02/27/2003 03:04 PM House HES
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+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
February 27, 2003
3:04 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Cheryll Heinze
Representative Paul Seaton
Representative Kelly Wolf
Representative Sharon Cissna
Representative Mary Kapsner
MEMBERS ABSENT
Representative Carl Gatto, Vice Chair
COMMITTEE CALENDAR
CONFIRMATION HEARINGS
PROFESSIONAL TEACHING PRACTICES COMMISSION
Lawrence Lee Oldaker - Auke Bay
Craig Baker - Kodiak
Vivian Dailey - Fairbanks
Kimberly Jockusch - Anchorage
- CONFIRMATION(S) ADVANCED
HOUSE BILL NO. 25
"An Act relating to health care decisions, including do not
resuscitate orders and the donation of body parts, and to powers
of attorney relating to health care, including the donation of
body parts; and providing for an effective date."
HEARD AND HELD
PREVIOUS ACTION
BILL: HB 25
SHORT TITLE:HEALTH CARE SERVICES DIRECTIVES
SPONSOR(S): REPRESENTATIVE(S)WEYHRAUCH
Jrn-Date Jrn-Page Action
01/21/03 0038 (H) PREFILE RELEASED (1/10/03)
01/21/03 0038 (H) READ THE FIRST TIME -
REFERRALS
01/21/03 0038 (H) HES, JUD, FIN
02/13/03 (H) HES AT 3:00 PM CAPITOL 106
02/13/03 (H) Heard & Held
02/13/03 (H) MINUTE(HES)
02/27/03 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
LAWRENCE LEE OLDAKER, Appointee
to the Professional Teaching Practices Commission
Auke Bay, Alaska
POSITION STATEMENT: Testified as appointee to the Professional
Teaching Practices Commission.
CRAIG BAKER, Appointee
to the Professional Teaching Practices Commission
Kodiak, Alaska
POSITION STATEMENT: Testified as appointee to the Professional
Teaching Practices Commission.
VIVIAN DAILEY, Appointee
to the Professional Teaching Practices Commission
Fairbanks, Alaska
POSITION STATEMENT: Testified as appointee to the Professional
Teaching Practices Commission.
KIMBERLY JOCKUSCH, Appointee
to the Professional Teaching Practices Commission
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Professional
Teaching Practices Commission.
REPRESENTATIVE BRUCE WEYHRAUCH
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As sponsor of HB 25, provided background
information and explained amendments to the committee.
LINDA SYLVESTER, Staff
to Representative Bruce Weyhrauch
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented amendments to CSHB 25, Version D,
and answered questions from the committee.
JENS SAAKVITNE, Director
Life Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of Amendment 3 to CSHB
25, Version D, and answered questions from the committee.
MARIA WALLINGTON, M.D., Ethicist
Providence Health Systems
Anchorage, Alaska
POSITION STATEMENT: Asked questions about CSHB 25, Version D,
expressed concerns, and answered questions from the committee.
RICHARD BLOCK
Christian Science Committee on Publications
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 25.
RON COWAN, Long Term Care Ombudsman
Mental Health Trust Authority
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 25 and suggested
any fine-tuning can be done in the next committee of referral.
MARGUERITE STITSON
AARP
Anchorage, Alaska
POSITION STATEMENT: Testified during hearing on HB 25 in
support of advance directives.
ROGER BRONSON, Executive Director
Alaska Mental Health Consumer Web
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 25, suggesting
any changes can be addressed in the next committee of referral.
EDIE ZUKAUSKAS, Attorney
Disability Law Center of Alaska, Inc.
Anchorage, Alaska
POSITION STATEMENT: Testified in support of CSHB 25, Version D,
and answered questions from the members.
SIOUX DOUGLAS
Hospice and Home Care of Juneau
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 25.
MARIE HELM
Juneau, Alaska
POSITION STATEMENT: Testified in support of CSHB 25, Version D.
CAROLE EDWARDS, R.N., Member
Legislative Committee, Alaska Nurses Association
Juneau, Alaska
POSITION STATEMENT: Testified in conceptual support of CSHB 25,
Version D; expressed concerns and answered questions from the
committee.
MARK JOHNSON, Chief
Community Health and Emergency Medical Services
Division of Public Health
Department of Health and Social Services
POSITION STATEMENT: Testified on CSHB 25, Version D, and
answered questions from the committee.
RICHARD RAINERY, Executive Director
Alaska Mental Health Board
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified in support of CSHB 25, Version D,
and offered suggested changes.
ROSALIE WALKER, President
Juneau Chapter of AARP;
Board Member, Older Persons Action Group (OPAG)
POSITION STATEMENT: Testified about the importance of HB 25 and
encouraged the committee to continue to work on it.
MARIE DARLIN
Capitol City Task Force, AARP
Juneau, Alaska
POSITION STATEMENT: During hearing on HB 25, said she is glad
the committee is taking time to ensure that it is done
correctly.
ACTION NARRATIVE
TAPE 03-19, SIDE A
Number 0001
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:04 p.m.
Representatives Wilson, Wolf, Heinze, Seaton, Cissna, and
Kapsner were present at the call to order. Representative Gatto
was excused from committee due to illness.
CONFIRMATION HEARINGS
Professional Teaching Practices Commission
Number 0120
CHAIR WILSON announced that confirmation hearings for the
appointees to the Professional Teaching Practices Commission
would be taken up as the first order of business.
Number 0139
LAWRENCE LEE OLDAKER, Appointee, to the Professional Teaching
Practices Commission, gave a brief history of his professional
career. He said he is currently a professor emeritus at the
University of Alaska Southeast, and has completed a three-year
tenure on the Professional Teaching Practices Commission,
currently serving as the chairman. Mr. Oldaker told the
committee his experience as a school superintendent and work in
guiding leadership programs that train principals and
superintendents have made him keenly aware of legal and ethical
responsibilities of educators. He said he taught a law class
and has always tried to focus on legal and ethical
responsibilities. Mr. Oldaker said he believes his service on
the commission is a logical extension of those academic and
professional experiences he has had.
Number 0225
REPRESENTATIVE KAPSNER made a motion to advance the confirmation
of Lawrence Lee Oldaker, appointee to the Professional Teaching
Practices Commission, to the joint session for consideration.
There being no objection, the confirmation of Lawrence Lee
Oldaker was advanced.
Number 0350
CRAIG BAKER, Appointee to the Professional Teaching Practices
Commission, testified via teleconference and gave a brief
history of his professional career. He told the committee he
has been teaching at Kodiak High School for 19 years. Mr. Baker
said it an honor to be appointed to the commission, and he looks
forward to the opportunity to uphold the ethics of his
profession.
Number 0406
REPRESENTATIVE WOLF asked Mr. Baker if he believes serving on
the commission would hamper his ability to be a good teacher.
Number 0441
MR. BAKER responded that he does not see it as a hindrance to
teaching, but rather an enhancement. He told the committee that
he has already attended meetings and feels he has learned a
great deal about the commission.
Number 0472
REPRESENTATIVE CISSNA made a motion to advance the confirmation
of Craig Baker, appointee to the Professional Teaching Practices
Commission, to the joint session for consideration. There being
no objection, the confirmation of Craig Baker was advanced.
Number 0534
VIVIAN DAILEY, Appointee to the Professional Teaching Practices
Commission, testified via teleconference and gave a brief
history of her professional career. She told the committee she
is currently the principal of North Pole High School, where she
has served for the past seven years. Ms. Dailey said that she
would like to serve on the commission to continue to promote
ethics among educators in Alaska. She said she feels it is
important to have a principal on the commission and she is
pleased to serve in that role.
Number 0605
REPRESENTATIVE HEINZE made a motion to advance the confirmation
of Vivian Dailey, appointee to the Professional Teaching
Practices Commission, to the joint session for consideration.
There being no objection, the confirmation of Vivian Dailey was
advanced.
Number 0644
KIMBERLY JOCKUSCH, Appointee to the Professional Teaching
Practices Commission, testified via teleconference and gave a
brief history of her professional career. She told the
committee that she has been teaching in the Anchorage School
District for 15 years. Ms. Jockusch said that she feels
educators should adhere to the highest standards. She feels it
is important that the commission monitor the teaching
profession, work proactively with new teachers, and sanction
teachers when there is a problem.
Number 0704
REPRESENTATIVE SEATON asked if there is a mentoring role in the
Professional Teaching Practices Commission.
Number 0727
MS. JOCKUSCH replied that she does not believe there is a
mentoring component in the commission because its role is to
look at ethical behaviors of teachers. However, Ms. Jockusch
said that she believes mentoring is a critical part of what
districts are doing around the state.
Number 0752
REPRESENTATIVE WOLF asked what "Box it, Bag it Mathematics" is.
Number 0766
MS. JOCKUSCH responded that it is a way of putting together
materials to teach mathematics. It is a hands-on method of
learning mathematics. The program was done in Anchorage about
10 years ago.
Number 0779
REPRESENTATIVE SEATON made a motion to advance the confirmation
of Kimberly Jockusch, appointee to the Professional Teaching
Practices Commission, to the joint session for consideration.
There being no objection, the confirmation of Kimberly Jockusch
was advanced.
HB 25-HEALTH CARE SERVICES DIRECTIVES
Number 0839
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 25, "An Act relating to health care decisions,
including do not resuscitate orders and the donation of body
parts, and to powers of attorney relating to health care,
including the donation of body parts; and providing for an
effective date."
Number 0849
REPRESENTATIVE BRUCE WEYHRAUCH, Alaska State Legislature, told
the committee he has appreciated working on this bill with
Representatives Heinze, Seaton, and Cissna, their staff,
professionals in the mental health and disability groups,
hospital sectors, and senior citizens groups. He told the
committee a lot of good comments and feedback have come in, and
what he has found through the course of those discussions is
that there are a lot of passionate, interested people working on
the issues.
REPRESENTATIVE WEYHRAUCH said he has a number of amendments to
this bill that he would like to bring before the committee. He
also pointed out that the bill has been referred to the House
Judiciary Standing Committee.
Number 1013
CHAIR WILSON announced that the procedure the committee will
follow in hearing bills is as follows: first, the sponsor of
the bill will introduce and explain the legislation; second,
professional testimony will be taken; third, public testimony
will be taken; fourth, questions will be taken from the
committee [because many times the questions members might have
will be answered in the course of the hearing]; and finally, the
committee will take up amendments. In this case, however, Chair
Wilson said since Representative Weyhrauch is the sponsor, the
committee will take those amendments whenever he is ready to
present them.
Number 1061
CHAIR WILSON moved to adopt CSHB 25, Version 23-LS0137\D
Bannister, 2/27/03, as a work draft. There being no objection,
Version D was brought before the committee.
REPRESENTATIVE WEYHRAUCH told the committee that this bill
brings into one [section in statute] end-of-life health care
decisions. The bill deals with powers of attorney for making
health care decisions, decisions relating to body parts
distribution, and end-of-life care and non-care decisions. The
bill addresses who can make those decisions for an individual if
they are incapacitated. It was designed to bring under one roof
the kind of decisions that individuals are faced with making at
end-of-life for loved ones. Representative Weyhrauch said that
a lot of this has been discussed at the previous hearing so he
said he would keep his comments brief.
Number 1151
REPRESENTATIVE SEATON asked for a synopsis of the changes in
this bill.
REPRESENTATIVE WEYHRAUCH provided a conceptual review of the
changes. He said most of the changes he is suggesting have come
about as a result of discussions with Dr. Maria Wallington,
medical ethicist for Providence Health Care System and the
Disability Law Center. He said he also tried to address
questions that were raised by Representatives Cissna and Heinze
at last week's meeting.
Number 1305
CHAIR WILSON asked if those changes are already in Version D.
REPRESENTATIVE WEYHRAUCH responded that the changes are in the
proposed committee substitute. He pointed out that there are
some amendments from Representative Cissna and Life Alaska on
the tissue-and-organ donation portion of the bill.
CHAIR WILSON asked the sponsor if he would like to present the
amendments at this time so those testifying will know what the
final bill will look like.
REPRESENTATIVE WEYHRAUCH presented Conceptual Amendment 1 and
asked if Linda Sylvester [staff assistant to Representative
Weyhrauch] would join him in presenting the amendment.
Conceptual Amendment 1 read [original punctuation provided]
Page 4, Line 20
Following (a)
Insert "except in the case of mental illness."
Other conforming amendments within Section
13.52.030, eliminating references to surrogates for
mental healthcare directives.
Number 1366
LINDA SYLVESTER, Staff to Representative Bruce Weyhrauch, said
that the amendment is important because in general terms the
health care directive creates an agent, which is a person who
has power of attorney for someone's health care, and also
creates a group of people called surrogates. This bill would
legally recognize surrogates and the hierarchy whereby the
surrogates are selected from a family order. She told the
committee there was some consideration given to including mental
health care groups in this section of the bill whereby an
individual can have a surrogate for mental health care.
However, based on conversations with Edie Zukauskas from the
Disability Law Center, the decision was made to completely
exempt mental health care from surrogates. Ms. Sylvester said
if an individual is going to be acting on behalf of another who
is mentally ill, that individual will have to be the mentally
ill person's guardian [who is appointed by the courts] or agent
[having power of attorney].
REPRESENTATIVE WEYHRAUCH told the committee it is important to
note that becoming a guardian for someone with mental illness
takes an extensive court procedure with a full plan of due
process rights in a court of law, with a court finding. He told
the committee that is an important consideration because that
does not happen easily.
Number 1446
REPRESENTATIVE SEATON moved to adopt Conceptual Amendment 1
[text provided previously]. Without objection, Conceptual
Amendment 1 was adopted.
REPRESENTATIVE WEYHRAUCH presented [Conceptual] Amendment 2,
which read [original punctuation provided]:
Page 5, Line 22
Following "decision."
Insert "and the primary physician makes the decision
based upon the best interest of the patient."
MS. SYLVESTER told the committee Dr. Wallington, an ethicist for
Providence Health System, was concerned with the situation when
surrogates are in conflict. She told the committee when there
is disagreement over medical care, generally the majority rules;
however, if the surrogates are evenly divided, then the entire
group of surrogates are disqualified. Dr. Wallington was
concerned that in this case it left no one to make decisions in
the best interest of the patient. Ms. Sylvester said that the
intention was to treat those surrogates as so conflicted; the
situation is so volatile, it is time to look outside that group,
and the decision reverts to the doctor. Some hospitals have
procedures whereby this actually reverts to an ethics committee.
There are mechanisms in place to handle these conflicts; this
language makes it crystal clear that the decision goes back to
the doctor. Ms. Sylvester told the committee this amendment is
based on the recommendation of Dr. Wallington, and they believe
this amendment clears that confusion.
Number 1610
REPRESENTATIVE HEINZE asked if the physician would then go to an
ethics committee or if he/she has the ultimate power.
MS. SYLVESTER replied that hospitals have different ways of
dealing with that kind of situation. She told the committee in
the real world the doctor is going to be making these decisions.
The amendment will give the doctor the legal right to make the
decision in the best interest of the patient.
REPRESENTATIVE HEINZE asked if the doctor is required to go to
an ethics committee, or if the physician can make that decision
without going to an ethics committee.
CHAIR WILSON clarified that each hospital will make its own
policy and the doctor will proceed based on what the hospital's
rules are.
Number 1629
REPRESENTATIVE SEATON moved to adopt Amendment 2 [text provided
previously]. Without objection, Amendment 2 was adopted.
Number 1638
CHAIR WILSON announced the committee will take a brief at-ease
at 3:35 p.m. The chair reconvened the meeting at 3:38 p.m.
REPRESENTATIVE WEYHRAUCH began discussion of what he was
offering as Amendment 3. He asked the committee to look at the
cover letter and attached suggestions from Life Alaska [a tissue
and organ donor organization]. The suggestions, titled
"Analysis of Current Uniform Anatomical Gift Act," in essence
were as follows, with Life Alaska's written comments given in
parentheses; Amendment 3, an inexact copy of the statutes
themselves with strikethroughs and nonstandard insertions, in
essence did what is shown below each recommendation in brackets:
Recommended deletions:
AS 13.50.014 (Requests by hospitals for anatomical
gifts)
[Deleted by Amendment 3]
AS 13.50.016(b) (Exemptions - none)
[Deleted by Amendment 3]
AS 13.50.020 (Potential donees and purposes for which
anatomical gifts may be made)
[Deleted by Amendment 3]
AS 13.50.030(d) (Designate donor surgeon - never
needed)
[Deleted by Amendment 3]
AS 13.50.030(f) (Covered elsewhere - sample form)
[Deleted by Amendment 3]
AS 13.50.050 (Allows for revocation - covered by new
House Bill 25)
[Deleted by Amendment 3]
AS 13.50.065 (Covered by feds)
[NOT deleted by Amendment 3]
AS 13.50.080 (Uniform - general purposes)
[Deleted by Amendment 3]
AS 13.50.090 (Short title)
[Deleted by Amendment 3]
Recommended additions:
Add to AS 13.050.016(a): "Call hosp. or donor
program" (Add teeth)
[Amendment 3 added "or donor program" after "inform
the appropriate hospital"]
Add to AS 13.50.030(e): "witnessed telephonic
consent"
[Subsection (e) in Amendment 3 read, "A gift by a
person designated in AS _____________ shall be made by
a document signed by the person or made by the
person's telegraphic, recorded telephonic, or other
recorded message."]
MS. SYLVESTER explained the recommendations. She said Life
Alaska had done an analysis of existing statute and had made
recommended revisions to the Uniform Anatomical Gift Act in
current statute. A lot of the provisions are in HB 25, but some
are left out and some need improvement. Jens Saakvitne of Life
Alaska did the analysis. HB 25 previously did not include a
section where law enforcement is supposed to do an investigation
on an accident victim's driver's license or on the individual's
person to see if there is an anatomical gift card. She told the
committee it does not have teeth in it, and it is not a
misdemeanor if law enforcement does not do it, but it does
result in a lot of good information. A lot of donors are donors
as a result of an accident outside of the hospital. Law
enforcement will need to call the hospital to bring this to its
attention and call the donor organization. She told the
committee Mr. Saakvitne is available on line to answer questions
from the members.
Number 1789
REPRESENTATIVE CISSNA asked if Amendment 3 is a draft of
existing law.
MS. SYLVESTER replied that the committee is looking at the
actual statute, the [Uniform Anatomical Gift Donation Act]. She
said she struck out the language that is going to be eliminated.
For example, it is not necessary to have a surgeon sign
anything, because there are other mechanisms that have taken
place over the years with hospitals to ensure that these things
happen. Ms. Sylvester told the committee that this conceptual
amendment uses the original text of the Uniform Anatomical Gift
Act. She said this language would be merged into HB 25 where
appropriate. Another example of language that is eliminated is
where the sample form is removed because this information
already exists in HB 25.
Number 1886
JENS SAAKVITNE, Director, Life Alaska, told the committee the
original statute of the Uniform Anatomical Gift Act that Alaska
adopted was passed by all 50 states and for many years has been
considered the "gold standard." However, Amendment 3 updates a
number of points which are needed. He said a typical organ
donor tends to be a younger person in good health until a
catastrophic event occurs, and those are the people who are
least likely to have an advance directive. In Amendment 3 there
is language from the Uniform Anatomical Gift Act that would lay
out a system of donation and clarify who would make that choice,
if there is no directive in place.
CHAIR WILSON asked Mr. Saakvitne if Amendment 3 inserts language
in CSHB 25, Version D, that would include forms that are
normally signed by individuals when they are admitted into the
hospital.
MR. SAAKVITNE replied that 90 percent of the people going into
the hospital who end up being organ donors are brought into the
hospital in a comatose state. Probably 50 percent of the tissue
donors do not go into the hospital at all or are brought in dead
on arrival, so there is no opportunity for a patient or patients
to sign a directive, unless he/she has done it before hand. Mr.
Saakvitne said in 20 years, the majority of people will have a
directive signed, but right now, it is a very small percentage.
Number 1967
REPRESENTATIVE CISSNA said Terry Bannister with Legislative
Affairs Legal Services expressed concern that it takes time to
put amendments together and assure the correct language is
included. She said if the changes are substantial it could take
a week or two to build the language. Representative Cissna said
it is important to have individuals testify on this specific
amendment who could help the members understand the implications
of it based on their experiences and the effect it would have on
people and organizations across the state. Representative
Cissna expressed concern in changing existing law without a
thorough review of its impact.
CHAIR WILSON replied that the next committee of referral [the
House Judiciary Standing Committee] will address the
implications of this law.
REPRESENTATIVE CISSNA told the committee that the next committee
of referral is the same committee that did wholesale repealing
of language last year. She said that the bill that is before
the committee now is actually the bill that went through the
House Judiciary Standing Committee last year.
CHAIR WILSON replied that if they have done this in the past,
they will be much more familiar with it than the Health,
Education and Social Services Committee.
Number 2079
REPRESENTATIVE CISSNA replied that this information is of
special interest to the people whom the Health, Education and
Social Services Committee serves. It is health issues. The
House Judiciary Standing Committee deals with judicial issues.
Number 2095
MARIA WALLINGTON, M.D., Ethicist, Providence Health System,
asked if the current bill requires hospitals to ask for
donations. Currently, Alaska is one of the best states in
requiring donation requests.
MR. SAAKVITNE responded that it is not in the language because
the federal government already demands that through its
conditions of participation. It is mandated by federal law.
MR. SAAKVITNE said he wanted to point out one other important
aspect of the amendment in the Uniform Anatomical Gift Act [AS
13.05.060], which guarantees to the decedent's family that there
is no cost associated with donations. He said he feels it is
important that this is in writing. Another part that he feels
is important is the guarantee of separation, which says that the
physician who is responsible for pronouncing someone dead,
cannot be involved in the donation or surgery of the organ that
is transplanted. In some form or other it is crucial to have
those safety mechanisms built in.
Number 2173
REPRESENTATIVE SEATON asked if the modifications being discussed
would make Alaska out of step or out of compliance with the
Uniform Anatomical Gift Act. He asked if this change would
create problems between states.
MR. SAAKVITNE responded that the amendment would keep Alaska
Statute very much in step with the Uniform Anatomical Gift Act.
He said the amendment would not be different from what other
states have.
Number 2190
REPRESENTATIVE SEATON moved to adopt Amendment 3 [explanation
provided previously].
Number 2200
REPRESENTATIVE KAPSNER told the committee that she does not wish
to object; however, she is concerned that the committee is
considering action on an amendment of this magnitude without
having had time to thoroughly review it.
Number 2250
CHAIR WILSON told the committee Amendment 3 will be set aside,
and asked the sponsor to provide the amendment in a format that
is normally provided to the committee [through Legislative
Affairs Legal Services].
Number 2290
REPRESENTATIVE SEATON withdrew his motion to adopt Amendment 3.
Representative Seaton told the committee he wanted to see the
amendment integrated into the bill.
REPRESENTATIVE WEYHRAUCH said he would be happy to have
Legislative Affairs Legal Services provide this as either an
amendment or as a sponsor substitute, whichever the chair
prefers.
CHAIR WILSON said the committee will make that decision after
all amendments have been presented.
REPRESENTATIVE WEYHRAUCH began discussion of Amendment 4 and
told the committee the last amendment he received was from
Representative Cissna. He asked if he should present it or if
Representative Cissna would prefer to do it. In response to
Chair Wilson's inquiry as to whether the amendment is a friendly
amendment, he responded that part of it is and part he would
like to discuss.
Number 2331
CHAIR WILSON told the committee that she would take testimony of
the CSHB 25 [Version D] while copies are made of Amendment 4.
TAPE 03-19, SIDE B
Number 2324
RICHARD BLOCK, Christian Science Committee on Publications,
testified via teleconference in support of HB 25. He said that
since he does not have a copy of CSHB 25 [Version D] in front of
him, he could not speak to that version of the bill. He said
that the Christian Science Committee on Publications' greatest
concern is for individuals to have the ability or freedom to
make his/her own choices with respect to health care. Of
particular interest to them is a new proposed section in the
bill, Sec. 13.52.010, which introduces the chapter on health
care decisions that provides for an advance health care
directive. He said their concern is for those who might like to
rely exclusively on prayer for healing. In this section
individuals can set out how he/she wishes health care be
provided and who can or should be designated as the agent for
making health care decisions when the individual is no longer
able to make them for himself/herself. Mr. Block said the
Christian Science Committee finds that to be beneficial because
it provides freedom and places the decision making where it
really belongs, and that is with the person himself [or
herself]. He said the sponsor asked that he be available to
answer any questions from the committee. He said he has not
heard anything discussed about the adoption of a model bill that
was offered sometime ago. The model offers the protections the
Christian Science Committee is looking for.
Number 2218
REPRESENTATIVE KAPSNER asked Mr. Block what section he was
referring to.
MR. BLOCK replied it was Sec. 13.52.010. This section provides
for an individual to select who would make health care decisions
and specifically what that individual would want if not able to
make those decisions himself/herself. Mr. Block said there are
other sections of interest that come later [in the bill] where
there is no advance directive and there is a selection of a
surrogate. The bill allows for individuals to write down what
health care he/she would like under certain circumstances and
whom they nominate as their agent for making health care
decisions on their behalf.
CHAIR WILSON thanked Mr. Block for being available and calling
from Paris, France.
REPRESENTATIVE CISSNA noted that her staff member, Andy
Josephson, had worked on Amendment 4 with Legislative Affairs
Legal Services staff, Terry Bannister. Representative Cissna
told the committee the amendment is a conceptual amendment and
that it took about a week to research and put together. Some of
the amendment pertains to the Uniform Anatomical Gift Act in law
right now, and some includes language for Title 47 that would be
repealed and was repealed by the House Judiciary Standing
Committee in last year's bill.
Number 2038
REPRESENTATIVE WEYHRAUCH asked if the chair would hold Amendment
4 until Amendment 3 has been heard.
REPRESENTATIVE SEATON clarified that Amendment 4 is to the
original bill, not the proposed committee substitute.
Number 2007
CHAIR WILSON said that she will be setting aside Amendments 3,
4, and 5 [by request of the sponsor]. Chair Wilson asked
Representative Weyhrauch, the sponsor, to work with Legislative
Affairs Legal Services and bring back a committee substitute
that incorporates Amendment 1 and 2, and an amendment that
includes Amendment 3.
CHAIR WILSON announced that the committee would proceed with
testimony on the bill.
Number 1883
RON COWAN, Long Term Care Ombudsman, Mental Health Trust
Authority, Department of Revenue, testified via teleconference
in support of HB 25. He told the committee he believes whatever
fine-tuning needs to be done can be done in the House Judiciary
Standing Committee. He supports the efforts being made not only
this year but last year as well.
Number 1831
MARGUERITE STITSON, AARP, testified via teleconference in
support of advance directives, speaking on her own behalf as
well. She told the committee she and her husband filled out an
advance directive over 10 years ago. Last year her husband
passed away while they were in another state. She said the
first thing the doctor asked her for was an advance directive
because her husband had bleeding on the brain and there was no
hope of recovery. She told the committee since she did have the
advance directive, she knew what he wanted, and it made it
easier on everyone. She said she wanted to express the
importance of having an advance directive.
Number 1799
ROGER BRONSON, Executive Director, Alaska Mental Health Consumer
Web, testified via teleconference in support of HB 25. Mr.
Bronson stated that he believes the bill is a good one and any
changes that need to be made can be adequately addressed in the
House Judiciary Standing Committee.
CHAIR WILSON told Mr. Bronson he might contact Representative
Weyhrauch, since there will be time to address concerns of the
bill before it is heard again.
Number 1762
DR. WALLINGTON asked whom she should talk with concerning
patients who suffer from depression, for example, in a case
where a patient is now unconscious and a doctor needs someone to
help make decisions for them. She said she is concerned that
physicians will be handicapped if it will be necessary to go to
court to appoint a guardian to make decisions for someone who
has had mental health problems in the past.
CHAIR WILSON said she believes most people who suffer from
mental illness have a guardian.
DR. WALLINGTON said there are many people who have forms of what
she would call mental illness, but which would not be considered
mental illness by the state. She said, for example, if an
individual has had situational depression or may have seen a
psychiatrist a few times, that does not mean that he/she cannot
carry on life independently.
Number 1691
REPRESENTATIVE WEYHRAUCH asked Dr. Wallington to clarify her
question.
DR. WALLINGTON gave an example when an individual is in a car
accident, the individual is unconscious with a brain injury, and
someone is needed to make decisions on his/her behalf. If the
individual does not have a mental health directive or an advance
directive, then there is a surrogate possibility after HB 25
becomes law. However, she said her understanding is that the
amendment pertaining to mental health concerns will require that
someone with mental health issues have either a guardian or two
physicians in determining their incapacity. She said she would
like to know what qualifies as a mental illness under this law.
Number 1567
REPRESENTATIVE WEYHRAUCH replied that he would like to have the
amendment drafted and have Dr. Wallington take a look at it to
see if it addresses her concerns.
Number 1567
EDIE ZUKAUSKAS, Attorney, Disability Law Center of Alaska, Inc.
("Disability Law Center"), said the Disability Law Center is not
trying to prevent medical treatment. The issues the law center
has in repealing the current statute are to assure that if
someone with mental health issues loses capacity, that the
treatment is done in a proper way. She said she would be happy
to talk to Dr. Wallington on this issue in another forum.
MR. JOSEPHSON commented that he is hearing good discussion on
this issue. He said one of the concerns Representative Cissna
had with the original bill was the repeal of existing law that
requires separate perspective for people with mental health
issues.
Number 1480
SIOUX DOUGLAS, Hospice and Home Care of Juneau, testified in
support of HB 25. She also spoke in support of the bill based
on her personal experiences in losing six close family members
in the last four years. Four of those deaths clearly
demonstrated the value of an advance directive. She said this
bill allows people to have a detailed directive, encourages
individuals to die with dignity, and to care for those loved
ones very much in the way that these individuals wish to be
cared for. This bill encourages people to plan ahead and
therefore prevents very difficult last minute decisions. Even
if individuals are in a dying state and are mentally very clear,
that is still a very tough time to explain to loved ones what an
individual wants. She told the committee that this bill is the
same as last year's bill, and urged the members to pass this
legislation. Ms. Douglas told the committee she was very
impressed with the members' willingness to allow this bill to be
even more comprehensive. She encouraged the members to clean up
all the statutes and not be afraid to repeal what is needed.
Number 1299
MS. DOUGLAS said that her husband, whom she married last year,
lost his wife to sudden death and had to make the decision about
donating her organs hours later. It was a tough emotional thing
to do, even though he and his wife had discussed this.
MS. DOUGLAS told the committee the Juneau End of Life Task Force
was formed a couple of years ago, after Bill Moyer's special on
television on death and dying in America. A whole momentum
developed across America, because people discovered that dying
is part of living. In Juneau, there was a town meeting where
individuals learned a lot about how much people care about this
issue, but had not been able to talk about it before. It makes
it easier for people to find, in one place in law, what an
individual can do, and it encourages them to do it in a very
compassionate way. She urged the members to pass this bill out
of committee.
Number 1203
MARIE HELM spoke on behalf of herself and family. She told the
committee that she has been a resident of Alaska [Juneau] for
the last 20 years. Ms. Helm explained that the importance of
advance directives recently hit home for her. She said she lost
her mother-in-law earlier this month. She learned a great deal
from that experience, as her mother-in-law had been in fragile
health for a long time, and had been in various hospitals. In
each hospital the atmosphere was very different. She said in
each hospital the administration, the physicians, and the staff
were working up to their highest sense of what was right and how
they could best serve the needs of the patient. However, the
end result for the family and the patient could be very
different.
MS. HELM said for example, in a hosptial in the state of
Washington the family's wishes were irrelevant. They [hospital
staff and physicians] really did not want to know what the
family felt or what was wanted. In fact, even what the patient
wanted was not particularly relevant to them. They felt they
knew best in this situation and wanted to be free to follow
their own wishes. In another hospital, the physicians and the
staff were extremely supportive. She said that was the
situation they were in when her mother-in-law passed on. Ms.
Helm said they were so grateful that they could speak with
hospital staff and physicians and be heard, not in a patronizing
way, but in a way that gave dignity in the last moments of her
mother-in-law's life. To have the opportunity to have things
the way she wanted at the end of her life was very important.
Ms. Helm said that as people live their lives with dignity, it
is important to leave with a sense of dignity. Ms. Helm thanked
the committee for the work they are doing.
Number 1060
CAROLE EDWARDS, Member, Legislative Committee, Alaska Nurses
Association, testified in support of HB 25 [Version D]. She
told the committee she is an oncology nurse and deals with death
and dying. Ms. Edwards told the committee the association
conceptually supports this bill. The association thinks it is
great to have everything in one place because often nurses are
the ones who are between the family, the physician, and the
patient.
MS. EDWARDS said the association has two questions or concerns.
Under Sec. 13.52.050, which deals with obligations of health
care providers, under (g)(3) [page 7, line 28] if the facility
does not comply with the wishes of the individual, the facility
must immediately make all efforts to transfer the patient to a
facility that will comply. In most areas in Alaska there is
only one provider. It is not always easy to transfer an
individual who is dying. She asked the committee to keep that
in mind as they are amending the bill. She said another concern
along with this is who would pay for the transfer if the
hospital does not go along with what the family wants. She
believes that insurance companies will not be too quick to pay.
She asked the committee to address this in some way.
DR. WALLINGTON commented on the above-mentioned section, saying
she believed it would be inappropriate to ask the hospital to
pay for transportation for people who want something other than
standard care. She said that she cannot see anyone asking a
physician to do something the physician would not do, unless it
was something illegal, for instance, assisted suicide.
CHAIR WILSON said that her interpretation is that health care
professionals assist the patients in making plans for transfer,
including preparations for a move, making calls, and other
details that would be helpful.
DR. WALLINGTON agreed that the hospital cannot abandon a patient
because he/she does not want to stay there.
Number 0779
MS. EDWARDS said she had an experience sometime ago, when she
had a patient that was dying and had spoken with the family, who
did not want the patient resuscitated. The physician who was
the primary care provider at that time was not comfortable
writing DNR [Do Not Resuscitate] orders. Therefore, nurses were
required to go charging in and resuscitate a terminally ill
cancer patient, whose family did not want him resuscitated. It
was a most difficult situation. This physician was always
uncomfortable writing DNR orders. She said her next question is
about Sec. 13.52.060(d) [page 8], regarding an oral order for
DNR from the physician. The bill says an oral or written order
can be taken; however, Bartlett [Regional] Hospital ("Bartlett")
requires a written order. There needs to be some thought to
that issue. The nurses are caught in the middle. She told the
committee the doctor is required to come into Bartlett and make
a written order because it is the most important order a
physician will ever give.
0507
REPRESENTATIVE KAPSNER asked if a required written order would
make it more difficult for telemedicine, particularly in rural
areas.
MS. EDWARDS replied that remote communities may want to have
some input on this, especially in areas that do not have a
physician present. Alaska has very unique situations and needs
to deal with things on a very different level than the rest of
the country.
REPRESENTATIVE KAPSNER said she can see hospitals' concern, but
not all Alaskans work under those conditions all the time.
MS. EDWARDS asked if it would be possible to provide that DNR
orders be either written or oral, depending on the facilities'
requirements.
Number 0467
MARK JOHNSON, Chief, Community Health and Emergency Medical
Services, Division of Public Health, Department of Health and
Social Services, testified that this is the section he is most
interested in. The way he reads the bill, he does not think
this precludes Bartlett Regional Hospital from having a written
requirement. He said what this language does is allow for the
flexibility that Representative Kapsner is alluding to. In a
state like Alaska there are circumstances that are going to
occur that are not in a hospital situation. He believes this
does not say that Bartlett has to allow oral orders, but he said
he is not a legal expert.
Number 0391
REPRESENTATIVE SEATON said he believes the language needs
clarity and it can be done in an amendment. He said he does not
want to put the nurses in a position where they have to obey the
law and violate the hospital's standard of care.
MS. EDWARDS said she has had arguments with doctors in the
middle of the night telling her to write the order, and her
saying, "I can't."
CHAIR WILSON said she believes the institution's rules would
cover the nurse in an instance like that.
MS. EDWARDS told the committee of her minor son who wanted to be
an organ donor when he got his driver's license because his
father and she are donors. However, he was not allowed to be an
organ donor because he was a minor. She told the committee that
kids that age are the primary donors. There should be some
mechanism considered for minors who want to donate and whose
parents approve of that to allow them to be donors. She said
the nurses association is supportive of this legislation.
Number 0194
RICHARD RAINERY, Executive Director, Alaska Mental Health Board,
Department of Health and Social Services, gave a couple of brief
comments about the bill. He wants the committee to know they
support HB 25. The concerns he has have been discussed with the
sponsor and stem from the fact that the bill repeals the Mental
Health Treatment Declaration, a law that was adopted in Alaska
in 1996. When this passed it was a result of grassroots
consumer efforts, and put Alaska on the forefront in protecting
consumer rights. He said the board's concern is that
protections currently in law are maintained. This would address
some of Dr. Wallington's concerns, he suggested, and also
protect some other decision-making conventions in the mental
health field. The board has communicated those issues with the
sponsor's office, and virtually all of them are addressed in the
proposed CS and the amendments adopted today. There are just a
couple left, and the board will make sure those points are
discuss with the sponsor before the bill is heard again.
Number 0077
ROSALIE WALKER, President, Juneau Chapter of AARP; Board Member,
Older Persons Action Group (OPAG), testified that both
organizations have been involved with this bill since its
conception two years ago. She said they have worked very
closely with the original sponsor, and continue to work closely
with the current sponsor by offering the organizations'
assistance. She said when the committee starts to "tweak" the
bill, they will be ready to "tweak." Ms. Walker stated that
this is a very important bill and the committee has shown great
respect by the work the members are doing.
TAPE 03-20, SIDE A
Number 0001
MS. WALKER shared a personal experience with the committee about
her mother's death last month. She told the members her mother
lived in Baltimore, Maryland, where advance directives have been
legal since 1993. At that time, the family got together with
her mother and agreed on everything. However, when her mother
reached the age of 90, she decided she did not want to give her
body away. Her mother told the family that as old and
dilapidated as she was, she felt there was nothing they [Johns
Hopkins Gerontology Department] can do with it. Ms. Walker said
her mother had been part of a study with Johns Hopkins
Gerontology Department, and the family tried to tell her that
there would be some usefulness. Her mother said no, Johns
Hopkins need's "young, fresh stuff." So the family had to go
through all the procedures again just to change that one portion
of the advance directive. It was not that hard, and it was done
to please her. She passed away two weeks shy of 94. She had
all of her faculties to the end. Ms. Walker said her mother
actually remembered more than she wanted her to. Her mother was
happy about the directives, but the family was happier because
everything she wanted was done. It made it very simple for the
family. Ms. Walker urged the committee to continue to work on
this bill.
Number 0183
MARIE DARLIN, Capitol City Task Force, AARP, testified in
support of HB 25 [Version D]. She concurred with Rosalie Walker
that she is happy that the committee is taking the time to
assure that the bill is done correctly. There is a good reason
for getting this done. She pointed out the Anchorage Daily News
article in Sunday's paper that talked about Alaska's poor end-
of-life care. Ms. Darlin told the committee one of the reasons
that Alaska got such a poor rating was lack of physicians and
nurses, but it says Alaska's laws do not support good care
planning such as living wills and powers of attorney for the
end-of-life care. Ms. Darlin said the state does have these
laws in place, but they are here, there, and everywhere within
the statutes. If the legislature can get all of this done now,
it would take care of many of the problems and the state would
be rated higher for end-of-life care. She said she would leave
a copy of the article for the members.
Number 0368
REPRESENTATIVE SEATON asked if the committee could get the bill
drafted to include all the amendments and proposed amendments in
a proposed committee substitute. He said he believes it will be
easier to deal with problems if the bill could be read as a
whole.
REPRESENTATIVE CISSNA agreed with Representative Seaton.
Number 0415
CHAIR WILSON announced that a committee substitute will be taken
up before the committee on Thursday, March 6. [HB 25 was held
over.]
ADJOURNMENT
Number 0451
There being no further business before the committee, the
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:45 p.m.
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