Legislature(2005 - 2006)Anch LIO Conf Rm

09/23/2005 08:00 AM HEALTH, EDUCATION & SOCIAL SERVICES


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08:19:51 AM Start
08:21:33 AM HB271
09:13:41 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Teleconference --
+= HB 271 LIMIT OVERTIME FOR REGISTERED NURSES TELECONFERENCED
Heard & Held
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       Anchorage, Alaska                                                                                        
                       September 23, 2005                                                                                       
                           8:19 a.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Tom Anderson                                                                                                     
Representative Vic Kohring                                                                                                      
Representative Berta Gardner                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Lesil McGuire                                                                                                    
Representative Sharon Cissna                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
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 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                                                                        
08/29/05       (H)       Status of Personal Care Attendant regs                                                                 
09/23/05       (H)       HES AT 8:00 AM Anch LIO Conf Rm                                                                        
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JANET CLARKE, Assistant Commissioner                                                                                            
Central Office                                                                                                                  
Finance And Management Services                                                                                                 
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the hearing on HB 271.                                                                    
                                                                                                                                
MIKE TIBBLES, Deputy Commissioner                                                                                               
Office of the Commissioner                                                                                                      
Department of Administration                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the hearing on HB 271.                                                                    
                                                                                                                                
REPRESENTATIVE CARL GATTO                                                                                                       
Alaska State Legislature                                                                                                        
POSITION STATEMENT:  Suggested topics to consider for HB 271.                                                                   
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 8:19:51  AM.                                                             
Representatives  Seaton,  Anderson,   Gardner,  and  Wilson  were                                                               
present at the call to  order.  Representative Kohring arrived as                                                               
the meeting was in progress.                                                                                                    
                                                                                                                                
8:21:33 AM                                                                                                                    
                                                                                                                                
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                   
                                                                                                                                
8:21:47 AM                                                                                                                    
                                                                                                                                
CHAIR  WILSON announced  that  the first  order  of business  was                                                               
HOUSE BILL NO.  271, "An Act relating to  limitations on overtime                                                               
for registered  nurses in health  care facilities;  and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
CHAIR  WILSON  said  the  committee  would  discuss  a  committee                                                               
substitute for  HB 271, [Version 24-LS0838\Y,  Bullock, 9/21/05],                                                               
but would  not "act on  it."   [Therefore, some of  the following                                                               
discussion relating  to changes to  the bill are in  reference to                                                               
Version Y.]                                                                                                                     
                                                                                                                                
8:22:03 AM                                                                                                                    
                                                                                                                                
JANET  CLARKE, Assistant  Commissioner,  Central Office,  Finance                                                               
And  Management   Services,  Department  of  Health   and  Social                                                               
Services (DHSS), revealed  that a contract [for  a long-term care                                                               
study] has  been awarded  to the  Public Consulting  Group (PCG).                                                               
She said  she is  not "up-to-speed"  regarding the  personal care                                                               
attendant regulation  process.   Notwithstanding that,  she noted                                                               
that "the  team and group  is reviewing the public  comments that                                                               
were extensive."   She said  all the information from  the public                                                               
hearings  had to  be transcribed  and many  written comments  are                                                               
being reviewed.                                                                                                                 
                                                                                                                                
8:23:18 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON  surmised that  the information  would be  ready for                                                               
the  committee  by  the  time session  begins  again  in  January                                                               
[2006].                                                                                                                         
                                                                                                                                
8:24:08 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON  reminded the  committee that  it had  discussed all                                                               
the  pros and  cons of  the different  aspects of  the bill,  and                                                               
recalled that  Representative Seaton  had a concern  about triple                                                               
overtime,  which  is  addressed  in the  aforementioned  CS  [not                                                               
adopted as a work draft].                                                                                                       
                                                                                                                                
8:24:37 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  noted  that during  [the  last]  hearing,                                                               
concerns  were expressed  by those  in the  health care  industry                                                               
that "having  the triple overtime  paid to nurses could  have the                                                               
unintended  consequence  of  reducing voluntary  overtime."    He                                                               
indicated that  it's human nature  that someone would opt  to get                                                               
paid  twice as  much through  working mandatory  overtime, rather                                                               
than  making less  through volunteering  for overtime.   He  said                                                               
[Version  Y]  would  keep  the overtime  amount  paid  to  nurses                                                               
exactly the same, but  a like amount would serve as  a fine.  The                                                               
fine, he  explained, would  be based  on hours as  well as  a set                                                               
amount.  He said the aforementioned  would get back to purpose of                                                               
bill:  giving consequence to those requiring mandatory overtime.                                                                
                                                                                                                                
8:26:31 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON said she thinks that's a good change.                                                                              
                                                                                                                                
8:26:39 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON said the language  to which he is referring                                                               
is in  Version Y, on  page 3, beginning on  line 14, and  read as                                                               
follows:                                                                                                                        
                                                                                                                                
          (c) Upon a finding by the commissioner that a                                                                         
     health care  facility has violated a  provision of this                                                                    
     chapter, the following civil penalties shall apply:                                                                        
               (1) for a first violation of this chapter,                                                                       
     the health care facility  shall receive a reprimand and                                                                    
     be assessed a  penalty equal to the  amount of overtime                                                                    
     compensation paid  to a nurse  for each hour  worked in                                                                    
     violation of this chapter;                                                                                                 
               (2) for a second violation of this chapter                                                                       
     within  12  months,  the  health  care  facility  shall                                                                    
     receive a reprimand and be  assessed a penalty equal to                                                                    
     the  amount of  overtime compensation  paid to  a nurse                                                                    
     for each hour worked in  violation of this chapter plus                                                                    
     $500;                                                                                                                      
               (3) for a third or subsequent violation of                                                                       
     this  chapter   within  12  months,  the   health  care                                                                    
     facility  shall  be assessed  a  penalty  equal to  the                                                                    
     amount  of overtime  compensation paid  to a  nurse for                                                                    
     each hour worked  in violation of this  chapter plus an                                                                    
     additional amount of not less  than $2,500 but not more                                                                    
     than $5,000 for each violation.                                                                                            
                                                                                                                                
8:29:18 AM                                                                                                                    
                                                                                                                                
MIKE TIBBLES,  Deputy Commissioner,  Office of  the Commissioner,                                                               
Department   of   Administration,   directed   attention   to   a                                                               
spreadsheet he  provided to the  committee.  He said  that during                                                               
the last hearing on HB 271,  there had been a comment regarding a                                                               
pay  reduction.    He  pointed  out some  letter  coding  on  the                                                               
spreadsheet.  He noted that  the third column read "GGU" [general                                                               
government  unit], which  includes nursing  staff.   He indicated                                                               
that the spreadsheet  shows historical benefits from  1984 to the                                                               
present.  He offered further details.                                                                                           
                                                                                                                                
8:32:00 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WILSON  indicated that  she was  expecting further                                                               
comparisons across  the state of hospitals,  pioneers' homes, and                                                               
the Alaska Psychiatric Institute (API).                                                                                         
                                                                                                                                
8:32:11 AM                                                                                                                    
                                                                                                                                
MR.  TIBBLES said  the  focus  of his  testimony  today would  be                                                               
regarding the issues of recruitment and salaries.                                                                               
                                                                                                                                
8:32:51 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON mentioned having heard that  there was an issue of a                                                               
raise that was taken away.                                                                                                      
                                                                                                                                
8:33:36 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  asked Chair  Wilson to review  the major                                                               
points of the bill.                                                                                                             
                                                                                                                                
8:34:22 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON said  nurses from API, the pioneers'  homes, and the                                                               
Department of  Corrections were represented  by the  state nurses                                                               
organization to bring  to attention the issue of  the shortage of                                                               
nurses and the  fact that nurses have been working  more than one                                                               
shift to cover that shortfall.   The state was mandating that the                                                               
nurses work overtime.  Research  has proven that when nurses work                                                               
overtime for  a sustained  period of time,  it's not  healthy for                                                               
the nurses  and it's a  safety issue  for patients.   Many states                                                               
have laws that don't allow mandatory overtime.                                                                                  
                                                                                                                                
CHAIR WILSON  said nurses  belong to a  union that  also includes                                                               
other  health  care  workers; therefore,  changes  made  for  the                                                               
nurses  would affect  the others.    She said,  for example,  lab                                                               
technicians and  radiology technicians  may be  part of  the same                                                               
union.                                                                                                                          
                                                                                                                                
8:38:18 AM                                                                                                                    
                                                                                                                                
MR.  TIBBLES,  in  response to  a  question  from  Representative                                                               
Gardner,  explained  that  the   GGU  refers  to  the  collective                                                               
bargaining  [unit],  while  Alaska  State  Employees  Association                                                               
(ASEA)  is  the union.    He  confirmed  that  the unit  is  very                                                               
diverse.                                                                                                                        
                                                                                                                                
8:38:48 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER,  [referring to the  aforementioned spread                                                               
sheet], observed  that the increase  of the Consumer  Price Index                                                               
(CPI)  in '85  of  2 percent  with  the GGU  wage  increase of  5                                                               
percent "would  have been a good  year," and then there  were not                                                               
pay raises  until 1990, when "it  went up 3.3 [percent]  for that                                                               
classification."   She concluded, "So,  during those  years where                                                               
the CPI change was really small  but there still was an increase,                                                               
they basically ... lost ground?"                                                                                                
                                                                                                                                
8:39:20 AM                                                                                                                    
                                                                                                                                
MR. TIBBLES  answered that's correct.   He noted that  a contract                                                               
submitted to the  legislature in 1987 was disapproved.   He noted                                                               
that  sometimes it  takes multiple  years for  negotiations.   He                                                               
offered further details.                                                                                                        
                                                                                                                                
REPRESENTATIVE GARDNER  stated, "[The]  bottom line is  that over                                                               
time, compared  to 20 years  ago, the members of  this bargaining                                                               
unit have  lost ground  as the  CPI increased.   It  looks pretty                                                               
dramatic."                                                                                                                      
                                                                                                                                
MR.  TIBBLES,  regarding  recruitment,  said  the  Department  of                                                               
Administration  and the  Department of  Health &  Social Services                                                               
have  collectively   held  a  number   of  meetings   to  forward                                                               
initiatives  to address  the  issue of  recruitment.   The  staff                                                               
within   the  Division   of  Personnel   in  the   Department  of                                                               
Administration  has  been  reorganized  in  order  to  set  up  a                                                               
professional   recruitment   position.     That   position   will                                                               
concentrate on those difficult-to-recruit  areas, such as nurses.                                                               
In response to  a question from Chair Wilson, he  said he doesn't                                                               
know whether  any RNs have  been hired, but  could find out.   He                                                               
explained  that the  position of  professional  recruiter is  not                                                               
expected  to be  filled until  approximately November  1, [2005].                                                               
He gave an  example whereby "looking at recruitment  a little bit                                                               
differently   really  did   pay   off  for   the  Department   of                                                               
Corrections."                                                                                                                   
                                                                                                                                
MS.  CLARKE said  since the  House Health,  Education and  Social                                                               
Services Standing Committee's hearing a  couple of weeks ago, the                                                               
department  has held  a  couple sessions  with  its head  nursing                                                               
management staff and a comprehensive  meeting with the University                                                               
of Alaska's nursing  school, talking about what's  being done for                                                               
other  private providers  and what  the state  and, particularly,                                                               
[the Department of  Health and Social Services] can do  to try to                                                               
increase  recruitment efforts  related  to  the nursing  students                                                               
attending the University of Alaska.   She said there are a number                                                               
of  management tools  to propose,  including  making attempts  to                                                               
increase the number of nurses  that go through clinical rotations                                                               
and state  facilities.  Other  ideas to consider  include whether                                                               
to develop  a stipend program for  nurses, tuition reimbursement,                                                               
and a loan repayment program.                                                                                                   
                                                                                                                                
                                                                                                                                
8:45:45 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON said, "That sounds  absolutely wonderful."  She said                                                               
those types of programs have  been used to attract physicians and                                                               
physicians' assistants to work in the Bush.                                                                                     
                                                                                                                                
8:46:47 AM                                                                                                                    
                                                                                                                                
MR. TIBBLES said the Division  of Personnel is "creating a single                                                               
point  of  contact  ... regarding  employment  opportunities  for                                                               
nurses."  For  example, a person may "inquire  into Department of                                                               
Corrections  about a  nursing position."   He  said, "Right  now,                                                               
we're  not  talking to  them  about  other nursing  opportunities                                                               
within the state."  He added, "We're  going to try to take a step                                                               
back and  look at  a bigger  view of it  and see  ...:   maybe if                                                               
someone's not appropriate  or even interested, or  even hired for                                                               
one area of nursing within the  state, maybe we could use them in                                                               
another area."                                                                                                                  
                                                                                                                                
MR. TIBBLES  said [the Department  of Administration]  is holding                                                               
conversations with  hiring managers regarding how  to best market                                                               
state positions because  some of the benefits of  working for the                                                               
State of Alaska are not widely  known.  There is more to consider                                                               
than just  the salary,  for example, a  generous leave  with cash                                                               
value.    He  offered  other   examples.  Mr.  Tibbles  said  the                                                               
department is  also working with  DHSS on  developing recruitment                                                               
materials.                                                                                                                      
                                                                                                                                
8:48:52 AM                                                                                                                    
                                                                                                                                
MR. TIBBLES,  in response to  a question from Chair  Wilson, said                                                               
there will  be many opportunities to  distribute the information,                                                               
for example, to people attending job fairs.                                                                                     
                                                                                                                                
8:49:01 AM                                                                                                                    
                                                                                                                                
MR.  TIBBLES,  regarding  compensation,  said there  is  a  draft                                                               
policy that is  currently under review and  should be implemented                                                               
by  mid-October.   The policy  will allow  hiring managers  to be                                                               
preapproved to offer advance step placement.                                                                                    
                                                                                                                                
8:52:12 AM                                                                                                                    
                                                                                                                                
MR.  TIBBLES  reminded  the  committee  that  the  department  is                                                               
working on a system that will  allow it to introduce market data.                                                               
He said there are two  processes to assigning ranges:  collective                                                               
bargaining, in  which a  dollar amount  is negotiated  per range,                                                               
and  assigning a  range to  a particular  range.   He offered  an                                                               
example.                                                                                                                        
                                                                                                                                
8:53:21 AM                                                                                                                    
                                                                                                                                
MR.  TIBBLES,   regarding  current  employees,  said   that  DHSS                                                               
management  is  reviewing the  workflow  process  to ensure  that                                                               
staff  resources are  being used  most efficiently.   He  offered                                                               
examples.  He said DHSS  is also collecting information regarding                                                               
current  working conditions  and what  nonmonitary changes  might                                                               
create  more  desirable working  conditions.    He mentioned  the                                                               
National Association  of State Personnel and  Executives (NASPE),                                                               
an association that has talked  about what other states have done                                                               
that have been attractive.   Flexible staffing was one item; more                                                               
training was another.  He  mentioned working with hiring managers                                                               
and staff to improve conditions for nurses.                                                                                     
                                                                                                                                
8:55:12 AM                                                                                                                    
                                                                                                                                
CHAIR  WILSON asked  if job  sharing  has been  considered as  an                                                               
option to offer nurses.                                                                                                         
                                                                                                                                
8:57:44 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON  welcomed Representative Kohring  via teleconference                                                               
and  reviewed the  change  that  would be  made  to  the bill  in                                                               
Version Y.  She  stated that she is open to  any changes that can                                                               
be  made so  that people  are  comfortable with  the bill,  while                                                               
still trying to address not forcing nurses to work overtime.                                                                    
                                                                                                                                
9:01:04 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON offered  three  points for  consideration:                                                               
First,  he stated,  "I'm wondering  whether  the nurses  actually                                                               
have  the  ability to  influence  and  to set  these  regulations                                                               
through  their bargaining  units, and  whether that's  where this                                                               
should be."   Second, he  noted that there is  no differentiation                                                               
in  the  bill regarding  the  number  of  nurses in  a  facility.                                                               
Third, he  said he  wants to  know the  reach of  the bill.   For                                                               
example, page  4, line  7, refers to  a "primary  care outpatient                                                               
facility", which he said sounds like  a doctor's office.  Page 4,                                                               
line 2, refers to an  "intermediate care facility", which he said                                                               
he wants  defined.   He noted the  language refers  to "federal",                                                               
"state",  and "private"  facilities, and  inquired as  to whether                                                               
that includes Native health service within the State of Alaska.                                                                 
                                                                                                                                
9:04:15 AM                                                                                                                    
                                                                                                                                
CHAIR  WILSON said  she  doesn't  know if  nurses  have much  say                                                               
regarding collective  bargaining.  She indicated  that there will                                                               
time to  research these  questions for  answers by  next session.                                                               
Regarding  large  and small  facilities,  she  said she  knows  a                                                               
distinction  was   made  regarding  critical   access  hospitals,                                                               
because most  of them are in  areas where there is  not access to                                                               
any other hospital,  but she said the issue has  not been brought                                                               
forward when there is more than one hospital in an area.                                                                        
                                                                                                                                
9:05:49 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON directed attention  to page 4, which refers                                                               
to  a  "primary care  outpatient  facility"  and "long-term  care                                                               
facility".  He  requested that the committee  obtain a definition                                                               
of  the scope  of  the  bill from  "the  department"  and if  the                                                               
current definition covers doctors' offices.                                                                                     
                                                                                                                                
9:08:03 AM                                                                                                                    
                                                                                                                                
CHAIR  WILSON reiterated  wanting  feedback between  now and  the                                                               
start of  session in January  2006.  She  said that in  the Lower                                                               
48,  some  states  require  that  there be  so  many  nurses  per                                                               
patient; they've gone much further  than this bill.  Chair Wilson                                                               
stated that she doesn't want to go any further than necessary.                                                                  
                                                                                                                                
9:08:45 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CARL GATTO,  Alaska State  Legislature, indicated                                                               
that  he would  like  to  know what  the  situation is  regarding                                                               
school nurses.                                                                                                                  
                                                                                                                                
9:09:16 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON revealed  that she is a  nationally certified school                                                               
nurse and  knows that some  schools require  a nurse for  so many                                                               
students.                                                                                                                       
                                                                                                                                
9:10:04 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   GATTO,   in   response   to   a   comment   from                                                               
Representative Anderson, said his wife  is currently at work as a                                                               
school nurse.   He  noted, "In  the first week  of school  she is                                                               
being paid for one day, but in order  to get the work done has to                                                               
show  up for  all five."   He  questioned whether  that would  be                                                               
considered uncompensated overtime.                                                                                              
                                                                                                                                
9:10:41 AM                                                                                                                    
                                                                                                                                
CHAIR WILSON said when she was  a nurse in North Carolina she was                                                               
the only nurse  at the school.   The law was changed  just as she                                                               
was leaving to require more than one nurse at the school.                                                                       
                                                                                                                                
9:11:28 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  suggested that various  hospitals around                                                               
the state could send in suggestions to the committee.                                                                           
                                                                                                                                
9:11:53 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO  indicated that  a  new  hospital would  be                                                               
opening in  the [Matanuska/Susitna]  Valley, which  will increase                                                               
the  need for  new  nurses.   He  suggested  he  may contact  the                                                               
director to give him a "head's up" regarding the bill.                                                                          
                                                                                                                                
9:12:47 AM                                                                                                                    
                                                                                                                                
CHAIR  WILSON encouraged  written testimony  for those  who don't                                                               
want to testify in person.                                                                                                      
                                                                                                                                
9:13:02 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GATTO  stated that  although  he  is not  on  the                                                               
committee, he would "appreciate being kept in the line up."                                                                     
                                                                                                                                
CHAIR WILSON  commented that she  had expected to hear  from more                                                               
nurses at today's meeting.                                                                                                      
                                                                                                                                
[HB 271 was held over.]                                                                                                         
                                                                                                                                
9:13:13 AM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health, Education and Social  Services Standing Committee meeting                                                               
was adjourned at 9:13:41 AM.                                                                                                  

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