Legislature(2001 - 2002)
04/25/2002 03:03 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
April 25, 2002
3:03 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Chair
Representative Peggy Wilson, Vice Chair
Representative John Coghill
Representative Gary Stevens
Representative Vic Kohring
Representative Sharon Cissna
Representative Reggie Joule
MEMBERS ABSENT
All members present
OTHER LEGISLATORS PRESENT
Representative Andrew Halcro
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 302(JUD)
"An Act defining the term 'mental health professional' for the
purpose of statutes relating to the evaluation of prisoners who
may need psychological or psychiatric treatment, for the purpose
of statutes relating to the evaluation of children in need of
aid and delinquent minors who may need to be confined in a
secure residential psychiatric treatment center or who should be
released from such a center, for the purpose of statutes
requiring certain professionals to report the possibility that a
vulnerable adult has been abused or neglected, and for the
purpose of statutes relating to mental health civil
commitments."
- MOVED HCS CSSB 302(HES) OUT OF COMMITTEE
SENATE BILL NO. 295
"An Act relating to the disclosure of information regarding
delinquent minors to certain licensing agencies; and providing
for an effective date."
- MOVED SB 295 OUT OF COMMITTEE
HOUSE BILL NO. 522
"An Act relating to medical services under the state Medicaid
program."
- MOVED HB 522 OUT OF COMMITTEE
CS FOR SENATE BILL NO. 182(FIN)
"An Act requiring reductions in payments to individuals under
certain benefit programs if appropriations are not sufficient to
fully fund the statutorily established levels of payments."
- HEARD AND HELD
HOUSE BILL NO. 505
"An Act defining the term 'mental health professional' for the
purpose of statutes relating to the evaluation of prisoners who
may need psychological or psychiatric treatment, for the purpose
of statutes relating to the evaluation of children in need of
aid and delinquent minors who may need to be confined in a
secure residential psychiatric treatment center or who should be
released from such a center, for the purpose of statutes
requiring certain professionals to report the possibility that a
vulnerable adult has been abused or neglected, and for the
purpose of statutes relating to mental health civil
commitments."
- SCHEDULED BUT NOT HEARD
PREVIOUS ACTION
BILL: SB 302
SHORT TITLE:DEFINITION OF MENTAL HEALTH PROFESSIONAL
SPONSOR(S): SENATOR(S) WILKEN
Jrn-Date Jrn-Page Action
02/19/02 2231 (S) READ THE FIRST TIME -
REFERRALS
02/19/02 2231 (S) HES, JUD
03/04/02 (S) HES AT 1:30 PM BUTROVICH 205
03/04/02 (S) Moved SB 302 Out of Committee
03/04/02 (S) MINUTE(HES)
03/06/02 2384 (S) HES RPT 4DP 1NR
03/06/02 2384 (S) DP: GREEN, WILKEN, LEMAN,
DAVIS;
03/06/02 2384 (S) NR: WARD
03/06/02 2384 (S) FN1: ZERO(HSS)
03/22/02 (S) JUD AT 1:30 PM BELTZ 211
03/22/02 (S) -- Meeting Canceled --
04/10/02 (S) JUD AT 1:30 PM BELTZ 211
04/10/02 (S) Moved CS(JUD) Out of
Committee
04/10/02 (S) MINUTE(JUD)
04/11/02 2729 (S) JUD RPT CS 2DP 2NR SAME TITLE
04/11/02 2730 (S) DP: TAYLOR, COWDERY;
04/11/02 2730 (S) NR: ELLIS, THERRIAULT
04/11/02 2730 (S) FN1: ZERO(HSS)
04/16/02 (S) RLS AT 10:30 AM FAHRENKAMP
203
04/16/02 (S) MINUTE(RLS)
04/17/02 2807 (S) RULES TO CALENDAR 4/17/02
04/17/02 2810 (S) READ THE SECOND TIME
04/17/02 2810 (S) JUD CS ADOPTED UNAN CONSENT
04/17/02 2810 (S) ADVANCED TO THIRD READING
UNAN CONSENT
04/17/02 2811 (S) READ THE THIRD TIME CSSB
302(JUD)
04/17/02 2811 (S) PASSED Y19 N- E1
04/17/02 2814 (S) TRANSMITTED TO (H)
04/17/02 2814 (S) VERSION: CSSB 302(JUD)
04/18/02 2996 (H) READ THE FIRST TIME -
REFERRALS
04/18/02 2996 (H) HES
04/25/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: SB 295
SHORT TITLE:LICENSING:DISCLOSURE OF MINORS' RECORDS
SPONSOR(S): SENATOR(S) KELLY
Jrn-Date Jrn-Page Action
02/13/02 2183 (S) READ THE FIRST TIME -
REFERRALS
02/13/02 2183 (S) HES, JUD
03/04/02 (S) HES AT 1:30 PM BUTROVICH 205
03/04/02 (S) Moved SB 295 Out of Committee
03/04/02 (S) MINUTE(HES)
03/06/02 2384 (S) HES RPT 5DP
03/06/02 2384 (S) DP: GREEN, WILKEN, LEMAN,
DAVIS, WARD
03/06/02 2384 (S) FN1: ZERO(HSS)
03/22/02 (S) JUD AT 1:30 PM BELTZ 211
03/22/02 (S) -- Meeting Canceled --
04/10/02 (S) JUD AT 1:30 PM BELTZ 211
04/10/02 (S) Moved Out of Committee
04/10/02 (S) MINUTE(JUD)
04/11/02 2729 (S) JUD RPT 5DP
04/11/02 2729 (S) DP: TAYLOR, COWDERY, ELLIS,
THERRIAULT,
04/11/02 2729 (S) DONLEY
04/11/02 2729 (S) FN1: ZERO(HSS)
04/16/02 (S) RLS AT 10:30 AM FAHRENKAMP
203
04/16/02 (S) MINUTE(RLS)
04/17/02 2807 (S) RULES TO CALENDAR 4/17/02
04/17/02 2809 (S) READ THE SECOND TIME
04/17/02 2809 (S) ADVANCED TO THIRD READING
UNAN CONSENT
04/17/02 2809 (S) READ THE THIRD TIME SB 295
04/17/02 2809 (S) COSPONSOR(S): HALFORD, LEMAN,
COWDERY,
04/17/02 2809 (S) AUSTERMAN
04/17/02 2810 (S) PASSED Y19 N- E1
04/17/02 2810 (S) EFFECTIVE DATE(S) SAME AS
PASSAGE
04/17/02 2814 (S) TRANSMITTED TO (H)
04/17/02 2814 (S) VERSION: SB 295
04/18/02 2996 (H) READ THE FIRST TIME -
REFERRALS
04/18/02 2996 (H) HES, JUD
04/25/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 522
SHORT TITLE:MEDICAID PAYMENTS FOR ABORTION
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
Jrn-Date Jrn-Page Action
04/18/02 3006 (H) READ THE FIRST TIME -
REFERRALS
04/18/02 3006 (H) HES, JUD, FIN
04/23/02 (H) HES AT 3:00 PM CAPITOL 106
04/23/02 (H) Heard & Held
04/23/02 (H) MINUTE(HES)
04/25/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: SB 182
SHORT TITLE:PRO RATA REDUCTIONS IN BENEFIT PROGRAMS
SPONSOR(S): FINANCE
Jrn-Date Jrn-Page Action
04/09/01 1014 (S) READ THE FIRST TIME -
REFERRALS
04/09/01 1014 (S) FIN
03/01/02 (S) FIN AT 9:00 AM SENATE FINANCE
532
03/01/02 (S) Heard & Held
03/01/02 (S) MINUTE(FIN)
03/20/02 (S) FIN AT 9:30 AM SENATE FINANCE
532
03/20/02 (S) Moved CSSB 182(FIN) Out of
Committee
03/22/02 2490 (S) FIN RPT CS 4DP 3NR SAME TITLE
03/22/02 2490 (S) DP: DONLEY, GREEN, LEMAN,
WARD;
03/22/02 2490 (S) NR: KELLY, AUSTERMAN, WILKEN
03/27/02 2533 (S) FN1: INDETERMINATE(GOV/ALL
DEPTS)
03/27/02 2533 (S) FN2: INDETERMINATE(HSS)
03/27/02 2533 (S) FN3: INDETERMINATE(HSS)
03/27/02 2533 (S) FN4: INDETERMINATE(HSS)
03/27/02 2533 (S) FN5: INDETERMINATE(HSS)
03/27/02 2533 (S) FN6: INDETERMINATE(HSS)
03/27/02 2533 (S) FN7: INDETERMINATE(HSS)
03/27/02 2533 (S) FN8: INDETERMINATE(HSS)
03/28/02 (S) RLS AT 8:30 AM FAHRENKAMP 203
03/28/02 (S) -- Time Change --
03/28/02 (S) MINUTE(RLS)
04/02/02 2586 (S) RULES TO CALENDAR 1OR 4/2/02
04/02/02 2587 (S) READ THE SECOND TIME
04/02/02 2588 (S) FIN CS ADOPTED UNAN CONSENT
04/02/02 2588 (S) ADVANCE TO 3RD READING FLD
Y13 N4 E2 A1
04/02/02 2588 (S) ADVANCED TO THIRD READING 4/3
CALENDAR
04/03/02 2616 (S) READ THE THIRD TIME CSSB
182(FIN)
04/03/02 2616 (S) PASSED Y13 N6 E1
04/03/02 2616 (S) ELLIS NOTICE OF
RECONSIDERATION
04/04/02 2635 (S) RECONSIDERATION NOT TAKEN UP
04/04/02 2636 (S) TRANSMITTED TO (H)
04/04/02 2636 (S) VERSION: CSSB 182(FIN)
04/05/02 2813 (H) READ THE FIRST TIME -
REFERRALS
04/05/02 2813 (H) HES, FIN
04/05/02 2813 (H) REFERRED TO HES
04/23/02 (H) HES AT 3:00 PM CAPITOL 106
04/23/02 (H) Heard & Held
04/23/02 (H) MINUTE(HES)
04/25/02 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
SENATOR GARY WILKEN
Alaska State Legislature
Capitol Building, Room 514
Juneau, Alaska 99801
POSITION STATEMENT: Presented SB 302 as sponsor and explained
changes in the committee substitute.
ANNE HENRY, Special Projects Coordinator
Central Office
Division of Mental Health & Developmental Disabilities
Department of Health & Social Services
PO Box 110620
Juneau, Alaska 99811-0620
POSITION STATEMENT: Answered questions on SB 302.
STACIE KRALY, Assistant Attorney General
Human Services Section
Civil Division (Juneau)
Department of Law
PO Box 110300
Juneau, Alaska 99811-0300
POSITION STATEMENT: Answered questions on SB 302.
WENDY HALL, Staff
to Senator Pete Kelly
Alaska State Legislature
Capitol Building, Room 518
Juneau, Alaska 99801
POSITION STATEMENT: Presented SB 295 on behalf of the sponsor.
ROBERT BUTTCANE, Legislative & Administrative Liaison
Division of Juvenile Justice
Department of Health & Social Services
PO Box 110635
Juneau, Alaska 99811-0635
POSITION STATEMENT: Answered questions on SB 295.
JOHN MIDDAUGH, MD, Chief
Epidemiology Section
Division of Public Health
Department of Health & Social Services
PO Box 240249
Anchorage, Alaska 99524-0249
POSITION STATEMENT: Testified against HB 522.
DEATRICH SITCHLER
520 Glacier Bay Circle
Anchorage, Alaska 99508
POSITION STATEMENT: Testified against HB 522.
JENNIFER RUDINGER, Executive Director
Alaska Civil Liberties Union (ACLU)
PO Box 201844
Anchorage, Alaska 99520
POSITION STATEMENT: Testified against HB 522.
DR. KATHLEEN TODD
Obstetrician/Gynecologist
Valdez Medical Clinic
PO Box 1829
Valdez, Alaska 99686
POSITION STATEMENT: Her testimony opposing HB 522 was read via
teleconference by Robin Smith.
PAULINE UTTER
13820 Jarvi Drive
Anchorage, Alaska 99515
POSITION STATEMENT: Testified against HB 522.
WILLIAM CRAIG
(No address provided)
POSITION STATEMENT: Commented on HB 522.
CHIP WAGONER
Alaska Catholic Conference
3294 Pioneer Avenue
Juneau, Alaska 99801
POSITION STATEMENT: Testified in support of HB 522.
KATHLEEN STEVENSON
(No address provided)
POSITION STATEMENT: Testified in support of HB 522.
ANNA FRANK, Executive Director
Planned Parenthood of Alaska
9300 Arlene
Anchorage, Alaska 99515
POSITION STATEMENT: Testified on HB 522.
JASON HOOLEY
(No address provided)
POSITION STATEMENT: Testified in support of HB 522.
ACTION NARRATIVE
TAPE 02-37, SIDE A
Number 0001
CHAIR FRED DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:03 p.m.
Representatives Dyson, Coghill, Stevens, Kohring, and Cissna
were present at the call to order. Representatives Wilson and
Joule arrived as the meeting was in progress.
SB 302 - DEFINITION OF MENTAL HEALTH PROFESSIONAL
CHAIR DYSON announced that the first order of business would be
CS FOR SENATE BILL NO. 302(JUD), "An Act defining the term
'mental health professional' for the purpose of statutes
relating to the evaluation of prisoners who may need
psychological or psychiatric treatment, for the purpose of
statutes relating to the evaluation of children in need of aid
and delinquent minors who may need to be confined in a secure
residential psychiatric treatment center or who should be
released from such a center, for the purpose of statutes
requiring certain professionals to report the possibility that a
vulnerable adult has been abused or neglected, and for the
purpose of statutes relating to mental health civil
commitments."
The committee took an at-ease from 3:05 p.m. to 3:06 p.m.
Number 0052
REPRESENTATIVE WILSON made a motion to adopt the proposed
committee substitute (CS) for SB 302, version 22-LS1410\O,
Lauterbach, 4/23/02, as a work draft. There being no objection,
Version O was before the committee.
SENATOR GARY WILKEN, Alaska State Legislature, sponsor,
explained the changes in the CS. The House CS deleted the
following: "(C) has submitted an application form and
application fee for licensure by a board named in this
paragraph;" which in the original bill is page 2, lines 14 and
15.
Number 0127
SENATOR WILKEN read the following sponsor statement:
Committee Substitute for Senate Bill 302 recognizes
the growth in the clinical mental health profession
and broadens the "mental health professional"
definition to include (1) a licensed clinical social
worker, (2) a licensed marital and family therapist,
and (3) a licensed professional counselor. The
current Title [47] definition was written in 1981
prior to passage of Alaska's licensing requirements
governing these master level mental health clinicians.
SENATOR WILKEN referred the committee to the handout, Comparison
Chart for Mental Health Disciplines covered under SB 302. He
explained that the first two columns, Psychologist and
Psychiatrist Associate, are current law; the next three columns,
the Clinical Social Worker, the Marital and Family Therapist,
and Licensed Professional Counselor, are added in SB 302 to do
the work of the first two columns. He continued reading the
sponsor statement:
A more inclusive mental health professional definition
increases the capacity of Alaska's mental health
system to protect our youth and adults who are
experiencing acute psychiatric crisis in our
communities. Today, not enough mental health
professionals are authorized under the current
definition to respond to some critical public safety
situations, particularly in rural Alaska. And yet
there are hundreds of licensed professionals who are
qualified to aid these Alaskans, but cannot, as they
do not fall under the current statutory definition.
Senate Bill 302 recognizes this problem and updates
the Title 47 definition.
The expanded "mental health professional" definition,
as stated in Senate Bill 302, increases the number of
trained professionals who will be: 1) Allowed to
provide mental health treatment for prisoners; 2)
Authorized to evaluate children and minors in custody
to determine placement in residential treatment
centers; 3) Required to report incidents of harm to
vulnerable adults; 4) Allowed to conduct civil
commitment evaluations.
SENATOR WILKEN commended the bill to the committee.
Number 0313
REPRESENTATIVE COGHILL asked whether the federal government
employees would have to be licensed in the state the same as
physicians and psychiatrists.
Number 0350
ANNE HENRY, Special Projects Coordinator, Central Office,
Division of Mental Health & Developmental Disabilities,
Department of Health & Social Services, came forward to respond
to questions. In response to Representative Coghill, Ms. Henry
recalled that the bill allows for people who are working under
contract with the federal government to not be licensed in the
state because they travel around from place to place in the
military or something like that.
Number 0378
REPRESENTATIVE COGHILL asked Ms. Henry if those people would be
able to do the civil commitments under this law.
MS. HENRY answered that they would be allowed to do that as an
emergency services employee in a community mental health center.
REPRESENTATIVE COGHILL wondered if those people would have
comparable qualifications or is there reason to believe that
there would be people without those qualifications.
MS. HENRY responded that a psychiatrist or medical doctor would
qualify.
The committee took an at-ease from 3:12 p.m. to 3:13 p.m.
CHAIR DYSON commented that in addition to qualifying people to
provide these other services, a number of insurance companies
don't allow third party payments unless the person has a license
that is recognized by the State. Some of the folks providing
these services will get additional access to third party payers
as a result of this action.
MS. HENRY responded that the only licensed profession that is
not recognized by insurance companies at this time is the
licensed professional counselors. She said her understanding
was that they had to go through the legislature to receive
parity for that, and this would not be the same thing.
REPRESENTATIVE JOULE moved to report the proposed CS out of
committee with individual recommendations and the accompanying
fiscal notes.
REPRESENTATIVE COGHILL said he had another question before he
was ready to vote on the bill. He reiterated his question about
the qualifications of the federal government employee.
Number 0750
STACIE KRALY, Assistant Attorney General, Human Services
Section, Civil Division (Juneau), Department of Law, answered
that she understands that the way the legislation is drafted,
the federal employee provision only applies to a psychiatrist or
a physician, and they would have to have the same licensure
requirements as a physician or psychiatrist in the State of
Alaska. It would not apply to the additional individuals listed
in the statute and the ones this bill would now include.
CHAIR DYSON asked if there was any objection to moving the bill.
There being no objection, HCS CSSB 302(HES) was reported out of
the House Health, Education and Social Services Standing
Committee.
SB 295 - LICENSING:DISCLOSURE OF MINORS' RECORDS
CHAIR DYSON announced that the next order of business would be
SENATE BILL NO. 295, "An Act relating to the disclosure of
information regarding delinquent minors to certain licensing
agencies; and providing for an effective date."
Number 0875
WENDY HALL, Staff to Senator Pete Kelly, Alaska State
Legislature, presented the bill on behalf of Senator Kelly,
sponsor. She told the committee that SB 295 was introduced as
an attempt to help facilitate state licensing agencies to ensure
quality care and safety concerns are met for all care facilities
and programs within the state. Currently, people age 16 and
older have their background researched if they are seeking
employment for a care license or with a care provider or are
residing in a home with a care provider seeking licensure.
However, information for individuals age 16 or younger is not
readily released to licensing agencies. That information is
only accessible through the Division of Juvenile Justice. Its
hands are somewhat tied in the fact it can only release certain
information in certain circumstances to certain licensing
agencies. A woman could apply for a day care license to provide
care out of her home and could have a 14-year old son living
there who is a convicted child molester. The licensing agencies
would have no knowledge about this and would give her the
license. She said that children and adults could be put in a
situation with an offender in the home.
REPRESENTATIVE COGHILL asked if this bill passes, will someone
go back and look at people who have licenses now.
MS. HALL answered no.
Number 0995
ROBERT BUTTCANE, Legislative & Administrative Liaison, Division
of Juvenile Justice, Department of Health & Social Services,
came forward to testify. He expressed support for SB 295. He
told the committee that over the years the legislature has
enacted a number of licensing bills requiring care licensing
authorities to do background checks on people 16 years and
older. The current delinquency statute governing delinquency
records isn't entirely sufficient to be able to release that
information.
MR. BUTTCANE described a situation in which a woman asks for a
daycare license in her own family home, and she has a 17-year-
old boy who lives in the home. Currently, the statute says that
the division can release the delinquency information if the 17-
year old is going to be an employee of the woman. Although
there may not be a clear intent that the 17-year old is going to
be employed by this woman in this daycare business, there is an
inferred employee relationship in that if mom runs out to the
store, she will leave the 17-year old in charge of the children.
Therefore, there is a quasi-employee relationship and thus that
information on the 17-year old is provided to the Department of
Education & Early Development. This legislation would make it
very explicit that the division actually has the authority to
provide relevant delinquency information to childcare and adult
care licensing entities.
MR. BUTTCANE told the committee that this fixes a problem. He
acknowledged there has not been a problem, but he doesn't want
to have a situation where information has been withheld from a
licensing agency that really is necessary to make an informed
decision about the safety of care providers.
Number 1106
REPRESENTATIVE COGHILL referred to page 2, lines 27 to 29 and
asked what "another jurisdiction that has the authority" might
be.
MR. BUTTCANE replied that sometimes licensing functions are
delegated to Native entities or municipalities. While they do
not have the ultimate licensing authority, some of the work to
gather information on licensing issues is delegated to another
entity. This would allow them on behalf of the agency that does
have licensing authority to gather that information.
Number 1152
REPRESENTATIVE COGHILL wondered if the same safeguards would be
followed as far as access to the information.
MR. BUTTCANE answered, yes, there are specific guidelines on how
to use that information and who has access to it. He explained
that it is delineated in the policies and practices as to how
that information is transmitted and used.
REPRESENTATIVE COGHILL asked about someone losing the license.
MR. BUTTCANE replied that this bill specifically allows the
division to give information to the licensing entity, and then
it's the licensing entity that makes the decisions about the
suitability of the applicant or whether to license the home.
There are a number of regulations that guide that as to when a
license can be issued or when it should be suspended because of
adverse information that's determined. This bill speaks only to
the authority that the division has to provide that information
to the licensing entity. What the licensing entity does with
that information is covered in other sections of the law, he
said.
Number 1244
CHAIR DYSON commented that his research says that a disturbing
number of perpetrators of sexual assault on children are
juveniles, including some who have profound disabilities.
Number 1267
REPRESENTATIVE WILSON moved to report SB 295 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, SB 295 was reported out of the
House Health, Education and Social Services Standing Committee.
The committee took an at-ease from 3:27 p.m. to 3:28 p.m.
HB 522 - MEDICAID PAYMENTS FOR ABORTION
Number 1350
JOHN MIDDAUGH, MD, Chief, Epidemiology Section, Division of
Public Health, Department of Health & Social Services, testified
via teleconference. He told the committee that he is board
certified in internal medicine and preventive medicine and has
practiced in Alaska since 1975. He has been the state
epidemiologist since 1980. He expressed opposition to HB 522.
He gave the following testimony:
My comments are meant to convey concerns from a
physician's point of view related to the practice of
medicine and the difficulty of applying the legal
language being proposed in this legislation within the
context of the physician/patient relationship. The
practice of medicine has as its basis special duties
and relationships between the physician and the
patient.
The proposed legislation contains language that is
very difficult to interpret within the context of a
doctor/patient relationship. The bill does not
recognize the necessity for respecting the uniqueness
of each patient as a standard for the physician and
patient together in consultation based upon the
patient's particular circumstances to arrive at the
best course of medical treatment.
Number 1400
In the absence of clear understanding of the meaning
of the language in the proposed legislation and its
interpretation, physicians may have great problems in
signing the certifications required by the
legislation, not because of any concern over the
medical necessity of the procedure, but due to
uncertainty over the vagueness of the language.
Problems with the proposed language that attempts to
restrict the definition of 'medically necessary'
involve terms that are not defined, and ultimately
would have to be interpreted in order to enforce the
statute. But who would make the decision and based on
what?
In the absence of knowledge of the legally and
ethically confidential intimate disclosures between a
patient and physician, how can a third party without
knowledge of the facts determine if the circumstances
'seriously endanger the physical health' or if a
'serious adverse physical condition' would be
significantly aggravated.
Number 1456
Because the practice of medicine encompasses a myriad
of decisions based upon circumstances of each
individual patient, there's a need for judgment in
arriving at the decision that a procedure is medically
necessary. The qualifying terms proposed in the
legislation are not objective and do not reflect the
medical standards of practice or interpretation.
Consider one example: Seriously endanger the physical
health - consider the horrible circumstances in which
a soldier steps on a landmine and loses both legs.
Why is it that in one instance a patient ends up with
a totally devastated life, becoming dependent upon
potent medications and alcohol and requiring long-term
institutional care, while in another instance, a
person with identical injuries becomes a national
leader, an advocate for veterans' rights and health
care? Patients are vastly different.
The heart of medical practice is for the physician and
patient together to weigh all alternatives, while
taking into account the unique circumstances for the
patient at the time. Another example is the wording
'psychological illness that requires medication.' But
many serious psychological illnesses are not treated
with medication. Consider the example of a pregnant
woman whose pregnancy precipitates abject despair and
causes the woman to become suicidal. Medical
treatment would not involve prescription of a
medication, but under the proposed legislation, this
woman would not be eligible for Medicaid coverage.
There is another serious problem with the proposed
language that may provide serious problems for a
physician and applying the legislation to practice,
and that's the use of the term 'would' in the bill
instead of 'could' or 'might.' It's not a trivial
difference, because depending on the legal
interpretation of any of these different words,
rarely, if ever in medicine, can a physician make a
prediction with 100 percent accuracy. Instead, the
physician's weighing probabilities and discussing
potential benefits and risks with the patient. The
standard of 'would' implies a certainty that could
almost never be able to be met.
Number 1548
And finally, the bill omits from Medicaid coverage the
instances in which a pregnant woman bears an infant
with horrible congenital malformations, even if
they're known to be incompatible with life. We're
currently facing in Alaska widespread outbreak due to
a virus (indisc.). It's a known common cause of
childhood disease that usually when contracted early
in childhood is mild and self-limited. Most adults
are immune, but about 30 percent of women in
childbearing age remain susceptible. If pregnant
women become infected with this virus during a
pregnancy, about 10 percent will suffer the loss of
the fetus due to fetal hydrops. ...
In conclusion, there is no science or medical
evidence-based justification for the proposed
legislation. The proposed legislation embodies the
rejection of the most basic principles of medical
practice and the existing powerful systems that assure
accountability for the standards of medical practice.
As you value the basic principles of medical practice
as an individual, as a legislator, and an eventual
patient, as a physician, I'm urging you not to support
the legislation.
Number 1613
CHAIR DYSON said the framers of this legislation do not want the
state financing abortions simply because the presence of that
unborn child is inconvenient to the mother. He wondered how can
that innocent life be protected from being disposed of using
public funds for capricious reasons.
Number 1656
DR. MIDDAUGH replied that there is a very high standard and high
bar for the practice of medicine today. He suggested that if
the bill stopped at page 1, line 12, that would be a very
important statement by the legislature compatible with the
standards of medicine to keep that high bar and to try to
mutually achieve those goals.
CHAIR DYSON asked Dr. Middaugh if the Hippocratic oath still
says, I will do no abortifacients.
DR. MIDDAUGH answered, yes it does. There's also the Oath of
Geneva and numerous standards by physicians, including
statements by the American College of Obstetrics & Gynecology
related to the very issues being talked about and the standards
of the physician/patient duties in this area.
Number 1703
CHAIR DYSON related that the gynecologists he's talked to always
say, Boy, when I'm dealing with a pregnant woman, I just realize
I have two patients, and I have a responsibility to look after
the health of both. He asked if Dr. Middaugh thought that was a
commonly held position by gynecologists.
DR. MIDDAUGH replied that he wasn't an obstetrician or
gynecologist, but he believes that the practice of medicine
involves very serious and weighty deliberations with a patient,
taking into account all the circumstances of that instance, and
with clinical judgment and the patient's informed consent,
arriving at the best medically and therapeutically indicated
course of action given those circumstances.
CHAIR DYSON wondered if it would be the best medically indicated
course of action for both patients.
DR. MIDDAUGH answered that he thinks the decision obviously
related to a pregnant woman involve her informed consent
combined with the physician's clinical judgment.
Number 1780
DEATRICH SITCHLER testified via teleconference. She read the
following:
I'm here to urge the committee to oppose this bill. I
would like to share with you my personal reasons why
this bill would be detrimental to many women with
similar situations to mine. At a young age, I was
diagnosed with hemophilia, a disease affecting the
blood. As a result of this condition, it could be
medically dangerous for me to carry a pregnancy to
term, because the loss of blood during delivery could
be potentially fatal to me.
I emphasize the word 'could.' There are cases where
women like me have had children successfully. But at
a very high risk; a risk that they have determined
they want to take. Under this bill, I probably would
not qualify for [Medicaid] services. Would I fit
under this medically necessary definition? My doctor
is not going to say that if I take a pregnancy to term
I would seriously endanger my physical health. My
doctor would probably say that there is, for example,
a 70 percent chance that carrying this pregnancy could
seriously endanger my physical health. I should not
be denied the right to Medicaid assistance because
there is a 30 percent chance that my pregnancy could
turn out okay.
No doctor could ever be certain of what would happen
if I carried a pregnancy to term. Especially in cases
like mine, where the woman has a high chance of a
serious endangerment to her physical health, she
should be the one to decide whether or not she is
willing to take that risk. This bill could force
women like me to carry their pregnancy to term and
risk their own lives, just because the doctor cannot
say for sure that carrying this pregnancy to term
would endanger their physical health.
Number 1853
I would also like to remind the committee members that
this decision to terminate my pregnancy would, like
many other women, be very painful for me, and I would
be doing this to potentially save my own life. There
are many women out there who will be forced to carry a
potentially dangerous pregnancy to term and risk their
own life, because they cannot afford to pay for an
abortion, and they don't fit into your very limited
category of women with medical problems. I don't
think the legislature should be making these life-
altering decisions for women just because they are of
low income. For these reasons I urge you to oppose
this bill as it is drafted.
Number 1880
CHAIR DYSON asked Ms. Sitchler if she believes there should be
any restrictions on the public funding of abortions.
MS. SITCHLER answered that she understands why people want to
stop women who just feel that they don't want to have the child
and have absolutely no reason at all. Her main concern is that
this bill is so limited. There are people at risk, and they
should be the ones to determine if they're at risk. She said
that she doesn't think that's necessarily the case for women who
are at absolutely no risk at all.
Number 1919
JENNIFER RUDINGER, Executive Director, Alaska Civil Liberties
Union (ACLU), testified via teleconference. She thanked the
committee for the opportunity to testify against HB 522. She
indicated that Dr. Middaugh has touched on some of the problems
in terms of the vagueness of the definition, the unworkability
of the wording of things like "seriously, significantly, highly
dangerous" as opposed to somewhat dangerous, and the question of
who decides what is serious. She stated:
In our estimation, the decision of what is a serious
aggravation of a health condition should be determined
by the patient who is suffering from whatever that
health condition or that adverse risk may be. What is
serious to me may not be too great a risk for somebody
else to take given our different life circumstances.
We generally believe that any medical decision
concerning health care belong in the purview of the
doctor/patient relationship, and that the government
should not be interfering in those decisions and those
health care choices.
Number 1985
MS. RUDINGER agreed that the word "would" in this version of the
bill is problematic. She reiterated that doctors don't make
absolute predictions. Doctors talk in terms of risks,
likelihood, and probability and give the patient options. Then
they tell the patient the likelihood of the various options, and
then the patient gives informed consent to whatever she decides
to do. She agrees that is a good system. The government
insisting that only women whose doctors certify that they
"would" suffer serious harm if they continue a pregnancy would
rule out a lot of poor women who rely on Medicaid for health
care.
CHAIR DYSON asked Ms. Rudinger at what point do taxpayers have
the right not to participate in something they find repugnant to
their conscience.
Number 2106
MS. RUDINGER said she understands that people's consciences may
be in conflict with how tax dollars are spent, and that happens
in many circumstances. She commented that people pay taxes to
the government, elect people who will use the money wisely, and
live with the consequences of how the tax dollars are spent.
Whether people disagree with defense spending or environmental
spending or development of appropriations, that's a consequence
of deciding that there will be government funding of anything
that comes from tax dollars. She noted that elective procedures
are not funded.
Number 2215
CHAIR DYSON agreed that they are trying to define what is
elective. He wondered how to go about restricting public
funding for abortions that are not medically necessary but only
because the presence of the unborn child in inconvenient. He
asked if the ACLU has ever weighed in on protecting an unborn
child under any circumstances.
MS. RUDINGER answered that she doesn't know. She said the ACLU
believes that women have the right to decide whether and when to
bear a child. She said the ACLU would come out strongly against
any measure that took that right away.
TAPE 02-37, SIDE B
Number 2270
MS. RUDINGER reiterated that it is a woman's choice to have that
child.
CHAIR DYSON asked Ms. Rudinger if the ACLU believes that a woman
should be able to terminate the life of a child virtually at any
time during the length of the pregnancy.
MS. RUDINGER replied that is not true. She explained that the
ACLU agrees with the Supreme Court decision in Roe vs. Wade that
as the pregnancy continues, the interest in the state of
protecting the fetus grows, the longer that the fetus is in
development; so, toward the end of the pregnancy, the state does
have a greater interest than in the beginning of the pregnancy.
Number 2217
ROBIN SMITH testified via teleconference. She added her
opposition to the bill, but read the following testimony of DR.
KATHLEEN TODD, Obstetrician/Gynecologist, Valdez Medical Clinic:
I urge you not to pass HB 522, limiting abortion
funding. This bill excludes any consideration of
fetal anomalies as a legitimate reason for abortion,
which I assure you, are high on many women's list of
legitimate reasons for abortion. Should my patient
whose fetus has multiple congenital anomalies
incompatible with life caused by a known exposure to
teratogenic agent be required to carry to term? This
bill also requires an impossibly high burden of proof
to protect the mother's health. We in medical care
are often faced with chances, not certainties. This
bill would require certainty before action was taken,
thus precluding most actions. Abortion and pregnancy
must remain the decision made by individuals who can
assess risk and weigh those risks based on their own
value systems.
In thinking about abortion funding, we need to keep in
mind where fairness lies. Those who argue against
spending government money on abortion as something
they don't believe in, forget that other people also
have deeply held beliefs. It's against my convictions
to knowingly carry to term a grossly deformed baby or
to try to carry septuplets or to endanger my life for
the sake of the fetus. I wouldn't do it, and I wish
that state money wasn't spent on these kind of
pregnancies. However, I don't think the state should
cut off all funding to a woman who doesn't have an
abortion in these circumstances. She might believe
differently than I do. The government needs to stay
neutral, not allowing anyone to impose abortion on
women, including the poor, but likewise not allowing
anyone to impose pregnancy on them.
Number 2117
PAULINE UTTER testified via teleconference on behalf of herself.
She urged the members to stop HB 522 in this committee. She
said she didn't think it was the legislature's business to
define "medically necessary abortion;" that is the physician's
job based on his/her best judgment. She continued her
testimony:
HB 522 is cruel. There is no consideration for severe
fetal anomalies; no consideration if a fetus is dead.
Why should the legislature force any woman to carry
such pregnancies to term? This bill cuts deeply into
the doctor/patient relationship; it sets a precedent.
Do you really want the legislature making health care
decisions for you because you are a person with a low
income? Doctors are being cautious. Doctors are
using Medicaid funds only when it is medically
necessary due to the recent Alaska Supreme Court
ruling. They serve financial consequences if an
abortion is not medically necessary. I don't think it
should be the legislature's job to define what is
medically necessary.
MS. UTTER urged the committee to defeat HB 522 and not pass it
out of the committee.
Number 2068
REPRESENTATIVE WILSON commented that if the fetus is dead, it
would not be considered an abortion.
MS. UTTER indicated that she wasn't sure about that because of a
situation she knew about in which a woman was carrying a fetus
that was brain dead and had to go out-of-state to get an
abortion.
Number 2000
WILLIAM CRAIG made the following comments on medical necessity:
We have individuals in this country who under the
guise of medical necessity could have been aborted.
Stephen Hawking cannot take care of himself. We would
not have his brilliant mind, on the other hand,
following medical necessity. I would disagree a
little bit about the necessity of having legislative
involvement in medical necessity.
Number 1980
CHIP WAGONER, Alaska Catholic Conference, testified that the
conference supports this bill. He suggested that even if this
bill was amended with different words mentioned earlier, those
people would probably still oppose this bill. The issue is not
whether a person has a right to an abortion; the issue is using
limited Medicaid funds to pay for those abortions that are not
medically necessary. He pointed out that the federal Medicaid
funds can only be used for those abortions to protect the life
of the mother or for pregnancies resulting from rape or incest.
The U.S. Supreme Court upheld the federal Hyde Amendment; it
also stated that states need not use their state money to fund
therapeutic abortions. In another case it held that states need
not use their Medicaid funds to fund non-therapeutic abortions.
Number 1915
MR. WAGONER said that half of the states that have looked at
this in their state constitutions have also concluded that
states need not fund those abortions that are not medically
necessary or even medically necessary. Half the states,
including Alaska, New Jersey, Massachusetts, and California,
have looked at their constitutions and concluded that the states
must fund medically necessary abortions. He acknowledged that
no court has said Medicaid dollars must be used to fund elective
abortions. When the Alaska Supreme Court ruled last summer, it
basically threw out the only regulation that dealt with funding
for Medicaid patients. He noted that HB 522 is as close as can
be to be broad enough to include medically necessary abortions
but narrow enough to not include the elective abortions. He
stated that the conference thinks there are elective abortions
currently being paid for with Medicaid funds.
CHAIR DYSON asked what the delta would be between the number of
abortions being done now opposed to how many would be done if
this bill becomes law.
MR. WAGONER replied that he didn't know that for Alaska, but in
Maryland, the number of abortions was cut by about 50 percent
according to one source. He told the committee that abortion is
the only procedure in Medicaid which can be for medically
necessary reasons or for elective reasons. That's why there is
a need to try to differentiate by statute and regulation the
difference.
Number 1764
KATHLEEN STEVENSON testified via teleconference. She told the
committee that she had worked in an office that performed
abortions. She scheduled appointments for people and estimated
that six out of eight patients scheduled each day were Medicaid
patients. She indicated that some of the patients had had one
or two abortions in the past year. She said that she doesn't
have strong feelings one way or another on the abortion issue,
but she said from working there and seeing how many people were
abusing this really disturbed her, and that was the reason she
left that job. She said she was glad to see this bill try to
tighten up some of the loopholes.
Number 1670
CHAIR DYSON asked Ms. Stevenson if she knew how many of the
abortions performed at that clinic were medically necessary.
MS. STEVENSON answered that in the year and a half she worked
there she could only remember two incidents.
CHAIR DYSON asked if there were any women with medical
conditions that would have been dangerous for them.
MS. STEVENSON answered that one of the two incidents she
remembered was due to a medical condition. She noted there were
two people in the office who scheduled the abortions, so there
may have been others.
Number 1566
CHAIR DYSON asked Ms. Stevenson if it was her impression that
[performing abortions] was a fairly remunerative business.
MS. STEVENSON said yes, and she highly respected the doctors and
the people working there.
Number 1436
REPRESENTATIVE CISSNA asked Ms. Stevenson how she would know the
reason for the person's appointment.
MS. STEVENSON replied that the patient would tell her. It
wasn't her job to grill these people; her job was to set up the
appointment. She summarized that the bill is a good idea to
close up the loopholes.
Number 1215
ANNA FRANK, Executive Director, Planned Parenthood of Alaska,
responded to the previous testimony and pointed out that it was
from someone who is not a doctor. She noted that these are
issues that are discussed with a doctor. Before someone can get
approval for Medicaid, she has to speak with a doctor and get a
medical recommendation for the procedure. It is not something
taken lightly by the doctors that Planned Parenthood works with.
Planned Parenthood helps coordinate poor women's need for an
abortion when it is medically necessary, and this happens at
least once a week.
MS. FRANK indicated that the previous testimony also points to
the fact that there is a very serious health care problem in
Alaska; there is not enough prevention care and money for the
poor women to get the prevention they need. For example, a
woman on Medicaid can only get one month's supply of birth
control pills at a time; whereas, someone with her own insurance
can get up to 13 months at a time. So, these women have to go
to a pharmacy every single month to get their pills. She
emphasized that if they live in rural Alaska, it is very
difficult to get to a pharmacy.
MS. FRANK referred to Mr. Wagoner's testimony about more women
getting abortions in Alaska - she's not sure that's true - but
it's probably because there is a huge access problem in Alaska
that needs to be factored into these decisions. With all due
respect to Mr. Wagoner, she said she did hear twice today where
people that are opposed to this bill are in favor of two
compromises. The first was from Dr. Middaugh who said if it
ended on page 1, line 12, it would be an okay bill and would
send a clear message to doctors to make sure that what they're
approving is actually medically necessary. The second was the
difference between "would" and "could" or "might." There are
instances where something "could" affect the pregnancy or health
of a woman, but it is more difficult to determine that it
"would." She agreed if that language were changed, it would
certainly be better.
Number 1038
CHAIR DYSON asked Ms. Frank if she feels that the doctors who
counsel pregnant women try to talk them out of having an
abortion if the child and woman are healthy.
MS. FRANK replied that the choice is up to a woman. Doctors
would not be doing their job by coercing women, but this bill
deals with "medically necessary abortions."
CHAIR DYSON said, so the doctors don't sense that they have two
patients that they have to look after; they're only looking
after and responding to the needs and desires of the one
patient, and there is no voice then for the other patient.
MS. FRANK answered that as Ms. Rudinger pointed out, the later
in the viability of the fetus later on in the gestational
period, the more the state has a compelling interest in the
fetus. Currently in Alaska, she believes that the life and
health of a woman is important.
CHAIR DYSON wondered if the life of that unborn child is
important enough to have doctors advocating for it when those
decisions are being made.
MS. FRANK replied that she didn't know the answer to that
question; she is not a doctor.
Number 0845
REPRESENTATIVE CISSNA commented that she has observed that the
choice to not have a child usually is a health issue. Ms. Frank
agreed with her.
Number 0812
JASON HOOLEY came forward to testify. He informed the committee
that although he is Staff to Representative Fred Dyson, he was
testifying as a citizen and taxpayer today. He stated:
I find it absolutely disgusting that my money would go
to pay for an abortion. I would not object to anyone
having an abortion in this discussion, but I would
object to using my earned money to do that. I would
encourage even stricter restrictions on funding for
abortion.
Number 0767
REPRESENTATIVE CISSNA asked Mr. Hooley how he feels about his
tax money going for systems that don't take care of kids well
when they get taken into foster care or put in children's homes
or things like that. They haven't been adequately funded, so
children get abused; they lose their ability to love and bond,
and they wind up spending their lives in prisons and half-lived
lives.
MR. HOOLEY said he doesn't support his tax money going for any
system that doesn't do a good job.
Number 0695
REPRESENTATIVE CISSNA told the committee that the Association of
Public Administration has a code of ethics that should apply to
the legislators. She shared its four main points: 1. Serve
the public interest; 2. Respecting the constitution and the
law; 3. Demonstrating personal integrity; 4. Striving for
professional excellence. She will get copies to the members.
Number 0379
CHAIR DYSON commented that in his reading of history, every
human rights issue was unpopular. He concluded with, "Those of
us who are wanting to give deference to the life of an unborn
child feel that it is a civil rights battle."
Number 0336
REPRESENTATIVE KOHRING moved to report HB 522 out of committee
with individual recommendations and the accompanying fiscal
notes.
REPRESENTATIVE JOULE objected.
A roll call vote was taken. Representatives Wilson, Coghill,
Kohring, and Dyson voted to report HB 522 out of committee.
Representatives Cissna and Joule voted against it. Therefore,
HB 522 was reported out of the House Health, Education and
Social Services Standing Committee by a vote of 4-2.
SB 182 - PRO RATA REDUCTIONS IN BENEFIT PROGRAMS
Number 0226
CHAIR DYSON referred to CS FOR SENATE BILL NO. 182(FIN), "An Act
requiring reductions in payments to individuals under certain
benefit programs if appropriations are not sufficient to fully
fund the statutorily established levels of payments." He told
the committee there wasn't time to craft amendments today, but
asked them to look at the proposed amendments to see if there is
something helpful to put together. [SB 182 was held over]
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:38 p.m.
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