
of the  cost.  Page 2  of the fiscal note  relates that currently                                                               
there  are  1,915 older  Alaskans  and  adults with  disabilities                                                               
receiving  waiver  services, of  those  about  570 reside  in  an                                                               
assisted living home  and thus wouldn't be  eligible.  Therefore,                                                               
the  1,345  is used  and  it's  estimated that  approximately  10                                                               
percent  of  those  would  have   caregivers  who  would  utilize                                                               
companion  services for  10 hours  a day  to allow  them to  work                                                               
full-time.   The  median  cost used  for  unskilled respite  care                                                               
workers  was $19.72  per hour.   For  overnight supervision,  the                                                               
assumption was that  10 percent of the 1,345  recipients would be                                                               
in need of  overnight companion services.  If  those were limited                                                               
to nine hours per evening and  three nights per week, the cost is                                                               
$3,737.70  for 135  recipients per  year.   Of the  approximately                                                               
1,200 recipients who don't qualify  for work-related or overnight                                                               
companion  services, the  department  estimates  that 90  percent                                                               
would utilize basic  companion services, limited to  10 hours per                                                               
week.  Ms. Clarke acknowledged  that the costs are startling, but                                                               
she opined that it does all add up.                                                                                             
                                                                                                                                
2:16:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE McGUIRE expressed interest  in the study reviewing                                                               
whether   there  is   a  population   currently   living  in   an                                                               
institution-like  setting who  could live  in a  home environment                                                               
with the  assistance of a  personal care attendant and  the adult                                                               
companion  services.     She  questioned   whether  any   of  the                                                               
aforementioned population would save the  state money or create a                                                               
neutral fiscal impact.                                                                                                          
                                                                                                                                
2:17:55 PM                                                                                                                    
                                                                                                                                
MS.  CLARKE clarified  that the  department didn't  calculate any                                                               
offsetting costs.  To qualify to be  in a nursing home one has to                                                               
meet the  nursing home level of  care.  She highlighted  that the                                                               
growth of  nursing homes  in Alaska  has really  been constrained                                                               
for the  last 10-15 years.   Prior  to the availability  of home-                                                               
and  community-based   services,  the  state's  only   source  of                                                               
services for  seniors were  nursing homes.    Ms.  Clarke related                                                               
the department's belief that there  will always be those who have                                                               
the  need  for  the  high  level  of  nursing  home  care.    She                                                               
reiterated that the state has  been lucky in maintaining a fairly                                                               
static  number  of  nursing  home   beds,  which  the  department                                                               
believes will continue in the future.                                                                                           
                                                                                                                                
2:19:42 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD addressed the question  regarding keeping people out                                                               
of  an  assisted  living home,  which  companion  services  would                                                               
probably  allow.   However, when  the individual  needs extensive                                                               
overnight  or daytime  supervision while  someone is  out of  the                                                               
house  working, the  wages for  the companion  would probably  be                                                               
comparable  to  personal  care/respite care  provider,  which  is                                                               
around $20.00 per  hour.  When providing companion  services on a                                                               
large scale, there isn't as much  of an economy of scale as would                                                               
be  achieved  in  an  assisted   living  home.    Therefore,  the                                                               
department doesn't  expect to  save money  by keeping  those with                                                               
more intensive  needs out  of assisted  living homes  and placing                                                               
them in companion  services.  Although there  might be individual                                                               
cases in which money would be  saved, there will also be cases in                                                               
which more money  would be spent.  Under the  waiver, there would                                                               
be an overall  cost neutrality because once a  service is offered                                                               
there isn't a  lot of ability to restrict the  service as long as                                                               
it's cheaper than an institution.                                                                                               
                                                                                                                                
2:22:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  informed  the  committee  that  companion                                                               
services are  listed in the  regulations, although  such services                                                               
haven't  been  implemented.   The  aforementioned  would  make  a                                                               
difference in terms of the timing,  she opined.  She related that                                                               
she  has recently  been involved  in  workshops regarding  senior                                                               
services  from  which  she  has surmised  that  Alaska  is  going                                                               
through some of the same  things other states have experienced in                                                               
the past.   Other states  and the Legislative Legal  and Research                                                               
Services 2004  study have found  that the average  for [companion                                                               
care services]  is $50 or so  a day, which is  significantly less                                                               
than  nursing home  care.   She inquired  as to  the department's                                                               
comments on that.                                                                                                               
                                                                                                                                
2:24:43 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD  opined that the  department would agree  that home-                                                               
and  community-based services  are  significantly less  expensive                                                               
than  institutional  care.     However,  the  department  doesn't                                                               
believe companion services would  significantly reduce the amount                                                               
of institutional care for which  the [department] pays.  Already,                                                               
the [department]  does an impressive  job with regard  to serving                                                               
people through the  home and the community and  have a relatively                                                               
small percentage of  folks served in institutional care.   At any                                                               
given time,  of the 3,300  people [being served], only  about 500                                                               
are in  nursing homes.  Mr.  Sherwood related that the  home- and                                                               
community-based  system,  including   companion  services,  would                                                               
increase overall expenditures on  waivers that wouldn't be offset                                                               
by a decline in nursing home units.                                                                                             
                                                                                                                                
2:26:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA   related  that   she  has   received  the                                                               
sentiment of  confusion with regard  to the changes being  put in                                                               
place.   Therefore, she was  pleased to hear Ms.  Clarke's desire                                                               
not  to  include more  changes  before  a  study has  been  done.                                                               
Representative Cissna  then expressed  interest in how  the state                                                               
will increase  its efforts to make  decisions regarding Medicaid.                                                               
She opined that the changes  [from last summer and these proposed                                                               
today] are "incredibly brutal."                                                                                                 
                                                                                                                                
2:28:55 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD, in  response to  Representative Seaton,  said that                                                               
the large  effect of  companion services is  that it  would allow                                                               
people  to remain  in their  own home  versus an  assisted living                                                               
facility [or] a nursing home.                                                                                                   
                                                                                                                                
2:30:04 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON  surmised  that  there   are  many  questions,  and                                                               
therefore it would serve the  committee to wait until it receives                                                               
the reports before deciding what to do next.                                                                                    
                                                                                                                                
[HB 303 was held over.]                                                                                                         
                                                                                                                                
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                   
                                                                                                                                
2:30:44 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced  that the last order of  business would be                                                               
HOUSE BILL NO.  271, "An Act relating to  limitations on overtime                                                               
for registered  nurses in health  care facilities;  and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
2:34:16 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  reminded the committee  that she introduced  HB 271                                                               
after hearing  concern about mandatory overtime  from nurses from                                                               
the  Alaska  Psychiatric  Institute   (API),  the  Department  of                                                               
Corrections,  and the  Pioneers'  Homes.   As  the  chair of  the                                                               
committee,  she opined  that  she was  concerned  with regard  to                                                               
public safety when a nurse is forced to work overtime.                                                                          
                                                                                                                                
2:37:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER inquired as  to whether mandatory overtime                                                               
for nurses is customary in private facilities.                                                                                  
                                                                                                                                
CHAIR WILSON said she didn't know.                                                                                              
                                                                                                                                
The committee took an at-ease from 2:38 p.m. to 2:44 p.m.                                                                       
                                                                                                                                
2:44:45 PM                                                                                                                    
                                                                                                                                
REBECCA  BOLLING, President,  Alaska  Nurses Association  (AaNA),                                                               
explained  that AaNA  is concerned  about mandatory  overtime and                                                               
has requested that the legislature  review this issue.  Mandatory                                                               
overtime is a  nationwide issue, she noted.   Therefore, AaNA has                                                               
urged  all states  to review  this  issue and  if necessary  pass                                                               
legislation  such as  HB 271.   Although  HB 271  focuses on  the                                                               
nurse, this legislation is first  and foremost based on a concern                                                               
for patient safety.                                                                                                             
                                                                                                                                
2:46:11 PM                                                                                                                    
                                                                                                                                
MS. BOLLING  highlighted that  mandatory overtime  is one  of the                                                               
notable  factors  contributing  to   medical  mistakes  and  poor                                                               
quality patient care.   In fact, the Institute  of Medicine (IOM)                                                               
estimates that  44,000-96,000 hospital  deaths can  be attributed                                                               
to medical errors each year.   Therefore, the IOM has recommended                                                               
that  all  overtime,  voluntary   or  mandatory,  for  nurses  be                                                               
curtailed.   Ms. Bolling reminded the  committee that nationwide,                                                               
and  especially  in Alaska,  data  shows  a growing  shortage  of                                                               
health  care workers,  particularly registered  nurses.   "As the                                                               
nursing  shortage  increases,  so   does  the  use  of  mandatory                                                               
overtime,"  she noted.    Since  as many  as  20  percent of  the                                                               
nursing  workforce is  planning to  leave the  profession in  the                                                               
next five  years, it's important to  review prohibiting mandatory                                                               
overtime  as an  aspect  of recruiting  and  retaining nurses  in                                                               
Alaska.   Although  there are  a number  of ways  to address  the                                                               
issue, HB 271 specifies that  a patient's safety shouldn't be put                                                               
at risk  in order to achieve  a short-term solution for  a larger                                                               
problem.  Furthermore, the legislation  specifies that the health                                                               
and  safety  of  nurses  shouldn't   be  at  risk  either.    She                                                               
acknowledged that  there will be  questions raised  regarding the                                                               
potential  costs  for  health  care  facilities.    However,  Ms.                                                               
Bolling urged  the committee to  review the costs  resulting from                                                               
medical errors and nurse absenteeism.                                                                                           
                                                                                                                                
2:47:57 PM                                                                                                                    
                                                                                                                                
MS. BOLLING related  the working conditions that  run nurses away                                                               
from the bedside, the hospital,  and in some cases the profession                                                               
itself.   Therefore, it's  not surprising there  is an  exodus of                                                               
nurses in  many health care settings,  particularly settings that                                                               
use  mandatory  overtime  as  a means  to  deal  with  inadequate                                                               
staffing  and shortages.    Ms. Bolling  reiterated  that HB  271                                                               
recognizes  that  errors  do   occur  during  medical  treatment,                                                               
particularly  when  nurses work  very  long  hours and  doing  so                                                               
consecutively.  In conclusion, Ms.  Bolling thanked the committee                                                               
and  Chair Wilson  for  making  the effort  to  learn about  this                                                               
important  issue within  the nursing  profession  and the  health                                                               
care community  at large.   She offered  that AaNA is  willing to                                                               
work with the legislature and  the administration to resolve this                                                               
issue.                                                                                                                          
                                                                                                                                
2:49:44 PM                                                                                                                    
                                                                                                                                
MS. BOLLING,  in response  to Representative  Gardner, reiterated                                                               
that the Institute  of Medicine has made the  suggestion that all                                                               
overtime, voluntary and mandatory, for nurses be curtailed.                                                                     
                                                                                                                                
REPRESENTATIVE GARDNER  asked if mandatory overtime  is a problem                                                               
for nurses in both the state and private sectors.                                                                               
                                                                                                                                
MS. BOLLING replied yes.                                                                                                        
                                                                                                                                
2:50:39 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON inquired  as  to how  many  states have  prohibited                                                               
mandatory overtime.                                                                                                             
                                                                                                                                
MS.  BOLLING said  she  didn't  know, but  deferred  to a  future                                                               
witness.                                                                                                                        
                                                                                                                                
2:50:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON returned to  the latest issue of Governing,                                                             
which relates  on page 24  that 90,000  patients in the  U.S. die                                                               
per year  due to  errors.   He asked  if there  is any  data that                                                               
details the  number of  deaths attributable  to the  condition of                                                               
mandatory overtime.                                                                                                             
                                                                                                                                
MS. BOLLING said  that she didn't have such data,  but offered to                                                               
obtain that data for the committee.                                                                                             
                                                                                                                                
2:52:08 PM                                                                                                                    
                                                                                                                                
RUSSELL GRANGE, Chief Human  Resources Officer, Providence Health                                                               
System - Alaska, informed the  committee that over the past three                                                               
years  the costs  of overtime  have  increased.   In response  to                                                               
Chair  Wilson,  Mr.  Grange  explained   that  Providence  has  a                                                               
practice of  "mandatory on-call" in  some areas of  the hospital.                                                               
However,  he  said  that  it's   infrequent  that  employees  are                                                               
expected to  work overtime on  a mandatory  basis.  In  regard to                                                               
the  specifics   of  the  aforementioned  practice,   Mr.  Grange                                                               
deferred to the nurse executive who will be speaking later.                                                                     
                                                                                                                                
2:54:15 PM                                                                                                                    
                                                                                                                                
MR.  GRANGE  informed the  committee  that  the average  overtime                                                               
expenditure  for  Providence Health  Care  System  in Alaska  for                                                               
registered  nurses  (RNs)  over  the past  three  years  is  $4.8                                                               
million.  Therefore, for RNs to  increase that to triple time for                                                               
overtime would  increase the  cost to $9.6  million.   Within the                                                               
Providence Health  System, there  is a practice  of trying  to be                                                               
comparable or  equitable with pay,  he noted.  Therefore,  if the                                                               
triple  time  pay  practice  for overtime  was  expanded  to  all                                                               
clinical employees, the  cost would rise to $7.8  million or with                                                               
triple time  it would be  $15.6 million.  Therefore,  triple time                                                               
for  all  health care  workers  for  the Providence  Health  Care                                                               
System  would  increase  from  $9.6   million  to  $19.2  million                                                               
annually.                                                                                                                       
                                                                                                                                
2:56:15 PM                                                                                                                    
                                                                                                                                
MR. GRANGE, in  response to Representative Gardner,  said that if                                                               
HB  271 passed  and there  was mandatory  overtime pay  at triple                                                               
time, there would  be a disincentive for  employees who currently                                                               
volunteer  to  work  overtime  to  continue  to  volunteer.    He                                                               
explained   that  Providence   Health   Care  System's   overtime                                                               
calculations have been based on  total overtime hours at time and                                                               
a  half versus  triple  time.   Mr.  Grange  highlighted what  he                                                               
called the national challenge of  the rising cost of health care.                                                               
The customers, in  this case the patients, would have  to pay for                                                               
the  increased costs.   Therefore,  instituting  triple time  for                                                               
overtime would exacerbate the cost of health care.                                                                              
                                                                                                                                
2:58:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON directed  attention to  page 3  of HB  271                                                               
where it  refers to  triple time.   He related  his understanding                                                               
that triple  time and a fine  are the penalties for  violation of                                                               
the chapter.   However, Mr.  Grange's testimony suggests  that HB
271 would mandate triple time for any overtime.                                                                                 
                                                                                                                                
MR.  GRANGE related  his understanding  that facilities  have one                                                               
hour  to  find   volunteers  for  overtime.     The  concern,  he                                                               
reiterated, is that  there would be a  disincentive for employees                                                               
to volunteer to work for time  and a half when they could receive                                                               
triple  time if  they  merely  waited an  hour.   Therefore,  the                                                               
facility  would  automatically  be placed  in  the  [triple-time]                                                               
situation.                                                                                                                      
                                                                                                                                
3:00:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON   asked  if  Mr.  Grange   would  be  more                                                               
comfortable if a nurse was paid  time and a half for overtime and                                                               
another time and a  half was added to the fines.    Therefore, it                                                               
wouldn't be compensation  to the nurse, but rather  would just be                                                               
part of  the fines.   For example,  currently a  second violation                                                               
[of mandatory overtime]  would result in a $500  fine with triple                                                               
time.    However, Representative  Seaton  suggested  that in  the                                                               
aforementioned situation the nurse would  receive time and a half                                                               
and an additional equal amount  per the [overtime] hours would be                                                               
added to the fine.                                                                                                              
                                                                                                                                
MR. GRANGE  surmised then  that the employer  would pay  the same                                                               
amount  of money,  although it  would be  in the  form of  a fine                                                               
rather than compensation for staff members.                                                                                     
                                                                                                                                
3:02:48 PM                                                                                                                    
                                                                                                                                
MR.  GRANGE related  that [the  human resource  managers] have  a                                                               
philosophical  preference   to  not   work  people   overtime  if                                                               
possible.   In  fact,  at Providence  it's  very infrequent  that                                                               
employees  are   required  to  work   overtime  because   of  the                                                               
associated  problems  and  the downside  to  employee  relations.                                                               
However, there  are occasions  in the  health care  business when                                                               
circumstances  arise such  that  there's no  choice  but to  have                                                               
people work  overtime.  Therefore, to  have a fine of  the nature                                                               
described   when   the   situation  is   unavoidable   would   be                                                               
problematic.                                                                                                                    
                                                                                                                                
3:04:35 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON inquired  as to the per hour wage  of an entry level                                                               
RN.                                                                                                                             
                                                                                                                                
MR.  GRANGE specified  that an  entry level  RN effective  5/1/05                                                               
receives $21.20/hour  base rate,  without benefits.   A  nurse at                                                               
Step 31, the highest, is paid $38.42/hour.                                                                                      
                                                                                                                                
3:06:07 PM                                                                                                                    
                                                                                                                                
MR.  GRANGE  acknowledged  the possible  alternative  of  placing                                                               
nurses on-call and  then calling them in instead  of triple time.                                                               
The  aforementioned would  increase Providence's  on-call expense                                                               
from $1.4 million  to almost $3 million and  place people on-call                                                               
who don't need to be today.   When an employee is on-call, he/she                                                               
has a to be on site within 60  minutes from the time called.  The                                                               
aforementioned really  restricts people's lives.   Therefore, the                                                               
on-call option is a poor alternative to triple time.                                                                            
                                                                                                                                
3:07:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if Mr.  Grange is referring  to page                                                               
2,  line 16  of  HB 271  and suggesting  that  the provision  may                                                               
provide a situation  in which many people are  scheduled for lots                                                               
of on-call  time in order  to avoid the triple  time consequence,                                                               
although it isn't necessary.                                                                                                    
                                                                                                                                
MR. GRANGE replied yes.                                                                                                         
                                                                                                                                
3:08:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  asked if  Mr. Grange has  a sense  of how                                                               
the  shortage  Providence  experiences compares  to  the  chronic                                                               
shortage for state institutions.                                                                                                
                                                                                                                                
MR.  GRANGE answered  that the  vacancy rate  for RNs  within the                                                               
Providence Health  System in Alaska  is approximately  6 percent,                                                               
which is  well below the national  average for vacancy rate.   He                                                               
said he didn't know how it compares with the state.                                                                             
                                                                                                                                
3:09:20 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON inquired  as  to how  much  more traveling  nurses,                                                               
"travelers," are paid per hour.                                                                                                 
                                                                                                                                
MR. GRANGE said he would provide that to the committee.                                                                         
                                                                                                                                
CHAIR WILSON  recalled that four years  ago [Wrangell's] hospital                                                               
was paying $45/hour for travelers.                                                                                              
                                                                                                                                
MR. GRANGE related that [Providence  Health Care System] tries to                                                               
minimize its use of travelers in  order to have the continuity of                                                               
its own employees.                                                                                                              
                                                                                                                                
MR. GRANGE, in response to  Representative Seaton, confirmed that                                                               
the 6  percent vacancy rate  is filled by voluntary  overtime and                                                               
travelers.                                                                                                                      
                                                                                                                                
3:11:19 PM                                                                                                                    
                                                                                                                                
DIANE   O'CONNELL,   Labor   Program  Director,   Alaska   Nurses                                                               
Association,  informed  the  committee  that  the  Alaska  Nurses                                                               
Association does  represent the  nurses of the  Providence Alaska                                                               
Medical Center.  Ms. O'Connell  opined that HB 271 isn't designed                                                               
or  intended   to  discourage  volunteerism.     The  legislation                                                               
provides for  voluntary overtime as well  as prescheduled on-call                                                               
time.  She  characterized the prescheduled on-call as  a key part                                                               
of the legislation.  Only a  couple of units in Providence have a                                                               
mandatory  overtime  question  because  there has  been  work  to                                                               
resolve the  issues.   However, when there  is a  mandatory call,                                                               
there is  mandatory overtime  eventually.   She pointed  out that                                                               
there  is a  shortage of  operating nurses,  and as  the shortage                                                               
becomes  more severe  the  nurses on  staff  are more  frequently                                                               
called  upon to  be on-call.   Ms.  O'Connell said  that although                                                               
it's being  handled fairly well currently,  she expressed concern                                                               
that  as   the  nursing  shortage   continues  it   will  worsen.                                                               
Therefore,  she  expressed  the desire  to  discourage  mandatory                                                               
overtime while  encouraging other  ways to address  this problem.                                                               
Ms.  O'Connell said  that the  nurses with  which she  has spoken                                                               
aren't interested in  overtime, whether it's triple  time or time                                                               
and a half.  The triple time  was used in order to grab attention                                                               
and deter the use of overtime.                                                                                                  
                                                                                                                                
3:15:48 PM                                                                                                                    
                                                                                                                                
MS. O'CONNELL said that she  didn't fully understand Mr. Grange's                                                               
position on the on-call status.   In Providence, one unit already                                                               
has  people on-call.    She  didn't believe  many  places in  the                                                               
hospital  have  a  set  on-call  schedule,  although  the  Alaska                                                               
Psychiatric Institute  is a  different matter  to which  they can                                                               
speak.   She  then informed  the  committee that  10 states  have                                                               
[passed] legislation  limiting the use of  mandatory overtime and                                                               
similar  legislation  has been  introduced  in  15 other  states,                                                               
including Alaska.                                                                                                               
                                                                                                                                
3:17:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  asked if the  new nursing program  at the                                                               
University of  Alaska - Anchorage  is working  toward alleviating                                                               
the shortage or  will many of those graduates  seek employment in                                                               
other [states].                                                                                                                 
                                                                                                                                
MS.  O'CONNELL  said   the  program  can't  help   but  help  the                                                               
situation.                                                                                                                      
                                                                                                                                
3:18:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SEATON  returned   to  his   earlier  suggestion                                                               
regarding triple  time and  asked whether it  would be  a concern                                                               
for Ms. O'Connell.                                                                                                              
                                                                                                                                
MS. O'CONNELL reiterated  that her main concern  is to discourage                                                               
mandatory  overtime, the  means  by which  it's accomplished  may                                                               
continue to  be the subject  of conversation.  Triple  time isn't                                                               
necessary for the nurse, she opined.   Although it seems that the                                                               
individual  that's  the  "victim"  in this  case  should  receive                                                               
additional  compensation,   limiting  overtime  results   in  the                                                               
individual  not  receiving  compensation   anyway.    In  further                                                               
response  to Representative  Seaton,  Ms. O'Connell  acknowledged                                                               
the  association's concern  with regard  to prescheduled  on-call                                                               
time, but  noted that it  understands the  need for people  to be                                                               
on-call and come in during  emergencies.  The desire, she opined,                                                               
is  to  limit  [prescheduled   on-call]  to  emergencies  because                                                               
there's a  difference between being  on-call for  emergencies and                                                               
mandatory overtime.                                                                                                             
                                                                                                                                
3:21:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  expressed the  need for the  Alaska Nurses                                                               
Association to review this and  provide suggestions as to how the                                                               
distinction  between   on-call  for  emergencies   and  mandatory                                                               
overtime can be made in the law.                                                                                                
                                                                                                                                
3:21:48 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON  reviewed HB  271,  which  limits the  overtime  in                                                               
nursing such  that a nurse  may not  be required or  coerced into                                                               
accepting an  assignment of  overtime if  the nurse  believes the                                                               
overtime  would  jeopardize  the   patient's  or  the  employee's                                                               
safety.  Chair Wilson specified that  HB 271 doesn't apply to the                                                               
following:   a nurse  on duty  in overtime  status because  of an                                                               
unforeseen  emergency  situation;  prescheduled on-call  time;  a                                                               
nurse voluntarily  working overtime;  the first hour  of overtime                                                               
status;   and  a   critical  access   hospital.     However,  the                                                               
legislation does  require that the  nurse should have at  least 8                                                               
consecutive hours time  off after working 12  or more consecutive                                                               
hours.  Furthermore, the health  care facility should provide for                                                               
an anonymous process  for patients and nurses  to make complaints                                                               
related to staffing  levels and patient safety.   The legislation                                                               
has protections  for complainants and specifies  the enforcement,                                                               
offenses, and penalties.                                                                                                        
                                                                                                                                
3:26:38 PM                                                                                                                    
                                                                                                                                
MARCIA COOPER, RN, Alaska Psychiatric  Institute (API),  informed                                                               
the committee  that nurses at  API are required to  work overtime                                                               
shifts  and usually  have  to work  overtime  shifts every  week.                                                               
However,  during   peak  times,  such  as   summer  vacation  and                                                               
holidays,  the overtime  shifts  are more  frequent  than once  a                                                               
week.  Ms.  Cooper related that she works the  11:00 p.m. to 7:00                                                               
a.m. shift, and therefore a  mandatory overtime shift would begin                                                               
at 7:00  a.m.  During that  time, Ms. Cooper related  that she is                                                               
required to give the morning  medications.  After already working                                                               
eight  hours, she  said  she suffers  from  fatigue, which  isn't                                                               
conducive   to  the   proper  and   accurate  administration   of                                                               
medication to  the patients.   From July 1  to August 26  of this                                                               
year,   API   employees,   including  the   psychiatric   nursing                                                               
assistances as well as the RNs,  have worked a total 437 overtime                                                               
shifts.   She noted  that many nurses  volunteer for  overtime in                                                               
order to remove  their names from the mandatory  overtime list to                                                               
ensure  they won't  be required  to  come in  on a  day they  are                                                               
scheduled to be  off.  Ms. Cooper informed the  committee that in                                                               
July  2005, API  nurses worked  54 overtime  shifts.   She echoed                                                               
earlier comments regarding that  overtime results in nurses being                                                               
more  prone to  mistakes, fatigue,  and burnout.   She  specified                                                               
that burnout results  in higher levels of turnover and  a lack of                                                               
experienced  personnel,  which  is supported  by  many  reputable                                                               
journals.                                                                                                                       
                                                                                                                                
MS. COOPER related that a  1992 American Journal of Public Health                                                               
study  found  that nurses  working  variable  schedules, such  as                                                               
mandatory overtime,  were twice as  likely to report  an accident                                                               
or  error and  two-and-a-half times  more likely  to report  near                                                               
miss  accidents.    The study  concluded  that  these  conditions                                                               
related to increased error rates on  the performance of tasks.  A                                                               
2000 IOM  report on safer  health systems relates  that designing                                                               
safe  medication administration  systems  for hospitals  requires                                                               
that  nurses work  with appropriate  staff levels.   "The  report                                                               
states that designing jobs with  attention to human factors means                                                               
attending to the effective work  hours, work loads, staff ratios,                                                               
sources of  distraction, and inversion  in assigned  shifts which                                                               
affects the  workers' circadian rhythms  and the  relationship to                                                               
fatigue,  alertness, and  sleep deprivation,"  she related.   Ms.                                                               
Cooper concluded:                                                                                                               
                                                                                                                                
     In short,  the practice of  requiring nurses at  API to                                                                    
     work  overtime shifts  not only  increases the  fatigue                                                                    
     and  likelihood of  burnout among  the nurses,  it also                                                                    
     increases  the  chances  of  errors  in  patient  care;                                                                    
     compromising the  responsibility of  the staff  and the                                                                    
     hospital  to  provide  reliable, accurate,  and  proper                                                                    
     medical  care  for  its  patients.    As  such,  it  is                                                                    
     imperative  that HB  271 is  passed, not  just for  the                                                                    
     nurses but for the patients that we treat every day.                                                                       
                                                                                                                                
3:30:52 PM                                                                                                                    
                                                                                                                                
MS. COOPER, in response to  Representative Seaton, specified that                                                               
the work schedule [for nurses] is  usually 7.5-8 hours a day with                                                               
12  hour  shifts  on  the   weekend.    In  further  response  to                                                               
Representative  Seaton,  Ms.  Cooper   said  that  the  mandatory                                                               
overtime  is usually  an 8  hour shift.   She  added that  it has                                                               
become more difficult to find someone who will split a shift.                                                                   
                                                                                                                                
3:32:27 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  asked if  the mandatory overtime  is such  that the                                                               
nurse doesn't work  two shifts back-to-back but  rather the nurse                                                               
comes in on his/her day off.                                                                                                    
                                                                                                                                
MS. COOPER  replied yes, adding  that on Saturday, her  usual day                                                               
off, she worked  from 3:00 a.m. to 7:00 a.m.   The aforementioned                                                               
allowed her  to get off the  mandatory overtime list so  that she                                                               
would hopefully not have to stay this weekend.                                                                                  
                                                                                                                                
3:33:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER posed a scenario  in which HB 271 were law                                                               
along with  a continuing shortage  of nurses, and inquired  as to                                                               
what would happen to the patients.                                                                                              
                                                                                                                                
MS. COOPER said she couldn't answer that.                                                                                       
                                                                                                                                
3:33:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  requested  that someone  comment  on  the                                                               
turnover  rate  and number  of  employee  sick  days.   She  also                                                               
requested that someone  comment on the general  retention rate of                                                               
nurses.                                                                                                                         
                                                                                                                                
3:35:36 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON inquired  as to the entrance level  and higher level                                                               
salaries of a nurse at API.                                                                                                     
                                                                                                                                
MS. COOPER deferred to an upcoming speaker from API.                                                                            
                                                                                                                                
3:36:06 PM                                                                                                                    
                                                                                                                                
J.W.  POUND,  RN,  Alaska  Psychiatric  Institute,  informed  the                                                               
committee that  he has worked for  API for 14 years.   He related                                                               
when he  started with API  he began as step  A, RN2.   Five years                                                               
ago comparative studies were performed  for Alaska's state nurses                                                               
salaries  because  of  problems with  recruiting  and  retention.                                                               
That study found that psychiatric  nurse salaries at API were far                                                               
below the national average.   Therefore, a 10 percent increase in                                                               
pay was given  and kept for two-and-a-half years and  then it was                                                               
taken  away by  labor relations  because of  the semantics.   The                                                               
aforementioned left many RNs in  financial hardship and again the                                                               
union  and  the  state  are  attempting  to  perform  comparative                                                               
studies,  which  reveal even  lower  salaries  than that  of  the                                                               
national average  salaries [of nurses].   Mr. Pound  informed the                                                               
committee of  the starting  wages for  nurses in  various states,                                                               
which highlighted API's low wages.   Furthermore, API offers less                                                               
evening  and  night differentials  than  most  facilities and  it                                                               
doesn't  offer  a  weekend  differential  at  all.    He  offered                                                               
examples of differentials in other states as well as other                                                                      
facilities in Alaska.                                                                                                           
                                                                                                                                
3:40:15 PM                                                                                                                    
                                                                                                                                
MR. POUND pointed out that most  facilities will have a bonus for                                                               
every certification  earned, such  as for advanced  life support,                                                               
CPR, and board certification.   Furthermore, facilities often pay                                                               
a  bonus for  education and  years of  experience.   However, API                                                               
does  not.   Mr.  Pound  explained  that  the annual  merit  step                                                               
increases  amount to  about $.88  each year  for the  first eight                                                               
years and then  there are two longevity periods  with an increase                                                               
of $1.09 for both.  Toward  the end of the [merit step increases]                                                               
there  are  two  five-year  longevity  periods  with  an  average                                                               
increase of  about $1.13 for both  of the five-year periods.   He                                                               
noted  that Providence,  Alaska Regional,  and Central  Peninsula                                                               
all have  a 30-31 step  program in  which an increase  is awarded                                                               
annually with  no empty longevity  years.  Mr. Pound  then turned                                                               
attention to  the Cost of  Living Allowance (COLA) for  which the                                                               
federal [employees]  have a 25  percent COLA while  [employees at                                                               
API] have 1.5-2 percent COLA.  In conclusion, Mr. Pound said:                                                                   
                                                                                                                                
     When one  adds up  all the extras  that the  state does                                                                    
     not allow  to the basic  RN's salary, one can  see that                                                                    
     the  nurses at  API  fare  far lower  than  any of  the                                                                    
     hospitals in  our nearby  surroundings or  the national                                                                    
     average.                                                                                                                   
                                                                                                                                
3:42:54 PM                                                                                                                    
                                                                                                                                
MIKE  ALEXANDER,  RN,  Alaska  Psychiatric  Institute,  began  by                                                               
informing the committee  that he is one of the  12-hour nurses on                                                               
the  weekends.   Mr. Alexander  opined that  his biggest  concern                                                               
with  mandatory overtime  is  patient and  employee  safety.   He                                                               
related the  scenarios in  which mandatory  overtime and  low pay                                                               
has caused  nurses to leave  API.  He  specified that the  pay is                                                               
important  with  regard  to   recruiting  and  retaining  nurses.                                                               
According to API's assistant director  of nursing, if a nurse can                                                               
be  kept for  two  years,  the nurse  will  stay.   However,  the                                                               
mandatory  overtime  is brutal.    Mr.  Alexander emphasized  his                                                               
observation that the  entire API staff is tired  and nurses don't                                                               
give patients their best when they are tired.                                                                                   
                                                                                                                                
MR.  ALEXANDER  related how  the  nurses  at  API have  tried  to                                                               
address the errors  that occur with mandatory  overtime by trying                                                               
not to have  the nurses working mandatory overtime  deal with the                                                               
medication  cart.   Furthermore, nurses  volunteer for  mandatory                                                               
overtime  when possible.   In  response to  the earlier  question                                                               
regarding  the  top  wage  at   API,  he  estimated  that  it  is                                                               
approximately $33.00 [an hour].                                                                                                 
                                                                                                                                
3:49:28 PM                                                                                                                    
                                                                                                                                
                                                                                                                                
REPRESENTATIVE  CISSNA  inquired  as   to  whether  incidents  of                                                               
injuries in correctional and  psychiatric facilities with violent                                                               
patients  is  ever  an  issue   [in  conjunction  with  mandatory                                                               
overtime].                                                                                                                      
                                                                                                                                
3:50:26 PM                                                                                                                    
                                                                                                                                
MR. ALEXANDER opined that the  aforementioned is a factor because                                                               
if a  nurse is  tired, the  nurse may  or may  not pickup  on the                                                               
signs  [of  an impending  violent  incident].   He  informed  the                                                               
committee  that   90-96  percent  of  suicides   in  correctional                                                               
facilities are  hangings, which  he estimated  to be  roughly the                                                               
same  percentage  in  psychiatric  facilities.   If  staff  isn't                                                               
alert, warning signs might not  be caught.  Therefore, the desire                                                               
is  to have  adequate staff.   Prohibiting  the use  of mandatory                                                               
overtime as a staffing tool is a major step forward.                                                                            
                                                                                                                                
3:53:01 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON, in  response  to  Representative Cissna's  earlier                                                               
question, related  that an IOM  study regarding nurse  work hours                                                               
and  health care  errors  estimates  that annually  44,000-98,000                                                               
hospital  deaths can  be attributed  to medical  errors to  which                                                               
mandatory overtime is a serious  contributing factor.  Therefore,                                                               
the  IOM   recommends  that  all  overtime   by  nurses,  whether                                                               
voluntary or mandatory, should be curtailed.                                                                                    
                                                                                                                                
3:54:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if there  are people on  the nursing                                                               
staff who count on overtime  for additional income, and therefore                                                               
would leave if overtime was eliminated.                                                                                         
                                                                                                                                
MR.  ALEXANDER replied  yes,  at  times.   However,  most of  the                                                               
nurses  at API  know when  they've [worked]  enough.   He related                                                               
that  the   overtime  at   API  amounts   to  about   $4,800  per                                                               
person/year.   He opined  that the  overtime creates  a perpetual                                                               
cycle of needing someone to  cover because staff become exhausted                                                               
and call in because they aren't fit to work.                                                                                    
                                                                                                                                
3:57:36 PM                                                                                                                    
                                                                                                                                
DOROTHY   FULTON,  Executive   Administrator,  Alaska   Board  of                                                               
Nursing, testified on  behalf of the board in support  of HB 271.                                                               
The Alaska Board  of Nursing, she related, feels that  a nurse is                                                               
a professional  level person and  should know when he/she  is not                                                               
safe  to  be practicing.    After  a  12  hour shift,  [a  nurse]                                                               
certainly isn't safe to practice, she opined.                                                                                   
                                                                                                                                
3:59:36 PM                                                                                                                    
                                                                                                                                
SHARA  SUTHERLIN,   Chief  Nurse  Executive,   Providence  Alaska                                                               
Medical Center (Providence),  related she has been  a nurse since                                                               
1976.  Ms.  Sutherlin informed the committee  that Providence has                                                               
an agreement with AaNA, which  codifies the essential elements of                                                               
nurse staffing in  the hospital.  The purpose  of this agreement,                                                               
she  related, is  to promote  the mutual  objective of  providing                                                               
quality patient  care through  stable employee  relationships and                                                               
to set  forth the agreement  reached with regard to  wages, hours                                                               
of  work, and  other terms  and  conditions of  employment.   Ms.                                                               
Sutherlin  related that  Providence has  utilized creative  ideas                                                               
and resources  to address  the issues  that impact  nursing care.                                                               
For instance, a  float pool is utilized.  She  explained that the                                                               
float  pool  is  a  separate department  within  Providence  that                                                               
employs nurses who like combination  care sets or have skill sets                                                               
beyond care sets.  The nurses  in the float pool are placed where                                                               
they are  needed.  Also,  Providence has  a registry or  per diem                                                               
staff  to  help   supplement  where  needed  as   well  as  cover                                                               
vacations.   Traveler  nurses,  who tend  to  be seasonal,  cover                                                               
vacations  as well  as  when there  are  core physician  staffing                                                               
issues.                                                                                                                         
                                                                                                                                
MS. SUTHERLIN  specified that  Providence basically  utilizes 12-                                                               
hour   shifts  throughout   the  medical   center,  which   is  a                                                               
combination  of  preference,  as  well  as  continuity  of  care.                                                               
Providence also has  rotational shifts as well  as nurse educator                                                               
positions.   As  pointed  out by  Dr. Linda  Aiken  (ph) and  Dr.                                                               
Porter  O'Grady  (ph), it's  not  always  the number  of  nurses.                                                               
Although  the  number of  nurses  at  the bedside  correlates  to                                                               
patient safety  and outcomes,  critical thinking  and educational                                                               
pursuits of  professional staff make the  difference, she opined.                                                               
The goal  of Providence  is not  to use  mandatory overtime  as a                                                               
priority  staffing   tool,  and   therefore  other   avenues  are                                                               
reviewed.  For example, in the  OR there are nurse fellowships in                                                               
order to allow nurses interested  in doing something different to                                                               
do  so.   Ms. Sutherlin  informed the  committee that  Providence                                                               
utilizes  mandatory on-call  in  the  CATH (ph)  lab  due to  the                                                               
emergency  situations   that  can  arise  in   an  interventional                                                               
cardiovascular patient.                                                                                                         
                                                                                                                                
MS. SUTHERLIN  further informed the committee  that Providence is                                                               
focused  on   increasing  patient  access   while  simultaneously                                                               
providing nurses the ability to  rest between shifts.  Last year,                                                               
Providence,  in attempting  to decrease  its need  for travelers,                                                               
expanded  its ability  to hire  adult critical  care nurses.   In                                                               
doing so,  Providence faced spending  more money to fill  some of                                                               
the  core positions  as  well as  to allow  the  nurses time  off                                                               
during the  summer.   She characterized  the aforementioned  as a                                                               
retention issue yet to be solved.                                                                                               
                                                                                                                                
4:06:40 PM                                                                                                                    
                                                                                                                                
MS. SUTHERLIN,  in response  to Representative  Seaton, confirmed                                                               
that a full-time nurse at  Providence would work three shifts per                                                               
week.                                                                                                                           
                                                                                                                                
4:07:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked if  Providence provides longer breaks                                                               
during its  12-hour shift  as compared to  the 8-hour  shift plus                                                               
overtime at API.                                                                                                                
                                                                                                                                
MS. SUTHERLIN  specified that at  Providence there are  15 minute                                                               
breaks every  four hours.   Furthermore, 30 minutes is  given for                                                               
meal  breaks.   In  fact, Providence  is using  a  log to  ensure                                                               
nurses  receive   their  breaks   in  the  adult   critical  care                                                               
[division].  However,  that's quite a challenge  in critical care                                                               
settings because critical care patients  don't always comply with                                                               
meal or break times.                                                                                                            
                                                                                                                                
4:08:39 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON recalled  that when  she was  a nurse  she scarcely                                                               
remembers taking  a 15-minute break,  which she  emphasized would                                                               
be most  important when one  works a  12-hour shift on  a regular                                                               
basis.                                                                                                                          
                                                                                                                                
4:08:59 PM                                                                                                                    
                                                                                                                                
MS. SUTHERLIN related her personal  belief that UAA has done much                                                               
to address the nursing shortage.   With Providence's vacancy rate                                                               
of 4-6  percent, it hasn't  had as many vacancies  as [necessary]                                                               
for  the graduate  nurses.   Furthermore,  the Providence  Alaska                                                               
Learning  Institute is  focused on  intensifying its  efforts for                                                               
internships and  fellowships as  well as  the resources  with the                                                               
advanced  practice nursing  team.   She related  that on  average                                                               
Providence hires between  25-40 new graduates a  year.  Moreover,                                                               
the  hospital is  connected with  Spokane  Community College  for                                                               
difficult to fill  positions.  She indicated the  need to utilize                                                               
creative  ways to  supplement staffing,  such  as rapid  response                                                               
teams, as recommended in the "The Wall of Silence."                                                                             
                                                                                                                                
4:11:38 PM                                                                                                                    
                                                                                                                                
MS. SUTHERLIN,  in response  to Representative  Seaton, confirmed                                                               
that the  12-hour shifts  are scheduled  three days  in a  row or                                                               
with  breaks.   Although there  is a  continuity issue,  there is                                                               
also  a  workplace  balance  issue.   Ms.  Sutherlin  noted  that                                                               
Providence recently won an award  in reviewing workplace balances                                                               
and providing resources,  such as child care centers  in order to                                                               
create  a schedule  that  works for  nurses  and their  families.                                                               
However, she acknowledged that it's a challenge.                                                                                
                                                                                                                                
4:13:05 PM                                                                                                                    
                                                                                                                                
PATRICIA CENTER (PH), Chair of  the Legislative Committee, Alaska                                                               
Nurses  Association (AaNA),  submitted the  written testimony  of                                                               
Kathleen  Gettys   (ph),  chair  of  the   Providence  Collective                                                               
Bargaining Unit.   Ms. Center then turned attention  to the issue                                                               
of RNs who work for the state.   The discussion today has been in                                                               
regard to the API  nurse shortage due to lack of  pay and lack of                                                               
competitive pay  with the  private sector.   In the  past, higher                                                               
benefits made  up for  the aforementioned.   However,  that's not                                                               
the case  now [with Tier  III and IV].   She alluded to  the fact                                                               
that  API is  not the  only  state facility  having trouble  with                                                               
retention, it's also  a problem with the  corrections facility in                                                               
Anchorage as  well as  the pioneers'  homes.   Furthermore, there                                                               
are  recruitment  and  retention  problems for  the  Division  of                                                               
Public Health nurses.  She recalled  that there was a request for                                                               
the Department of Administration to review the pay of nurses.                                                                   
                                                                                                                                
MS. CENTER then turned to  mandatory overtime, which has resulted                                                               
in a "death  spiral" in other states.  Since  there's a shortage,                                                               
employers  have used  "mandation"  to make  existing nurses  work                                                               
more and  address the shortage.   However, that  increases injury                                                               
and burnout rates  amongst nurses.  California, which  was one of                                                               
the first  states to  prohibit mandatory  overtime, found  in the                                                               
three  years  after  passage  of the  prohibition  a  60  percent                                                               
increase in  nurses applying  for RN  licenses.   Therefore, it's                                                               
great that  Alaska is being proactive  in this matter.   She then                                                               
related that one of the reasons  most of the hospitals within the                                                               
state  haven't had  a problem  [with mandatory  overtime and  low                                                               
pay] is  because they are  covered by union contracts.   Although                                                               
the unions [for  nurses in private facilities]  have been working                                                               
on the issue, the state  employees' union, under which the nurses                                                               
in  state facilities  fall, isn't  on top  of nursing  profession                                                               
issues as much as the [private] hospital and nursing unions.                                                                    
                                                                                                                                
MS.  CENTER   related  that   the  average   age  of   nurses  is                                                               
approximately 48.  Furthermore,  the physical demands of hospital                                                               
nurses  are tremendous,  especially as  society becomes  heavier.                                                               
She  highlighted that  [UAA's]  School of  Nursing  is trying  to                                                               
double its  output, which  Ms. Center  hoped would  coincide with                                                               
the  number of  nurses  who will  retire in  the  next couple  of                                                               
years.   She offered that  most of  the nurses who  graduate from                                                               
UAA do remain  in Alaska, and therefore she  expressed her belief                                                               
that it's worthwhile to continue to support that effort.                                                                        
                                                                                                                                
4:18:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER asked if other  states have tried to poach                                                               
Alaska's nursing graduates.                                                                                                     
                                                                                                                                
CHAIR WILSON related that an  unidentified speaker said he saw an                                                               
advertisement  on   the  Internet  to  which   nine  out-of-state                                                               
agencies responded in three days.                                                                                               
                                                                                                                                
4:19:25 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON   commented  that  within  public   health  various                                                               
diseases that  once were believed  to be overcome  are returning.                                                               
Therefore, public health nurses are critical.                                                                                   
                                                                                                                                
4:20:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA emphasized  the  need to  ensure that  all                                                               
nurse positions  are covered,  especially in  view of  the public                                                               
health concerns the state may face,  such as the bird flu that is                                                               
working its way across Siberia.                                                                                                 
                                                                                                                                
4:21:54 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON talked about a  conference she attended in which the                                                               
discussion was about when the  pandemic will hit.  Therefore, she                                                               
was  pleased that  the state  is talking  about it  and providing                                                               
training on it.                                                                                                                 
                                                                                                                                
MS. CENTER interjected that Alaska is  fortunate in that it has a                                                               
strong public health infrastructure.                                                                                            
                                                                                                                                
4:23:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  inquired as  to how  HB 271  compares with                                                               
the legislation proposed or adopted in other states.                                                                            
                                                                                                                                
MS. CENTER related  that HB 271 was drafted  after legislation in                                                               
other  states.   However, she  deferred to  others regarding  the                                                               
specifics.  She  related that studies have shown that  as soon as                                                               
a nurse  goes into  overtime, the chance  of an  error increases.                                                               
Therefore, some  states have specified  a cap with regard  to the                                                               
amount of hours a nurse can work  in a week.  In further response                                                               
to Representative Seaton,  she said that at the  moment [AaNA] is                                                               
looking at the mandatory component of overtime.                                                                                 
                                                                                                                                
4:26:08 PM                                                                                                                    
                                                                                                                                
MS. O'CONNELL  specified that  AaNA isn't  looking at  an all-out                                                               
ban of  overtime but  rather limits on  mandatory overtime.   She                                                               
acknowledged that  there are variations  on the  legislation, but                                                               
she focused on the shortest and  simplest version with a limit on                                                               
overtime rather than a complete ban.                                                                                            
                                                                                                                                
4:27:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON commented  on  the  difficulty in  getting                                                               
legislation  through, and  therefore expressed  the hope  that it                                                               
isn't necessary  to follow up  with another piece  of legislation                                                               
later.                                                                                                                          
                                                                                                                                
MS. O'CONNELL  said that certainly  isn't her goal,  although she                                                               
noted that  there may need  to be changes to  HB 271 in  order to                                                               
address the concerns that have been specified.                                                                                  
                                                                                                                                
4:28:25 PM                                                                                                                    
                                                                                                                                
STACEY ALLEN (ph), RN, Alaska  Regional Hospital, Laborers' Local                                                               
341, related that  the Laborers' Local 341 supports HB  271.  She                                                               
said that  there is  precedent in  other industries  for limiting                                                               
the  time  period  an  individual  works  due  to  public  safety                                                               
concerns.  However, HB 271 is  a bit different than how the issue                                                               
has  been addressed  in other  industries because  it allows  the                                                               
nurse to say he/she is not safe.                                                                                                
                                                                                                                                
4:30:08 PM                                                                                                                    
                                                                                                                                
JANET  CLARKE,  Assistant  Commissioner, Finance  and  Management                                                               
Services, Department of Health and  Social Services, related that                                                               
DHSS doesn't  like using overtime.   Furthermore,  the department                                                               
attempts to  limit the amount  of mandatory overtime it  uses and                                                               
utilize voluntary  overtime when possible.   As today's testimony                                                               
has related, the managers, supervisors,  and nurses work hard not                                                               
to compromise care.   In the specialized facilities,  API and the                                                               
pioneers' homes, the state is  responsible for providing care for                                                               
a very  vulnerable population.   Therefore, [DHSS] is in  a Catch                                                               
22.                                                                                                                             
                                                                                                                                
MS. CLARKE characterized  mandatory overtime as a  symptom of the                                                               
circumstances.    Overtime  is  a   primary  issue  in  API,  the                                                               
pioneers'  homes,  and  the  juvenile  facilities,  although  the                                                               
juvenile justice  employees aren't nurses.   Public health nurses                                                               
don't  have  overtime  issues,  but  there  are  recruitment  and                                                               
retention issues in  that area.  Ms. Clarke  attributed the major                                                               
cause of  overtime to the  fact that DHSS  can't fill all  of its                                                               
nursing positions in  a timely fashion.  If  the current budgeted                                                               
authorized  positions  were  filled, the  problem  with  overtime                                                               
would  be negligible.   She  highlighted the  vacancy problem  by                                                               
reminding  the  committee of  Providence's  vacancy  rate of  4-6                                                               
percent  as  compared to  [the  state  facilities] 15-20  percent                                                               
vacancy  rate for  nurses.   The turnover  rate [for  the state's                                                               
nurses]  is  about 17  percent  on  average.   She  informed  the                                                               
committee that she recently was  informed of a 23 percent vacancy                                                               
rate for nurses at API.                                                                                                         
                                                                                                                                
MS. CLARKE,  in addressing  why overtime is  used, turned  to the                                                               
national nurse shortage and said  employers need to be proactive,                                                               
flexible, and competitive.  However,  that's not the case for the                                                               
state.    Furthermore,  nurses are  represented  by  the  general                                                               
bargaining unit, which doesn't specialize in the nursing field.                                                                 
                                                                                                                                
4:34:27 PM                                                                                                                    
                                                                                                                                
MS.  CLARKE,  in response  to  Chair  Wilson, related  that  DHSS                                                               
utilizes contract nurses, which are similar to travelers.                                                                       
                                                                                                                                
RON  ADLER,  CEO,  Alaska Psychiatric  Institute,  Department  of                                                               
Health  and   Social  Services,  specified  that   of  the  three                                                               
temporary  relief  agencies  in Anchorage  only  two  psychiatric                                                               
nurses can  be obtained  to come  to API.   Such nurses  would be                                                               
paid between  $45-$60, just as  they would for a  general medical                                                               
facility  like Providence.   He  noted  that psychiatric  nursing                                                               
isn't the most desirable field.                                                                                                 
                                                                                                                                
4:34:57 PM                                                                                                                    
                                                                                                                                
MS.  CLARKE informed  the committee  that  state facilities  also                                                               
utilize on-call  nurses.   However, it's  very difficult  to fill                                                               
the high  number of  vacancies.   Furthermore, the  state doesn't                                                               
offer  some  of  the  benefits   that  are  attractive  to  nurse                                                               
candidates,  such as  signing bonuses,  on-site daycare,  premium                                                               
relocation  programs,  and a  central  recruiting  effort in  the                                                               
state.    Moreover, the  state's  hiring  system doesn't  provide                                                               
flexibility for  quick job offers.   In  fact, there have  been a                                                               
couple of instances  in which a nurse, while  waiting to complete                                                               
the hiring process, has taken  a position elsewhere.  She pointed                                                               
out  that other  employers  offer yearly  merit  steps as  nurses                                                               
achieve certification  levels, while  the state's nurses  top out                                                               
at longevity  steps as  described earlier.   Finally,  Ms. Clarke                                                               
highlighted that the state's salary  schedule is below the market                                                               
and thus is a barrier to recruitment and retention.                                                                             
                                                                                                                                
4:37:26 PM                                                                                                                    
                                                                                                                                
MS. CLARKE returned  to the earlier mentioned pay  raise that was                                                               
taken  from state  nurses after  being in  effect for  two years.                                                               
She explained  that the  former CEO  of API  saw that  there were                                                               
going  to be  issues in  retention and  recruitment of  nurses as                                                               
well  as the  market  going  in a  different  direction than  the                                                               
state's  salary  schedule.   She  pointed  out  that there  is  a                                                               
provision  in state  pay for  standby  pay, which  means that  an                                                               
individual  is on  call.   Therefore, the  former CEO  decided to                                                               
offer standby  pay to  all nurses.   However,  the union  filed a                                                               
grievance that  the standby pay  option should also  be available                                                               
to nursing assistants as well  as nurses.  During the arbitration                                                               
phase, the  state labor relations  mandated that API  stop paying                                                               
standby pay to all nurses.                                                                                                      
                                                                                                                                
4:38:55 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked  if it's equally as difficult  to obtain nurse                                                               
assistants as it is RNs.                                                                                                        
                                                                                                                                
MS. CLARKE replied no.                                                                                                          
                                                                                                                                
MR. ADLER  interjected that  it's more  difficult to  obtain RNs,                                                               
who are licensed and without whom a hospital can't function.                                                                    
                                                                                                                                
MS. CLARKE,  in response  to Chair Wilson,  related that  most of                                                               
the state employees  are covered by the  general government unit,                                                               
which is the case with the RNs and the nurse assistants.                                                                        
                                                                                                                                
4:40:29 PM                                                                                                                    
                                                                                                                                
MS. CLARKE opined:                                                                                                              
                                                                                                                                
     We either  have to  have some special  dispensation for                                                                    
     some  ability  to  be  more  proactive,  flexible,  and                                                                    
     competitive or we're  kind of in a Catch  22 because if                                                                    
     we can't solve  those causes of not being  able to fill                                                                    
     our authorized  positions and this  bill were  to pass,                                                                    
     you've really  put us in a  barrel.  We really  need to                                                                    
     deal with  those other issues  as well, and  that's ...                                                                    
     what I would urge the committee to consider.                                                                               
                                                                                                                                
4:41:05 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON requested that Ms.  Clarke think about what could be                                                               
done  legislatively  to  allow  special  dispensation  for  these                                                               
facilities to [go outside of the state employee construct].                                                                     
                                                                                                                                
4:41:31 PM                                                                                                                    
                                                                                                                                
MR. ADLER  said that the  three employees from API  who testified                                                               
today were remarkably  accurate.  He surmised that  the three are                                                               
relating  that API  isn't  attractively priced  in  terms of  the                                                               
hourly wage.                                                                                                                    
                                                                                                                                
4:43:20 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON  pointed out  that  there  is a  teacher  placement                                                               
agency, which  might be something  that could be helpful  for the                                                               
recruitment of RNs.                                                                                                             
                                                                                                                                
4:44:46 PM                                                                                                                    
                                                                                                                                
MR. ADLER  noted that Providence does  a nice job with  regard to                                                               
recruitment and retention.  He  suggested that at some point, the                                                               
state is  going to  have to  think outside of  the box  such that                                                               
API, the pioneers'  homes, and public health  are viewed together                                                               
and  working under  the umbrella  of DHSS  in order  to create  a                                                               
lifetime  of vocational  experiences  for licensed  professionals                                                               
[at all levels].  Perhaps such  a think-tank within DHSS would be                                                               
appropriate, he opined.                                                                                                         
                                                                                                                                
4:45:47 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  commented that such  should be reviewed  before the                                                               
crisis  gets worse  because if  the state  doesn't gain  control,                                                               
institutions may close.                                                                                                         
                                                                                                                                
4:46:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  asked if this  crisis is partly  to blame                                                               
for the empty beds at the pioneers' homes.                                                                                      
                                                                                                                                
CHAIR WILSON said that it's one of the reasons.                                                                                 
                                                                                                                                
4:46:19 PM                                                                                                                    
                                                                                                                                
MR.  ADLER informed  the  committee that  API  has an  incredible                                                               
workforce and one of the  lowest restraint seclusion rates in the                                                               
U.S.  for a  state psychiatric  hospital.   The  ability to  keep                                                               
employees  and  patients  safe   is  remarkable,  he  emphasized.                                                               
However, the staff  is suggesting that it's not going  to be this                                                               
way forever.                                                                                                                    
                                                                                                                                
4:46:54 PM                                                                                                                    
                                                                                                                                
MILA  COSGROVE, Director,  Division of  Personnel, Department  of                                                               
Administration,   informed  the   committee  that   the  division                                                               
oversees  the state's  recruitment services,  employee relations,                                                               
et  cetera.   In  response  to an  earlier  request for  overtime                                                               
figures, Ms. Cosgrove directed attention  to a document entitled,                                                               
"Overtime Paid in  Fiscal Year 2005 to Nurses by  Facility".  She                                                               
clarified  that  the  aforementioned   document  only  refers  to                                                               
nursing positions.   The  second and  third columns  relates that                                                               
there  are more  employees  who worked  overtime than  positions,                                                               
which she attributed to the fact  that the number of positions is                                                               
the number of  budgeted positions.  A position  may become vacant                                                               
and  be replaced  during the  course of  the year,  and therefore                                                               
it's possible to have more employees  over the course of a fiscal                                                               
year than there are positions.                                                                                                  
                                                                                                                                
4:48:56 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  surmised then that  if more people  were recruited,                                                               
the amount of overtime would decrease.                                                                                          
                                                                                                                                
MS. COSGROVE  replied yes, adding  that the straight  wages would                                                               
increase because  of the increase  in employees.   However, since                                                               
these are employees  of facilities that are open 24  hours a day,                                                               
there will  always be  overtime issues.   In further  response to                                                               
Chair Wilson, Ms. Cosgrove specified  that the [overtime] figures                                                               
refer  to primarily  time-and-a-half and  don't include  overtime                                                               
for holiday purposes.   She noted that there  are special letters                                                               
of  agreement  for  employees  of  24-hour  facilities  to  "swap                                                               
holidays."   The number  4 handout breaks  down the  specific job                                                               
class titles, she pointed out.                                                                                                  
                                                                                                                                
MS. COSGROVE  then returned to  her testimony.  She  related that                                                               
the U.S. is experiencing a  general reduction in applicant pools,                                                               
not just in nursing.  The  aforementioned is related to the aging                                                               
of the  Baby Boomers and the  fact that there are  less people to                                                               
take  their place.    However, nursing  is  critical because  the                                                               
services can't merely  be stopped when there  isn't enough staff.                                                               
Ms. Cosgrove  turned to the  national shortage of nurses  that is                                                               
caused by the same  factors as well as the fact  that there is an                                                               
overall increase in  the demand for nurses,  in part attributable                                                               
to the  aging of  Baby Boomers  who require  more health  care as                                                               
well  as the  way  the U.S.  administers its  health  care.   She                                                               
indicated  that  the  duties  and  responsibilities  assigned  to                                                               
nurses have changed over the  years, which has also increased the                                                               
demand for nurses.                                                                                                              
                                                                                                                                
4:51:54 PM                                                                                                                    
                                                                                                                                
MS.  COSGROVE  turned  attention  to  the  "State  Public  Health                                                               
Employee Worker  Shortage Report", which speaks  mostly to public                                                               
health.    The  report  relates  that 85  percent  of  the  state                                                               
agencies  responding   to  the   survey  indicated   that  severe                                                               
personnel  shortages  were  seen   with  health  care  personnel.                                                               
Furthermore, the Department of Labor  & Workforce Development has                                                               
projected  that  between 2002  and  2012  there  will be  a  33.3                                                               
percent increase  in registered  nurse positions.   She clarified                                                               
that  the  aforementioned  percentage   is  in  addition  to  the                                                               
positions  that  are  already present  and  doesn't  replace  the                                                               
outgoing employees.   As an  employer, the State of  Alaska feels                                                               
that pressure, she opined.                                                                                                      
                                                                                                                                
4:52:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  returned attention  to the  overtime table                                                               
and the last column referring to the average hours per position.                                                                
                                                                                                                                
MS.  COSGROVE  specified that  the  column  reflects the  average                                                               
hours  worked   per  employee   in  these   job  classifications.                                                               
However,  because voluntary  overtime  is used  first  a list  of                                                               
employees  with  overtime  hours   worked  would  relate  a  huge                                                               
[discrepancy].   Therefore,  she requested  the average  hour per                                                               
employee per the fiscal year.                                                                                                   
                                                                                                                                
4:54:22 PM                                                                                                                    
                                                                                                                                
MS. COSGROVE  continued with her  testimony and related  that the                                                               
primary  employers of  nurses  for  the state  are  DHSS and  the                                                               
Department of  Corrections.   At the end  of calendar  year 2004,                                                               
there   were   about   279   positions   allocated   to   nursing                                                               
classifications.    The  Division  of Personnel  tries  to  track                                                               
turnover and  retirement eligibility data, although  the division                                                               
is having difficult  with its aging system.   Therefore, the data                                                               
isn't 100 percent [accurate].   The handout in number 4 specifies                                                               
that  the [state]  has  about  a 17  percent  turnover rate  [for                                                               
nurses employed  by the  state], which  looks quite  different in                                                               
the job class  level.  For instance, at the  Nurse 1 level, there                                                               
is a  50 percent turnover rate  and at the Journey/Nurse  2 level                                                               
the turnover rate is about 22 percent.                                                                                          
                                                                                                                                
4:55:40 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked  if exit interviews are performed  in order to                                                               
determine why the nurses employed by the state are leaving.                                                                     
                                                                                                                                
MS. COSGROVE replied  yes, but it isn't highly used.   She agreed                                                               
with  Chair  Wilson that  an  exit  interview would  probably  be                                                               
helpful.  Ms.  Cosgrove then turned to the other  factor that the                                                               
division  is reviewing,  which  is the  aging  of the  workforce.                                                               
Last  year   a  fairly  comprehensive  retirement   analysis  was                                                               
published.  That analysis relates that  at the end of fiscal year                                                               
2004,  13.9  percent  of  employees  in  nursing  positions  were                                                               
eligible to  retire in  one year.   That percentage  increases to                                                               
35.2 percent when viewed in  a five-year window.  Therefore, this                                                               
confluence of events needs to be watched, she opined.                                                                           
                                                                                                                                
4:56:47 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON turned  attention  to the  document that  specifies                                                               
that by 2012,  [the state] will need another  1,666 nurses, which                                                               
doesn't include the one-third that will be lost to that point.                                                                  
                                                                                                                                
MS. COSGROVE  replied yes, and  specified that the  document from                                                               
the  Department  of  Labor  &  Workforce  Development  refers  to                                                               
positions while  she is now  discussing people available  to fill                                                               
those  positions.   In  further  response  to Chair  Wilson,  Ms.                                                               
Cosgrove, said that one-third of  the current 280 positions would                                                               
be  approximately   95  positions.     She  confirmed   that  the                                                               
[document]  is referring  to  the public  and  private sector  in                                                               
Alaska.   Ms. Cosgrove explained  that she isn't saying  that the                                                               
state  will  necessarily  increase  its need  for  nurses  by  33                                                               
percent, but 35 percent of the  state's nurses can retire in five                                                               
years.  Therefore, even if  the state doesn't increase the number                                                               
of nursing  positions, finding people  for the vacancies  will be                                                               
more  difficult because  the competition  will  be more  intense.                                                               
She characterized it as basic supply and demand.                                                                                
                                                                                                                                
4:58:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  if nurses who are able  to retire do                                                               
so  when they  are  eligible,  or do  nurses  tend  to stay  past                                                               
retirement.                                                                                                                     
                                                                                                                                
MS. COSGROVE informed  the committee that the  division is hoping                                                               
to,   this  year,   be  able   to  accurately   review  projected                                                               
retirements  versus actual  retirements.   She related  her "gut-                                                               
level guess"  that most [nurses]  retire because they  can retire                                                               
with the  full state employment  and work elsewhere for  a higher                                                               
hourly wage.   She mentioned  HB 161, and informed  the committee                                                               
that the  state has  no retired  nurses who  have returned.   The                                                               
aforementioned she  attributed to the  fact that nurses  can work                                                               
anywhere, whereas  the expertise  of many other  public employees                                                               
is in  the public  sector.   In the way  of background  data, Ms.                                                               
Cosgrove informed the  committee that the average  years of state                                                               
service for  a Nurse 2  are 6.67 years  and 1.29 years  for entry                                                               
level nurses.                                                                                                                   
                                                                                                                                
MS.  COSGROVE  then turned  to  the  fact  that state  wages  are                                                               
trailing private sector wages.   In fact, the state's entry level                                                               
[nursing] wages are approximately  7.3 percent below Providence's                                                               
wage.     Furthermore,  private   sector  companies   enjoy  more                                                               
flexibility than the state, in  terms of offering various bonuses                                                               
and  more steps.   Additionally,  the state's  classification and                                                               
pay  plan  isn't  established  to  address  fluctuations  in  the                                                               
market, rather  the state's  plan is  established to  ensure that                                                               
all  state's  employees receive  like  pay  for  like work.    To                                                               
address the aforementioned,  the division has a  number of short-                                                               
term  and  long-term  strategies.    In  fact,  the  division  is                                                               
reviewing a  policy that  would change the  way nurses  are hired                                                               
and  at what  level they  would enter  the pay  scale.   The same                                                               
policy change would  allow a hiring manager the  ability to offer                                                               
something to the nurse more quickly than is currently allowed.                                                                  
                                                                                                                                
5:02:08 PM                                                                                                                    
                                                                                                                                
MS.  COSGROVE explained  that  the  aforementioned policy  change                                                               
would allow  hiring managers to  advertise and start nurses  at a                                                               
wage as  high as  $27.46 an  hour, which  she characterized  as a                                                               
competitive entry  level wage.   The division is also  creating a                                                               
proactive  recruitment  function  in   order  to  work  with  the                                                               
operating agencies and  nurses will be the first  to be reviewed.                                                               
The aforementioned will allow the  division to review recruitment                                                               
efforts,  job fairs,  partnering with  the university,  marketing                                                               
state  employment, and  other outreach  efforts designed  to make                                                               
the  state,  as an  employer,  more  visible.   Furthermore,  the                                                               
division  is designing  and implementing  both entrance  and exit                                                               
surveys.   The division also  plans to work with  hiring managers                                                               
to  market the  state's  nondirect salary  compensation, such  as                                                               
leave, holiday, and  retirement benefits that may  be better than                                                               
the  state's primary  competitors.   The division  is looking  to                                                               
partner  with  representatives  from the  operating  agencies  to                                                               
strategize efforts to  rearrange the work.  With  regard to long-                                                               
term  goals,  the  division  is  reviewing  the  state's  current                                                               
classification and  compensation structure in order  to determine                                                               
the legal  options that exist  to allow market data  to influence                                                               
wage assignments.                                                                                                               
                                                                                                                                
5:05:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON   asked  if  any  of   the  aforementioned                                                               
[strategies/goals] require legislative fixes.                                                                                   
                                                                                                                                
MS.  COSGROVE  answered that  at  this  point  most of  what  was                                                               
mentioned is  what can  be done  administratively.   However, the                                                               
larger  issue of  the classification  and compensation  structure                                                               
may require legislative  action.  She assured  the committee that                                                               
if that's the case, the division will approach the legislature.                                                                 
                                                                                                                                
CHAIR  WILSON opined  that [the  nurse shortage]  is a  challenge                                                               
that requires thinking  outside of the box.   Therefore, she said                                                               
she was open to any suggestions.                                                                                                
                                                                                                                                
5:07:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  if the fact that Tier  IV will cover                                                               
occupational  disability  has  been  identified  as  an  area  of                                                               
concern within the nursing profession.   He also asked if that is                                                               
being  reviewed as  one of  the recruitment  tools under  the new                                                               
legislation.                                                                                                                    
                                                                                                                                
MS. COSGROVE  said she couldn't specify  whether that's something                                                               
that could be highlighted as  a marketing tool since the division                                                               
is  still  in  the  process of  putting  together  a  recruitment                                                               
strategy.                                                                                                                       
                                                                                                                                
5:10:00 PM                                                                                                                    
                                                                                                                                
ROD BEANY  (PH) mentioned that he  had spoken with the  chair and                                                               
said  that he  would talk  with the  administration regarding  an                                                               
administrative way to address the  salary and recruiting problems                                                               
and  to survey  the membership  regarding their  view of  HB 271.                                                               
The  committee  has  already  heard a  lot  of  the  membership's                                                               
concern in  that the  passage of HB  271 would  increase overtime                                                               
costs.   With  regard to  the  issue of  mandatory overtime,  Mr.                                                               
Beany recalled his time as the  director in Utah and related that                                                               
he had  flexibility with the  state institutions to  keep current                                                               
with the  market.  He  offered that since his  membership doesn't                                                               
use mandatory overtime  very much, he expressed the  need to find                                                               
ways  to address  competitive salaries  and have  the ability  to                                                               
make  adjustments when  necessary in  order to  have some  parity                                                               
with the private sector.  He  offered to work with the department                                                               
on achieving management flexibility.                                                                                            
                                                                                                                                
[HB 271 was held over.]                                                                                                         
                                                                                                                                
5:13:48 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health, Education and Social  Services Standing Committee meeting                                                               
was adjourned at 5:17 p.m.                                                                                                      
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects