Legislature(2005 - 2006)

02/28/2006 04:05 PM HES


Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       February 28, 2006                                                                                        
                           4:05 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Vic Kohring                                                                                                      
Representative Sharon Cissna                                                                                                    
Representative Berta Gardner                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Tom Anderson                                                                                                     
Representative Carl Gatto                                                                                                       
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 442                                                                                                              
"An  Act  relating  to  the   validity  of  advance  health  care                                                               
directives,  individual  health  care instructions,  and  do  not                                                               
resuscitate orders; relating to  the revocation of advance health                                                               
care directives; relating to do  not resuscitate orders; relating                                                               
to resuscitative  measures; relating  to the liability  of health                                                               
care  providers and  institutions;  relating  to an  individual's                                                               
capacity for making  health care decisions; and  providing for an                                                               
effective date."                                                                                                                
                                                                                                                                
     - MOVED HB 442(HES) OUT OF COMMITTEE                                                                                       
                                                                                                                                
HOUSE JOINT RESOLUTION NO. 31                                                                                                   
Relating  to  designating September  9,  2006,  as Fetal  Alcohol                                                               
Spectrum Disorders Awareness Day.                                                                                               
                                                                                                                                
     - MOVED HJR 31 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 271                                                                                                              
"An  Act  relating  to limitations  on  overtime  for  registered                                                               
nurses in health care facilities;  and providing for an effective                                                               
date."                                                                                                                          
                                                                                                                                
     - MOVED CSHB 271(HES) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE CONCURRENT RESOLUTION NO. 5                                                                                               
Relating to support of community water fluoridation.                                                                            
                                                                                                                                
     - MOVED HCR 5 OUT OF COMMITTEE                                                                                             
                                                                                                                                
HOUSE BILL NO. 426                                                                                                              
"An Act relating to medical assistance eligibility and coverage                                                                 
for persons under 21 years of age."                                                                                             
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
HOUSE BILL NO. 412                                                                                                              
"An Act relating to the waiver of undergraduate expenses for a                                                                  
spouse or dependent of a deceased resident peace officer or                                                                     
member of the armed services or fire department."                                                                               
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
HOUSE BILL NO. 258                                                                                                              
"An Act relating to aggravating factors at sentencing."                                                                         
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 442                                                                                                                  
SHORT TITLE: HEALTH CARE DECISIONS                                                                                              
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH                                                                                         
                                                                                                                                
02/10/06       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/10/06       (H)       HES, JUD                                                                                               
02/21/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/21/06       (H)       Scheduled But Not Heard                                                                                
02/23/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/23/06       (H)       Heard & Held                                                                                           
02/23/06       (H)       MINUTE(HES)                                                                                            
02/28/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HJR 31                                                                                                                  
SHORT TITLE: FETAL ALCOHOL SPECTRUM DISORDERS DAY                                                                               
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH                                                                                         
                                                                                                                                
02/08/06       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/08/06       (H)       HES                                                                                                    
02/23/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/23/06       (H)       <Bill Hearing Rescheduled to 2/28/06>                                                                  
02/28/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
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)       Heard & Held                                                                                           
08/29/05       (H)       MINUTE(HES)                                                                                            
09/23/05       (H)       HES AT 8:00 AM Anch LIO Conf Rm                                                                        
09/23/05       (H)       Heard & Held                                                                                           
09/23/05       (H)       MINUTE(HES)                                                                                            
01/24/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
01/24/06       (H)       Heard & Held                                                                                           
01/24/06       (H)       MINUTE(HES)                                                                                            
02/14/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/14/06       (H)       Scheduled But Not Heard                                                                                
02/21/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/21/06       (H)       Scheduled But Not Heard                                                                                
02/23/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/23/06       (H)       Scheduled But Not Heard                                                                                
02/28/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HCR  5                                                                                                                  
SHORT TITLE: FLUORIDATION                                                                                                       
SPONSOR(s): REPRESENTATIVE(s) SEATON                                                                                            
                                                                                                                                
03/09/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/09/05       (H)       CRA, HES                                                                                               
02/02/06       (H)       CRA AT 8:00 AM CAPITOL 124                                                                             
02/02/06       (H)       Moved Out of Committee                                                                                 
02/02/06       (H)       MINUTE(CRA)                                                                                            
02/03/06       (H)       CRA RPT 5DP                                                                                            
02/03/06       (H)       DP: SALMON, NEUMAN, CISSNA, THOMAS,                                                                    
                         OLSON                                                                                                  
02/21/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/21/06       (H)       Scheduled But Not Heard                                                                                
02/23/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/23/06       (H)       Scheduled But Not Heard                                                                                
02/28/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JACQUELINE TUPOU, Staff                                                                                                         
to Representative  Bruce Weyhrauch                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 442,  Version G, and HJR 31, on                                                               
behalf of  Representative Weyhrauch,  Sponsor and  Prime Sponsor,                                                               
respectively.                                                                                                                   
                                                                                                                                
JOHN DAWSON, Partner                                                                                                            
Davis Wright and Tremaine Limited Liability Partnership (LLP);                                                                  
Representative, Providence Anchorage Anesthesia Medical Group                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Responded to  questions regarding  HB 442,                                                               
Version G.                                                                                                                      
                                                                                                                                
JOHN BITNEY, Lobbyist                                                                                                           
Alaska Nurses Association (ANA)                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Testified in  support of CSHB  271, Version                                                               
P.                                                                                                                              
                                                                                                                                
CINDY FOLSOM, Staff                                                                                                             
to Representative Sharon Cissna                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Responded to questions on                                                                                  
                                                                                                                                
LAURIE HERMAN, Regional Director                                                                                                
Government Affairs                                                                                                              
Alaska  State  Hospital  and Nursing  Home  Association  (ASHNHA)                                                               
Providence Alaska Medical Center                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified in support for  CSHB 271, Version                                                               
P, save opposition for Section 18.09.010.                                                                                       
                                                                                                                                
KATHERINE SHOWS, Staff                                                                                                          
to Representative Paul Seaton                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HCR  5 on behalf of Representative                                                               
Seaton, Prime Sponsor.                                                                                                          
                                                                                                                                
WILLIAM MARLEY, Doctor of Dental Surgery (DDS)                                                                                  
Chairman, Fluoridation Committee                                                                                                
Alaska Dental Society (ADS)                                                                                                     
Homer, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of HCR 5.                                                                             
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 4:03:48  PM.                                                             
Representatives Seaton, Cissna, Gardner,  and Wilson were present                                                               
at  the call  to order.   Representative  Kohring arrived  as the                                                               
meeting was in progress.                                                                                                        
                                                                                                                                
HB 442-HEALTH CARE DECISIONS                                                                                                  
                                                                                                                                
4:04:12 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE BILL NO.  442, "An Act relating to the  validity of advance                                                               
health care directives, individual  health care instructions, and                                                               
do not resuscitate orders; relating  to the revocation of advance                                                               
health care  directives; relating  to do not  resuscitate orders;                                                               
relating to resuscitative measures;  relating to the liability of                                                               
health   care  providers   and  institutions;   relating  to   an                                                               
individual's  capacity  for  making health  care  decisions;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
4:04:18 PM                                                                                                                    
                                                                                                                                
JACQUELINE  TUPOU,  Staff   to  Representative  Bruce  Weyhrauch,                                                               
Alaska State Legislature, presented HB  442, Version G, on behalf                                                               
of  Representative   Weyhrauch, Sponsor,  and stipulated  that no                                                               
changes were made subsequent to the committee's previous review.                                                                
                                                                                                                                
REPRESENTATIVE SEATON moved to  adopt Amendment 1, 24-LS1618\G.1,                                                               
Bannister, 2/24/06, which read [original punctuation provided]:                                                                 
                                                                                                                                
     Page 3, lines 24 - 26:                                                                                                     
          Delete "or if the physician reasonably believes                                                                   
     that the patient does not have a qualifying condition"                                                                 
                                                                                                                                
     Page 4, line 25, following "chapter;":                                                                                     
          Insert "or"                                                                                                       
                                                                                                                                
     Page 4, lines 27 - 31:                                                                                                     
          Delete "or                                                                                                        
               (D) because the health care provider or                                                                      
     institution has a good faith  belief that the condition                                                                
     requiring   cardiopulmonary   resuscitation  or   other                                                                
     resuscitative  measures   is  not  precipitated   by  a                                                                
     qualifying condition;"                                                                                                 
                                                                                                                                
4:05:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON explained that on  page 3, lines 24-26, and                                                               
page 4, lines  27-31, Version G allows a physician  to override a                                                               
do not  resuscitate (DNR) order,  which "is against what  we were                                                               
doing  in the  adoption of  the five  wishes bill,  ... and  so I                                                               
offer Amendment  1."  He  continued, stating that  the provisions                                                               
in the amendment allow a physician  to disregard a DNR order when                                                               
a  procedure  is being  performed  that  is  not related  to  the                                                               
qualifying condition  of the DNR order  and resuscitation becomes                                                               
necessary.   To  further comply  with the  five wishes  bill, the                                                               
amendment  deletes  the  clause   which  allows  a  physician  to                                                               
disregard  a DNR  directive when  they believe  that the  patient                                                               
does not have a qualifying condition.                                                                                           
                                                                                                                                
4:08:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  described her experience of  doctors being                                                               
loathe to allow  people to die unless  everything is specifically                                                               
spelled out and the DNR order is at hand.                                                                                       
                                                                                                                                
4:09:33 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON withdrew  her objection, and there  being no further                                                               
objection, Amendment l was adopted.                                                                                             
                                                                                                                                
4:09:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   GARDNER  referred   to   the  document   labeled                                                               
Amendment   24-LS1618\G.2,   Bannister   2/28/06,   [subsequently                                                               
adopted  as   Amendment  2]  which  read   [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Page 1, line 4:                                                                                                            
          Delete    "of    health   care    providers    and                                                                  
     institutions"                                                                                                            
          Insert "and discipline of health care providers,                                                                    
     institutions, and facilities"                                                                                            
                                                                                                                                
     Page 2, line 25, through page 3, line 10:                                                                                  
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 4, line 25, following "chapter;":                                                                                     
          Insert "or"                                                                                                       
                                                                                                                                
     Page 4, lines 27 - 31:                                                                                                     
          Delete "or                                                                                                        
               (D)  because the health care provider or                                                                     
     institution has a good faith  belief that the condition                                                                
     requiring   cardiopulmonary   resuscitation  or   other                                                                
     resuscitative  measures   is  not  precipitated   by  a                                                                
     qualifying condition;"                                                                                                 
                                                                                                                                
     Page 5, lines 3 - 12:                                                                                                      
          Delete all material and insert:                                                                                       
        "* Sec. 7.  AS 13.52.080 is amended by  adding a new                                                                
     subsection to read:                                                                                                        
          (c)  A health care provider, health care                                                                              
     institution, or health care facility  is not subject to                                                                    
     civil  or  criminal  liability, or  to  discipline  for                                                                    
     unprofessional conduct,  if a do not  resuscitate order                                                                    
     prevents   the  health   care  provider,   health  care                                                                    
     institution,  or health  care facility  from attempting                                                                    
     to resuscitate  a patient who  requires cardiopulmonary                                                                    
     resuscitation or  other resuscitative  measures because                                                                    
     of  complications  arising  out of  health  care  being                                                                    
     administered  to   the  patient  by  the   health  care                                                                    
     provider,  health  care  institution,  or  health  care                                                                    
     facility.  This  subsection  does   not  apply  if  the                                                                    
     complications  suffered by  the patient  are caused  by                                                                    
     reckless  or intentional  actions  on the  part of  the                                                                    
     health  care  provider,  health  care  institution,  or                                                                    
     health care facility."                                                                                                     
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 6, line 4:                                                                                                            
          Delete "sec. 7"                                                                                                       
          Insert "sec. 5"                                                                                                       
                                                                                                                                
4:10:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER explained that  this amendment is designed                                                               
to ensure that,  when a conflict arises between the  needs of the                                                               
care provider and  the needs of the patient holding  a DNR order,                                                               
that  "the needs  of  the  care provider  could  never trump  the                                                               
confirmed   DNR   desires  of   the   individual   even  if   the                                                               
circumstances weren't dealing with  the fatal illness."  Further,                                                               
she explained  that the amendment inserts  the terms "discipline"                                                               
and  "facilities"  in  title  of  the  bill.    The  addition  of                                                               
"discipline", she  said, "Is to  avoid a care provider  having an                                                               
internal punishment for not resuscitating  someone who held a DNR                                                               
order."  Because the contents  of this amendment overlap with the                                                               
previously adopted  Amendment G.1,  she noted that  two deletions                                                               
would need to be made.   She instructed the committee to make the                                                               
following  change  to  the   document  [subsequently  adopted  as                                                               
Amendment  2], by  deleting the  language on  page 1,  lines 5-6,                                                               
which read:                                                                                                                     
                                                                                                                                
     Page 2, line 25, through page 3, line 10:                                                                                  
          Delete all material.                                                                                                  
                                                                                                                                
4:14:40 PM                                                                                                                    
                                                                                                                                
JOHN  DAWSON,   Partner,  Davis   Wright  and   Tremaine  Limited                                                               
Liability    Partnership   (LLP);    Representative,   Providence                                                               
Anchorage   Anesthesia  Medical   Group,   explained  that   this                                                               
amendment eliminates  the provisions  which would allow  a doctor                                                               
to correct a  physician error or disregard a DNR  order, when the                                                               
need for resuscitation  is the result of a  procedure not related                                                               
to  the qualifying  condition.   Although this  effectively "ties                                                               
the  doctor's  hands"  the amendment  provides  the  doctor  with                                                               
liability immunity for honoring a DNR order at all costs.                                                                       
                                                                                                                                
4:15:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON pointed out  that Mr. Dawson was addressing                                                               
the amendment, page  1 beginning with line 20, but  not the lines                                                               
of the bill  itself, page 4, lines 26-27, which  he understood to                                                               
be the area that Representative Gardner was referencing.                                                                        
                                                                                                                                
REPRESENTATIVE GARDNER  concurred and  directed the  committee to                                                               
disregard her pervious  request and to delete  from the amendment                                                               
[subsequently adopted as  Amendment 2], page 1,  lines 4-19, thus                                                               
this ensures  that a care  provider who  follows a DNR  order, is                                                               
not subject to a law suit.                                                                                                      
                                                                                                                                
CHAIR  WILSON   clarified  and  confirmed  the   changes  to  the                                                               
amendment.                                                                                                                      
                                                                                                                                
4:17:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER moved to adopt Amendment 2, 24-                                                                          
LS1618\G.2, Bannister 2/28/06.                                                                                                  
                                                                                                                                
4:19:05 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON clarified that Amendment 2 would now read as                                                                       
follows:                                                                                                                        
                                                                                                                                
     Page 1, line 4:                                                                                                            
          Delete    "of    health   care    providers    and                                                                  
     institutions"                                                                                                            
          Insert "and discipline of health care providers,                                                                    
     institutions, and facilities"                                                                                            
                                                                                                                                
     Page 5, lines 3 - 12:                                                                                                      
          Delete all material and insert:                                                                                       
        "* Sec. 7.  AS 13.52.080 is amended by  adding a new                                                                
     subsection to read:                                                                                                        
          (c)  A health care provider, health care                                                                              
     institution, or health care facility  is not subject to                                                                    
     civil  or  criminal  liability, or  to  discipline  for                                                                    
     unprofessional conduct,  if a do not  resuscitate order                                                                    
     prevents   the  health   care  provider,   health  care                                                                    
     institution,  or health  care facility  from attempting                                                                    
     to resuscitate  a patient who  requires cardiopulmonary                                                                    
     resuscitation or  other resuscitative  measures because                                                                    
     of  complications  arising  out of  health  care  being                                                                    
     administered  to   the  patient  by  the   health  care                                                                    
     provider,  health  care  institution,  or  health  care                                                                    
     facility.  This  subsection  does   not  apply  if  the                                                                    
     complications  suffered by  the patient  are caused  by                                                                    
     reckless  or intentional  actions  on the  part of  the                                                                    
     health  care  provider,  health  care  institution,  or                                                                    
     health care facility."                                                                                                     
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 6, line 4:                                                                                                            
          Delete "sec. 7"                                                                                                       
          Insert "sec. 5"                                                                                                       
                                                                                                                                
4:20:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked whether Amendment 2 affects [page 4]                                                                
line 26, which refers to a woman of childbearing age.                                                                           
                                                                                                                                
REPRESENTATIVE  GARDNER clarified  that  this amendment  provides                                                               
liability immunity  to a physician  who honors a DNR  order, save                                                               
for  reckless  or  intentional  actions which  do  not  uphold  a                                                               
professional standard of care.                                                                                                  
                                                                                                                                
4:21:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON pointed  out that  Amendment 1  dealt with                                                               
[page 4] lines 28-31 including  the preceding "or" [line 27], and                                                               
not line [26] which refers to  a woman of child bearing age, thus                                                               
it remains within the bill.   He stated that his understanding of                                                               
the  intent  of  Amendment  2,  is to  protect  the  health  care                                                               
provider/institution  from  liability.   He  asked  whether  this                                                               
language would allow a physician  to demonstrate gross negligence                                                               
and not be held responsible for their actions.                                                                                  
                                                                                                                                
4:22:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER   asked  for  the  legal   difference  of                                                               
negligent and reckless.                                                                                                         
                                                                                                                                
MS.  TUPOU stated  that  negligence means  "of  neglecting to  do                                                               
things" and  that's what  you are  allowing in  this legislation;                                                               
for the physician  to not act and not correct  an error, which is                                                               
what precipitated the inclusion of  the language "intention to be                                                               
reckless" and "intentional action".                                                                                             
                                                                                                                                
REPRESENTATIVE GARDNER  stated that it is  her understanding that                                                               
under  the  usual  standard  of  care a  doctor  could  be  found                                                               
negligent;  however, in  the  case of  a DNR  order  a doctor  is                                                               
acting in  an intentionally negligent  manner.  By  following the                                                               
patients DNR order, the doctor  should not be held responsible or                                                               
legally liable.                                                                                                                 
                                                                                                                                
REPRESENTATIVE  SEATON provided  that  it would  be an  egregious                                                               
oversight  if this  bill provided  language which  would allow  a                                                               
doctor the  latitude to  err, for example  "operate on  the wrong                                                               
leg," and be absolved of the responsibility.                                                                                    
                                                                                                                                
4:23:54 PM                                                                                                                    
                                                                                                                                
JOHN DAWSON  said that the focus  of the bill is  to hold doctors                                                               
free  of liability  where complications  result from  negligence.                                                               
The  bill  does  not  distinguish between  negligence  and  gross                                                               
negligence  because  the distinction  between  the  two terms  is                                                               
difficult  even  for  the  courts to  determine.    However,  the                                                               
distinction between negligence and  recklessness is clear-cut and                                                               
a liability release for recklessness  is excluded from this bill.                                                               
A  surgeon is  negligent, if  he overlooks  something or  makes a                                                               
mistake, but if he knows that  what he is engaging in will result                                                               
in  a  particular  complication,  such conduct  could  be  termed                                                               
reckless.    Disregarding  a  known   risk  is  what  constitutes                                                               
recklessness  and  the  courts  are  able  to  clearly  delineate                                                               
between these  two terms.   He conceded that  he is not  sure how                                                               
the  "wrong leg"  scenario would  be considered  given these  two                                                               
terms, but  he opined  that it would  be considered  to represent                                                               
more than negligence.                                                                                                           
                                                                                                                                
4:25:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON maintained his  concern for "the wrong leg"                                                               
scenario and  suggested that gross negligence  should be included                                                               
in  the language  of this  bill.   He stressed  that a  liability                                                               
release  for   an  act  constituting  gross   negligence  is  not                                                               
allowable under any circumstances.                                                                                              
                                                                                                                                
REPRESENTATIVE GARDNER  agreed, and stated that  if complications                                                               
arise from negligence,  the doctor should be held  liable, but if                                                               
death occurs due to negligence for  the purpose of honoring a DNR                                                               
order, the doctor should be protected.                                                                                          
                                                                                                                                
4:27:05 PM                                                                                                                    
                                                                                                                                
MS. TUPOU stated:                                                                                                               
                                                                                                                                
     It gets  to what is the  intent of the amendment.   ...                                                                    
     at what  point do  you want the  doctor to  rectify his                                                                    
     ...  mistake.   That's why  we're trying  to deal  with                                                                    
     this in the liability section.                                                                                             
                                                                                                                                
MS. TUPOU pointed out that if  negligence is the action which the                                                               
committee wishes a  doctor to take then the  original language of                                                               
the bill  should be maintained,  and she reiterated  the original                                                               
bill  language  regarding  secondary and  qualifying  conditions.                                                               
She  stressed that  these  two amendments  disallow  a doctor  to                                                               
correct a  procedural error  when a  DNR order  is in  place, and                                                               
said:                                                                                                                           
                                                                                                                                
     If you  want doctors  to carry that  [DNR order]  out I                                                                    
     think  you  need  to  be  clear  ...  about  what  [the                                                                    
     doctors]  ...  liability  is, here  in  this  liability                                                                    
     section, because  if not, you're  not going to  get the                                                                    
     patient's wishes  honored, and ... [doctors]  are going                                                                    
          to correct their mistakes for that secondary                                                                          
     condition, which is what the bill initially did."                                                                          
                                                                                                                                
4:28:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA provided  a  hypothetical  situation of  a                                                               
person  who  holds a  DNR  order  and  who manages  to  extricate                                                               
theirself from a  life support intensive care  unit (ICU) system,                                                               
only to be  resuscitated and have the life support  replaced by a                                                               
health  care provider.   She  asked how  an intervention  of this                                                               
type would be handled.                                                                                                          
                                                                                                                                
MS. TUPOU responded  that if a patient required  life support for                                                               
their primary  qualifying condition,  that would be  specified in                                                               
their DNR  order, and this  legislation only  addresses secondary                                                               
conditions.  She requested clarity  regarding the language of the                                                               
amendments,  and where  the  committee would  like  to place  the                                                               
responsibility for liability as discussed.                                                                                      
                                                                                                                                
REPRESENTATIVE SEATON provided that  the intent of this amendment                                                               
is  to  hold  a  doctor  liable for  reckless  behavior,  and  he                                                               
stressed that  it should also include  language stipulating gross                                                               
negligence.    He  suggested  that  the  sponsor  will  have  the                                                               
opportunity to incorporate  the intent of the  amendment into the                                                               
bill, prior to its review in a subsequent committee.                                                                            
                                                                                                                                
4:31:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  moved  Amendment  1  to  Amendment  2  as                                                               
follows:                                                                                                                        
                                                                                                                                
     Page 2, line 7, between the words "by" and "reckless"                                                                      
          Insert "gross negligence,"                                                                                            
                                                                                                                                
There  being  no  objection,  Amendment  1  to  Amendment  2  was                                                               
adopted.                                                                                                                        
                                                                                                                                
There being  no further objection,  Amendment 2, as  amended, was                                                               
adopted.                                                                                                                        
                                                                                                                                
4:32:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to  report  HB  442,  Version  24-                                                               
LS1618\G,   as  amended,   out  of   committee  with   individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no  objection,  CSHB  442(HES)  was reported  out  of  the  House                                                               
Health, Education and Social Services Standing Committee.                                                                       
                                                                                                                                
HJR 31-FETAL ALCOHOL SPECTRUM DISORDERS DAY                                                                                   
                                                                                                                                
4:32:36 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  [announced] that the  next order of  business would                                                               
be  HOUSE  JOINT  RESOLUTION  NO.  31,  Relating  to  designating                                                               
September 9, 2006, as Fetal  Alcohol Spectrum Disorders Awareness                                                               
Day.                                                                                                                            
                                                                                                                                
4:32:58 PM                                                                                                                    
                                                                                                                                
JACQUELINE  TUPOU,  Staff   to  Representative  Bruce  Weyhrauch,                                                               
Alaska  State   Legislature,  presented  HJR  31   on  behalf  of                                                               
Representative  Weyhrauch, Prime  Sponsor, paraphrasing  from the                                                               
sponsor statement,  which read  as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     House Joint Resolution 31  designates September 9, 2006                                                                    
     Fetal Alcohol  Spectrum Disorders Awareness  Day. Fetal                                                                    
     Alcohol  Spectrum  Disorders  are  the  single  largest                                                                    
     cause  of  mental retardation  in  Alaska  and are  one                                                                    
     hundred percent preventable.                                                                                               
                                                                                                                                
     International FAS  Awareness Day was first  observed on                                                                    
     September  9, 1999.  It  began when  a  small group  of                                                                    
     adoptive and foster parents  of children afflicted with                                                                    
     FAS  and Fetal  Alcohol Effect  (FAE) came  together on                                                                    
     the Internet to ask  this compelling question, "What if                                                                    
     a world  full of FAS  and FAE parents all  got together                                                                    
     on the ninth  hour of the ninth day of  the ninth month                                                                    
     of the ninth year and  asked the world to remember that                                                                    
     during the nine months of  pregnancy a woman should not                                                                    
     consume alcohol?"                                                                                                          
                                                                                                                                
     The designation  of FASD Awareness  Day is  intended to                                                                    
     focus  attention  on the  high  cost  of Fetal  Alcohol                                                                    
     Spectrum  Disorders  to  our  state  and  the  ease  of                                                                    
     prevention.  Currently, more  American babies  are born                                                                    
     with FAS  than with Down Syndrome,  Muscular Dystrophy,                                                                    
     and  HIV  combined.  The  simple  fact  is  no  alcohol                                                                    
     consumed  during pregnancy  has  been established  safe                                                                    
     for  the  fetus. If  women  do  not drink  any  alcohol                                                                    
     during their nine  months of pregnancy, alcohol-related                                                                    
     birth defects would be eliminated.                                                                                         
     We  ask  Alaskans  to  come  together  at  9:09  am  on                                                                    
     September 9, 2006 for a  "pregnant pause" to reflect on                                                                    
     preventing FASD's  and also to remember  throughout the                                                                    
     year to continue  to reach for the  goal of eradicating                                                                    
     Fetal Alcohol Spectrum Disorders.                                                                                          
                                                                                                                                
The committee took an at-ease 4:34:39 PM from to 4:35:11 PM.                                                                
                                                                                                                                
[The committee returned to HJR 31 later in the meeting.]                                                                        
                                                                                                                                
4:35:16 PM                                                                                                                    
                                                                                                                                
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                   
                                                                                                                                
4:35:29 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced  that the next 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."                                                                                                         
                                                                                                                                
CHAIR WILSON  described the two  subcommittee meetings  that were                                                               
held, resulting in the new version  of the bill.  She pointed out                                                               
that  the  Governor's budget  includes  funding  to increase  the                                                               
state  employed  nurses  wages, providing  a  market  competitive                                                               
compensation.   During  the second  meeting of  the subcommittee,                                                               
she  reported, nurses  from New  Jersey,  Oregon, and  Washington                                                               
responded to  inquiries regarding  the recently  implemented bans                                                               
on  mandatory overtime  in  their  states, and  how  it has  been                                                               
working  for them.   She  explained that  these states  have each                                                               
implemented  a  system   which  requires  a  nurse   to  lodge  a                                                               
complaint,  thus instigating  an  investigation  to identify  and                                                               
deal  with  a  possible  overtime infraction.    The  nurses  who                                                               
testified,  unanimously affirmed  that  this  system works  well;                                                               
however, there is  no data available to back  up their testimony,                                                               
and the hospitals contacted did not offer comment.                                                                              
                                                                                                                                
CHAIR WILSON  delineated the specific changes  that the concerned                                                               
"stakeholders" agreed  to in  the bill:   the penalty  aspect was                                                               
removed,  facilities will  not incur  a penalty  should they  use                                                               
mandatory  overtime; the  bill  excludes  Certified Nurses  Aides                                                               
(CNAs), critical access hospitals are  included in the bill; each                                                               
facility  is   required  to  provide  a   semiannual  report  [to                                                               
Department of Health and Social  Services] showing monthly totals                                                               
of mandatory  overtime hours,  voluntary overtime  hours, on-call                                                               
hours,  and contract  nurses hours;  and the  state nursing  wage                                                               
will  be  increased  in  the  2007  budget.    She  stressed  the                                                               
importance for  having the  data reported,  and explained  how it                                                               
will be  crucial for future  analysis and planning.   In response                                                               
to  a question,  she explained  that the  CNAs were  excluded, as                                                               
they are not affected by the mandatory overtime issue.                                                                          
                                                                                                                                
4:43:15 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON  moved to  adopt  CSHB  271, Version  24-LS0j838\P,                                                               
Bullock,  2/23/06,  as the  working  document.   There  being  no                                                               
objection, Version P was before the committee.                                                                                  
                                                                                                                                
4:44:04 PM                                                                                                                    
                                                                                                                                
JOHN BITNEY,  Lobbyist, Alaska  Nurses Association  (ANA), stated                                                               
support  for   Version  P,  as   a  reasonable   compromise  that                                                               
establishes  a policy  to allow  nurses  to say  "no" to  working                                                               
overtime   without  fear   of  retribution,   and  the   language                                                               
acknowledges  and respects  a nurses'  professional standard  for                                                               
responsive patient care.                                                                                                        
                                                                                                                                
4:46:00 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  directed the committee's  attention to  the written                                                               
testimony provided  by Rod Betit,  President of the  Alaska State                                                               
Hospital & Nursing Home Association  (ASHNHA), and suggested that                                                               
they take a moment to review its contents.                                                                                      
                                                                                                                                
The committee took an at-ease from 4:46:47 PM to 4:47:13 PM.                                                                
                                                                                                                                
[The  committee  returned  attention  to  HB  271  later  in  the                                                               
hearing.]                                                                                                                       
                                                                                                                                
4:47:22 PM                                                                                                                    
                                                                                                                                
HJR 31-FETAL ALCOHOL SPECTRUM DISORDERS DAY                                                                                   
                                                                                                                                
CHAIR WILSON  returned the committee's  attention to  HOUSE JOINT                                                               
RESOLUTION NO. 31, Relating to  designating September 9, 2006, as                                                               
Fetal Alcohol Spectrum Disorders Awareness Day.                                                                                 
                                                                                                                                
4:47:33 PM                                                                                                                    
                                                                                                                                
JACQUELINE  TUPOU,  Staff   to  Representative  Bruce  Weyhrauch,                                                               
Alaska State Legislature,  resumed the presentation of  HJR 31 on                                                               
behalf of  Representative Weyhrauch,  Prime Sponsor,  and pointed                                                               
out that each  year more children are born in  America with fetal                                                               
alcohol  spectrum  disorders  (FASD)  than  with  Down  Syndrome,                                                               
muscular  dystrophy,  and   human  immunodeficiency  virus  (HIV)                                                               
combined.   In urging  the committee to  swiftly pass  this joint                                                               
resolution, she stated  that if mothers are aware  not to consume                                                               
alcohol during pregnancy FASD is entirely avoidable.                                                                            
                                                                                                                                
CHAIR  WILSON stressed  that  it is  not often  that  there is  a                                                               
disease that is 100 percent avoidable as is FASD.                                                                               
                                                                                                                                
4:48:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER asked about the  reference on page 1, line                                                               
14, to  mental illness,  and stated that  she has  not heretofore                                                               
heard that FASD is a cause of mental illness.                                                                                   
                                                                                                                                
MS.  TUPOU responded  that she  is not  qualified to  answer that                                                               
question,  but  stated  that the  language  for  this  resolution                                                               
primarily  reflects  what was  drafted  for  a nation  wide  bill                                                               
provided by the office of United States Senator Lisa Murkowski.                                                                 
                                                                                                                                
REPRESENTATIVE   CISSNA  interjected   that   some  conduct   and                                                               
behavioral disorders  of young children  have been  attributed to                                                               
FASD,  and asked  her staff  member, Cindy  Folsom, to  offer her                                                               
opinion.                                                                                                                        
                                                                                                                                
MS. TUPOU  conjectured that perhaps mental  illness is considered                                                               
a secondary disability caused by FASD.                                                                                          
                                                                                                                                
4:50:22 PM                                                                                                                    
                                                                                                                                
CINDY  FOLSOM,  Staff  to Representative  Sharon  Cissna,  Alaska                                                               
State  Legislature, speaking  from  her experience  as a  retired                                                               
school  counselor, stated  that it  is true  that FASD  can cause                                                               
conduct  disorders, thus  providing a  context that  could relate                                                               
FASD to mental illness.                                                                                                         
                                                                                                                                
4:50:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  moved  to  report HJR  31,  Version  24-                                                               
LS1530\G, out  of committee  with individual  recommendations and                                                               
the accompanying fiscal notes.   There being no objection, HJR 31                                                               
was  reported  out of  the  House  Health, Education  and  Social                                                               
Services Standing Committee.                                                                                                    
                                                                                                                                
4:51:01 PM                                                                                                                    
                                                                                                                                
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                   
                                                                                                                                
CHAIR  WILSON returned  the committee's  attention to  HOUSE BILL                                                               
NO.  271,  "An  Act  relating  to  limitations  on  overtime  for                                                               
registered nurses  in health care  facilities; and  providing for                                                               
an effective date."                                                                                                             
                                                                                                                                
4:51:04 PM                                                                                                                    
                                                                                                                                
LAURIE  HERMAN,  Regional  Director, Government  Affairs,  Alaska                                                               
State Hospital and Nursing  Home Association (ASHNHA), Providence                                                               
Alaska Medical  Center, stated support  for CSHB 271,  Version P,                                                               
save opposition  for Section 18.09.010,  which provides  that the                                                               
nurse  will  be  the  sole  determiner  of  whether  overtime  is                                                               
appropriate, thus removing management from the process.                                                                         
                                                                                                                                
4:52:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER asked why it  would not be appropriate for                                                               
the individual  to decide whether  they could safely  continue to                                                               
work.                                                                                                                           
                                                                                                                                
LAURIE  HERMAN  explained  that  the  nurse  makes  the  decision                                                               
whether  the  overtime  was  mandatory   or  voluntary,  for  the                                                               
purposes of filling out the monthly overtime report.                                                                            
                                                                                                                                
CHAIR  WILSON clarified  that the  reports are  generated by  the                                                               
hospitals, and  it will be  apparent to the  individuals involved                                                               
whether  the overtime  was  mandatory or  voluntary.   She  said,                                                               
"That's the reality of what started the bill to begin with."                                                                    
                                                                                                                                
4:53:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER moved  to  report CSHB  271, Version  24-                                                               
LS0838\P,  Bullock, 2/23/06,  as amended,  out of  committee with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There being no  objection, CSHB 271(HES) was reported  out of the                                                               
House Health, Education and Social Services Standing Committee.                                                                 
                                                                                                                                
4:54:21 PM                                                                                                                    
                                                                                                                                
HCR 5-FLUORIDATION                                                                                                            
                                                                                                                                
CHAIR WILSON announced that the  final order of business would be                                                               
HOUSE  CONCURRENT  RESOLUTION  NO.  5,  Relating  to  support  of                                                               
community water fluoridation.                                                                                                   
                                                                                                                                
4:54:38 PM                                                                                                                    
                                                                                                                                
KATHERINE  SHOWS, Staff  to  Representative  Paul Seaton,  Alaska                                                               
State  Legislature presented  HCR 5  on behalf  of Representative                                                               
Seaton, Prime  Sponsor, paraphrasing from the  sponsor statement,                                                               
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
     House  Concurrent  Resolution  5  resolves  to  provide                                                                    
     fluoridation    in   all    Alaskan   water    systems.                                                                    
     Fluoridated  water  has   been  shown  to  dramatically                                                                    
     reduce dental  carries, especially  in children.  It is                                                                    
     one  of  the  most  efficient ways  of  providing  cost                                                                    
     effective preventative  health care; every $1  spent on                                                                    
     fluoridation  saves  $37  in  future  dental  expenses.                                                                    
     Currently,  all  cities  in Alaska  with  a  population                                                                    
     exceeding 30,000 have access  to fluoridated water. The                                                                    
     benefits  of fluoridated  water should  be extended  to                                                                    
     all Alaskans.                                                                                                              
                                                                                                                                
     HCR 5  would also require  all new water systems  to be                                                                    
     engineered   with   the  capacity   for   incorporating                                                                    
     fluoride.  Communities would  not  be  required to  add                                                                    
     fluoride  but would  have the  ability  to do  so at  a                                                                    
     later date without costly retrofitting.                                                                                    
                                                                                                                                
     Tooth   decay  is   a   serious   problem  in   Alaska,                                                                    
     particularly  in  rural  areas  that  do  not  exercise                                                                    
     proper  dental  hygiene  or eating  habits,  and  where                                                                    
     access  to  dentists  is  not  available.  Poor  dental                                                                    
     health  puts  a  major  burden  upon  Medicaid/Medicare                                                                    
     programs.                                                                                                                  
                                                                                                                                
     Fluoridating community  water systems is  an investment                                                                    
     in Alaska's public health  that produces great returns.                                                                    
     HCR  5   makes  it   clear  that  the   State  supports                                                                    
     communities in  taking this step to  improve the dental                                                                    
     health of their residents.                                                                                                 
                                                                                                                                
MS. SHOWS  pointed out  the letters of  support in  the committee                                                               
packet,  but   also  noted  letters   of  opposition   which  she                                                               
attributes to the fact that fluoride  is a toxic chemical and can                                                               
be  harmful.   She  stated  that  the  only known  fatality  from                                                               
fluoride  occurred   in  Hooper  Bay,  due   to  sustained  over-                                                               
fluoridation to the  municipal water system.   However, she noted                                                               
that  more  strict  regulations  have  been  implemented  by  the                                                               
Department of Environmental Conservation  (DEC), since the Hooper                                                               
Bay incident,  which should preclude  a recurrence of  that type.                                                               
Finally, she  said that  fluoride has been  used in  public water                                                               
systems   for   about   sixty   years,   its   effectiveness   is                                                               
statistically  supported  by  numerous  studies,  and  17  states                                                               
currently require fluoridation in their public water systems.                                                                   
                                                                                                                                
4:57:18 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  pointed out  that this  bill in  no way  mandates a                                                               
community to  fluoridate their water,  but does require  that all                                                               
new  water  systems  be  engineered   to  allow  for  the  future                                                               
administration of fluoride.                                                                                                     
                                                                                                                                
4:58:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER stated  her support  for the  resolution,                                                               
but expressed  a concern  for fluoridation  and provided  a brief                                                               
history of  her experience in  Colorado Springs,  Colorado, where                                                               
clinical  fluoride levels  are natural  to  the water  presenting                                                               
adverse effects to some residents.                                                                                              
                                                                                                                                
4:59:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KOHRING asked whether  one of the primary chemical                                                               
components of fluoride is not  also a primarily ingredient in rat                                                               
poison.   Further, he asked why  it would be necessary  to drink,                                                               
bathe, and  otherwise inundate our  bodies via a  systemic intake                                                               
of  fluoride versus  requesting  a  topical, localized,  personal                                                               
application by a dental care provider.                                                                                          
                                                                                                                                
MS. SHOWS  responded that she  is not familiar with  the contents                                                               
of rat poison.  She said  that the levels of fluoride provided in                                                               
community water  systems are  at a low  level and  not considered                                                               
harmful to  humans.   She pointed  out that  one of  the greatest                                                               
benefits of fluoride  in a public water system is  for people who                                                               
do  not have  alternative access  to fluoride  or regular  dental                                                               
care.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  KOHRING  stated,  "I'd be  very  concerned  about                                                               
having my  children consume  a chemical."   Further, he  asked if                                                               
the sponsor had  completed an in-depth analysis  of the potential                                                               
health risks associated with systemic ingestion of fluoride.                                                                    
                                                                                                                                
MS.  SHOWS   stated  that  the  health   problems  are  primarily                                                               
fluorosis, which  is a discoloration  of the teeth,  and possible                                                               
bone density loss.   She maintained that the  Hooper Bay incident                                                               
was  an  anomaly  which  cannot  occur  again  provided  the  new                                                               
administration standards.   She  reiterated that  this is  a bill                                                               
which allows each  community to choose fluoridation  and does not                                                               
impose a mandate.                                                                                                               
                                                                                                                                
REPRESENTATIVE  KOHRING maintained  his  concern for  encouraging                                                               
the use  of a chemical that  carries a risk for  potential health                                                               
problems.    He also  questioned  the  oversight for  its  proper                                                               
administration into the public water  supply, and the possibility                                                               
for concentrations of  fluoride to occur in different  parts of a                                                               
water system.                                                                                                                   
                                                                                                                                
5:03:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  has primarily lived where  fluoridation is                                                               
utilized, and the dentists and  health professionals that she has                                                               
consulted  support  the  use  of fluoride.    She  described  the                                                               
problems that  she has  witnessed in the  remote villages  due to                                                               
the lack of  dental care, where an eroded  dental condition often                                                               
results  in  a  patient  undergoing a  costly  emergency  medical                                                               
evacuation.                                                                                                                     
                                                                                                                                
5:06:08 PM                                                                                                                    
                                                                                                                                
WILLIAM  MARLEY,  Doctor  of   Dental  Surgery  (DDS),  Chairman,                                                               
Fluoridation  Committee,  Alaska  Dental  Society  (ADS),  stated                                                               
support for HCR 5, which does  not impose a mandate, or represent                                                               
a  cost to  the  state,  but does  provide  leadership for  state                                                               
agencies to function in a unified  manner.  He suggested that the                                                               
committee  refer  to the  booklet  Fluoride  Facts, published  in                                                             
1999, by the  American Dental Association (ADA),  for an in-depth                                                               
understanding of  the benefits of  fluoridation.  One  study done                                                               
in  Alaska  has indicated  that  children  who drink  fluoridated                                                               
water experience 50  percent less dental disease.   He maintained                                                               
that  fluoridation is  an  effective means  to  help people  curb                                                               
dental  disease,  especially  if  they fall  in  a  lower  socio-                                                               
economic, class or otherwise have  limited access to dental care.                                                               
The  Center  for Disease  Control  (CDC)  has begun  the  Healthy                                                               
Families Initiative (HFI)  which has issued a  goal to fluoridate                                                               
75 percent of the United States  water supply systems by the year                                                               
2010.   The Alaska Department  of Health and Social  Services has                                                               
signed onto the HFI.                                                                                                            
                                                                                                                                
5:11:33 PM                                                                                                                    
                                                                                                                                
DR.  MARLEY acknowledged  the Hooper  Bay casualty  and explained                                                               
how  the  oversight has  been  corrected  with a  certified  two-                                                               
operator system  designed to  eliminate errors  in administration                                                               
of  this  toxic   chemical.    He  also   described  the  natural                                                               
fluoridated  water  phenomena  of the  southwest  United  States,                                                               
explaining  how in  some cases  the  fluoride is  removed as  the                                                               
recommended dosage  is only  one part per  million.   This allows                                                               
for minimal incidents of negative  health side effects, which, he                                                               
opined,   are  overridden   by   the   dental  health   benefits.                                                               
Continuing, he stressed that by  encouraging the bush communities                                                               
to  fluoridate their  water  supplies, the  dental  needs of  the                                                               
residents  would be  reduced to  the point  that the  dental care                                                               
available in any village would  be adequate.  Finally, he pointed                                                               
out that Article  7, Section 2, of the  Alaska State Constitution                                                               
says that  "the legislature shall  provide for the  promotion and                                                               
protection of the  public health," and to that  end, studies show                                                               
that healthy teeth play an important role.                                                                                      
                                                                                                                                
The committee took an at-ease from 5:18:12 PM to 5:18:37 PM                                                                 
                                                                                                                                
5:18:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  moved to report HCR  5, Version 24LS0327\Y                                                               
out  of   committee  with  individual  recommendations   and  the                                                               
accompanying  fiscal notes.   There  being no  objection, HCR  5,                                                               
Version  Y was  moved  out  of the  House  Health, Education  and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
5:18:58 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that, due  to scheduling difficulties, the                                                               
House Health,  Education and  Social Services  Standing Committee                                                               
meetings would be postponed until further notice.                                                                               
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health, Education and Social  Services Standing Committee meeting                                                               
was adjourned at 5:19:20 PM.                                                                                                  
                                                                                                                                

Document Name Date/Time Subjects