02/10/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB95 | |
| HB105 | |
| HB106 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 95 | TELECONFERENCED | |
| = | HB 105 | ||
| = | HB 106 | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 10, 2005
3:18 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Tom Anderson
Representative Sharon Cissna
Representative Berta Gardner
Representative Vic Kohring
MEMBERS ABSENT
Representative Paul Seaton, Vice Chair
Representative Lesil McGuire
COMMITTEE CALENDAR
HOUSE BILL NO. 95
"An Act relating to public health and public health emergencies
and disasters; relating to duties of the public defender and
office of public advocacy regarding public health matters;
relating to certain claims for public health matters; making
conforming amendments; and providing for an effective date."
- MOVED CSHB 95(HES) OUT OF COMMITTEE
HOUSE BILL NO. 105
"An Act relating to coverage for adult dental services under
Medicaid; and providing for an effective date."
- MOVED CSHB 105(HES) OUT OF COMMITTEE
HOUSE BILL NO. 106
"An Act establishing the senior care program and relating to
that program; creating a fund for the provision of the senior
care program; repealing ch. 3, SLA 2004; and providing for an
effective date."
- MOVED CSHB 106(HES) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 95
SHORT TITLE: PUBLIC HEALTH DISASTERS/EMERGENCIES
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
01/21/05 (H) READ THE FIRST TIME - REFERRALS
01/21/05 (H) HES, JUD
02/10/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 105
SHORT TITLE: MEDICAID FOR ADULT DENTAL SERVICES
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
01/24/05 (H) READ THE FIRST TIME - REFERRALS
01/24/05 (H) HES, FIN
02/08/05 (H) HES AT 3:00 PM CAPITOL 106
02/08/05 (H) Heard & Held
02/08/05 (H) MINUTE(HES)
02/10/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 106
SHORT TITLE: SENIOR CARE PROGRAM
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
01/24/05 (H) READ THE FIRST TIME - REFERRALS
01/24/05 (H) HES, FIN
02/08/05 (H) HES AT 3:00 PM CAPITOL 106
02/08/05 (H) Heard & Held
02/08/05 (H) MINUTE(HES)
02/10/05 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
RICHARD MANDSAGER, M.D., Director
Division of Public Health
Alaska Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented HB 95 to the committee.
MICHAEL MACLEOD-BALL
American Civil Liberties Union
Anchorage, Alaska
POSITION STATEMENT: Presented concerns about HB 95.
NATHAN JOHNSON, Division Manager
Anchorage Municipal Department of Health and Human Services
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 95.
DAN BRANCH, Senior Assistant Attorney
Civil Division
Department of Law
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding HB 95.
DELISA CULPEPPER, Chief Operating Officer
Alaska Mental Health Trust Authority
(Address not provided)
POSITION STATEMENT: Testified in support of HB 105.
PAMELA HAWEK
Anchorage Neighborhood Health Center
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 105.
DIANE DISANTO, Special Assistant
to Mayor Mark Begich
Municipality of Anchorage
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 105.
RICHARD GREEN, Major
Salvation Army
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 105.
GEORGE BIRD, M.D.
Tanana Chiefs Conference
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 105.
DENA SUMMER PEDEBONE
Tanana Chiefs Conference
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 105.
TOM BORENSTEIN, D.D.S., Director of Dental Services
Southeast Alaska Regional Health Consortium
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 105.
MARIE DARLIN
AARP Capital City Task Force
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 105 and 106.
SUSAN PHIPPS
National Alliance for the Mentally Ill
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 105.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:18:40 PM.
Representatives Anderson, Cissna, Gardner, and Wilson were
present at the call to order. Representative Kohring arrived as
the meeting was in progress.
HB 95-PUBLIC HEALTH DISASTERS/EMERGENCIES
3:20:10 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 95, "An Act relating to public health and public
health emergencies and disasters; relating to duties of the
public defender and office of public advocacy regarding public
health matters; relating to certain claims for public health
matters; making conforming amendments; and providing for an
effective date."
3:20:18 PM
RICHARD MANDSAGER, M.D., Director, Division of Public Health,
Alaska Department of Health and Social Services presented HB 95
to the committee. He directed attention to "slides" printed in
a handout available in the committee packet and read the quote
from the Institute of Medicine on page 2: "Public Health is what
we, as a society, do collectively to assure the conditions in
which people can be healthy." He said:
What we're going to be talking about today is the
governmental part of the public health system. And I
think it's important to just put it in context that
public health system is a partnership of government,
of individuals, of nonprofits and communities of
municipal governments, and other levels of government
too. ... As I think about the contributions of the
governmental part of the public health system in our
country over the last 150 years, as a physician, it
seems to me the most significant undertaking in our
country was the institution of sewage removal and
treatment in cities that started in the 1800s. And
then shortly thereafter, provision of safe water began
being instituted throughout cities. In post-World War
II era, ... protection from vaccine-preventable
diseases. ... In more recent decades, clean indoor air
is a part of the governmental action, and ... taking
lead out of gasoline to prevent lead poisoning.
DR. MANDSAGER turned to page 3 and continued:
It is important to remember that public health is not
health care; we're talking today about the focus on
populations, not individuals primarily. We're talking
about prevention primarily, not treatment, and
government's unique role in this; ... the legal
obligations to prevent disease, disability, injury,
and illness among populations. ... [For example:]
immunizations to prevent vaccine-preventable diseases;
PPDs [purified protein derivative, a method of testing
for tuberculosis, or Tb] ...; [and] injury
prevention.... [Public health personnel] train with
small outbreaks; we're pretty invisible if the job is
done right, but it's important to always be prepared
and trained and in the background for when we're
needed.
3:24:56 PM
DR. MANDSAGER continued:
We have much better laboratory testing capabilities
since [the terrorist attacks of September 11, 2001] as
a part of our preparedness mission. But there are
weaknesses and that's really what we're talking about
today. The inadequate legal authorities that are
addressed in the proposal that's before you in HB 95;
the inadequate laboratory facility for virology, HB
100, that'll be considered by another committee; our
dependence on federal funds ...; and then [the stress
on] staff to be able to both prepare and to deliver
services every day....
DR. MANDSAGER turned attention to page 5 that showed photos of
old public health enemies such as polio, influenza, and
tuberculosis. He explained that the traditional disease
controls included quarantine and isolation, and he pointed out
that these controls are "buried in this bill ... as to what
authorities government has, hopefully to use rarely, but needs
to have available when needed." He then turned to page 7
regarding SARS (Severe Acute Respiratory Syndrome), and said
that in 2003 the legislature amended the current statute to give
[the Department of Health and Social Services] the authority to
quarantine or isolate if needed in case there was a SARS
outbreak. He said:
These days we worry a lot about something called avian
flu. It's in Southeast Asia. It's now become endemic
in the poultry and duck and other bird populations in
Southeast Asia. It's very virulent and lethal; [it
has] about a 70 percent mortality rate in Southeast
Asia in the last couple of years. Thankfully it's not
very transmissible, human to humans; it's mostly from
birds to humans and people that live in close
proximity. In the last three months, though, ... the
World Health Organization [WHO] reported the first
three cases of possible human-to-human transmission.
If this mutates and becomes transmissible, it's a bad
disease and we need to be prepared. So I would argue
that it's both the right thing to do, that we need to
update our statutes; and it's also the ethical thing
to do, that we need to be prepared as a community....
It's about balance between the mission to protect
public health and the ... obligation for individuals
to have due process rights if government overreaches.
And that's the balance we're trying to achieve in this
statute.
DR. MANDSAGER then directed attention to page 8 and said:
Our laws are old. The basic statutes date from
territory days. They have been amended twice: in 1995
and 2003, once for Tb and once for SARS, but are
generalizable in the current understanding of the
courts. Now we might get lucky and the judge might
construe that we have broad authorities and give us
the right to quarantine or isolate if we need to. But
it's not a good policy that we should go forward
depending on different judicial interpretations in
different courts for how to proceed. So this is a set
of laws that is old; it's stood us pretty well but
needs to be updated.
3:28:54 PM
DR. MANDSAGER turned to page 9 and explained HB 95 to the
committee. He said:
It's a framework that brings up to date the current
understandings of public health missions, services,
and role. It gives clear authority for the control
for conditions of public health importance and defines
that term, because that's really the essence of what
the governmental part of the public health system
does. And it provides modern due process provisions
for the protection of individual rights. ... [HB 95]
defines the essential public health services that's
based on accepted definitions from U.S. Public Health
Function Task Force. It's based on work from the
Institute of Medicine.... This proposal describes the
state's role in protection and promotion of the
public's health, provides clear authority for control
of conditions of public health importance through the
tools of surveillance, epidemiologic investigation,
treatment, quarantine, and isolation.
DR. MANDSAGER related a story in which the [Division of Public
Health] worked in partnership with the Centers for Disease
Control and Prevention (CDC) and the community of Kivilina to
test the villagers for possible lead contamination last summer.
He also shared a story about the town of Ambler. He explained
that construction activities were halted in town last summer
because asbestos was found in the gravel. Last fall the
division asked for adult volunteers from Ambler to have x-rays
so doctors could look for signs of asbestos-caused scarring in
their lungs. Dr. Mandsager told the committee that these two
stories are examples of noninfectious disease work that the
governmental part of public health is involved in.
DR. MANDSAGER pointed out that the bill will strengthen the
confidentiality and security of records. He said, "We feel
strongly that we depend really on voluntary provision of data
... and we have a big responsibility to the public to protect
that data, [to ensure] that it's kept in a confidential and
secure manner. ... The current statutes are not very clear about
what our responsibilities are about that."
3:33:14 PM
DR. MANDSAGER turned to page 11 and stated that the bill has
five different parts: purpose and intent in Section 1;
administration of public health laws by the department in
Sections 4, 5, and 7; public health authority and powers in
Section 8; legal representation and court powers in Sections 9,
10, and 11; and general provisions in Sections 2, 3, 6, 12, and
13. He moved to page 12 and explained three of the five parts
in more depth:
[The] purpose and intent [of HB 95] is really to
protect and promote the health of the citizens of this
state to the greatest extent possible. ...
Administration of public health law ... [is to]
modernize and clarify the public health powers,
clarify the nature of regulations for reporting, ...
definition of "conditions of public health
importance." And the powers and authority is really
around the infectious disease part, around quarantine,
isolation, [and] treatment. ... The mission of public
health is to protect the health of the community, so
once somebody is found to have an infectious disease,
the person really then has a choice: they can choose
to stay isolated or they can choose to get treated.
DR, MANDSAGER emphasized that quarantine and isolation are used
very rarely. He noted that in the last decade the division has
only thought about using it twice. He then explained that page
13 refers to a memo from Legislative Legal and Research Services
regarding HB 95. He said that there are seven different
questions raised in the memo. The first question was whether
sufficient notice is provided in due process provisions. He
commented that from the department's view, there is a fair
balance between individual rights and public protection. The
second question was why refusal of medical treatment is allowed.
He responded that an infected person may choose to be isolated
rather than treated. The third question asked why there are no
criminal penalties for non-compliance. He replied that he feels
penalties will be required very infrequently, and that if people
do not comply it will not be out of criminal intent but out of
fear. The fourth question was whether access to medical records
provision HIPPAA (Health Insurance Portability and
Accountability Act of 1996) compliant, and Dr. Mandsager replied
that it was. The fifth question was if an indirect court rule
amendment was made by this bill. He responded that this may be
an issue, and there is a proposed amendment to the bill to fix
this.
3:40:01 PM
REPRESENTATIVE ANDERSON moved to adopt Amendment 1, labeled 24-
GH1002\A.2, Mischel, 2/10/05, which read:
Page 1, line 4, following "amendments;":
Insert "amending Rules 4, 7, 8, 38, 40, 65, 72,
and 77, Alaska Rules of Civil Procedure;"
Page 24, following line 12:
Insert new bill sections to read:
"* Sec. 12. The uncodified law of the State of
Alaska is amended by adding a new section to read:
INDIRECT COURT RULE AMENDMENTS. (a)
AS 18.15.375(c)(3), (d), and (e) and 18.15.385(d) -
(k), as added by sec. 8 of this Act, have the effect
of amending Rules 4, 7, 8, and 77, Alaska Rules of
Civil Procedure, relating to the form and timing of
service of process, pleadings, and motions by adding
special proceedings, timing, and pleading requirements
for matters involving public health.
(b) AS 18.15.375(c)(3), (d), and (e) and
18.15.385(d) - (k), as added by sec. 8 of this Act,
have the effect of amending Rule 38, Alaska Rules of
Civil Procedure, relating to a right to a trial by
jury, by requiring a court trial in matters involving
public health.
(c) AS 18.15.375(c)(3), (d), and (e) and
18.15.385(d) - (k), as added by sec. 8 of this Act,
have the effect of amending Rule 40, Alaska Rules of
Civil Procedure, relating to the trial calendar and
continuances, by requiring expedited hearings and
specific standards for and timing of granting of
continuances in matters involving public health.
(d) AS 18.15.375(c)(3), (d), and (e) and
18.15.385(d) - (k), as added by sec. 8 of this Act,
have the effect of amending Rule 65, Alaska Rules of
Civil Procedure, relating to injunctions, by allowing
temporary and ex parte injunctions to be issued and by
expediting the procedures related to injunctive relief
in matters involving public health.
(e) AS 18.15.387, as added by sec. 8 of this
Act, has the effect of amending Rule 72, Alaska Rules
of Civil Procedure, relating to eminent domain
actions, by authorizing the Department of Health and
Social Services to take immediate control over certain
businesses and property in cases of public health
disasters.
* Sec. 13. The uncodified law of the State of
Alaska is amended by adding a new section to read:
TWO-THIRDS VOTE REQUIRED. AS 18.15.375(c)(3),
(d), and (e), 18.15.385(d) - (k), and 18.15.387, as
added by sec. 8 of this Act, take effect only if sec.
12 of this Act receives the two-thirds vote of each
house required by art. IV, sec. 15, Constitution of
the State of Alaska."
Renumber the following bill sections accordingly.
There being no objection, Amendment 1 was adopted.
3:40:26 PM
DR. MANDSAGER moved to the sixth question listed on page 13:
"Why are parents deprived party status in quarantine/isolation
hearings of unemancipated minors?" He replied that this was an
error that should be corrected.
3:42:15 PM
REPRESENTATIVE ANDERSON moved to adopt Conceptual Amendment 2:
Page 15, line 16:
Delete "minor; however, parents or guardians of
the minor do not have party status in the proceedings
under this section"
Insert "minor"
[The committee members recognized that this was a conceptual
amendment taken from an amendment labeled 24-GH1002\A.1,
Mischel, 2/10/05, which Representative Anderson split into two
separate amendments.]
There being no objection, Conceptual Amendment 2 was adopted.
3:43:36 PM
DR. MANDSAGER turned to the seventh question on page 13, "Is
shared jurisdiction with DEC [Alaska Department of Environmental
Conservation] in cases involving contaminated material in a
public health disaster addressed?" He replied that HB 95 is the
result of discussions between Department of Health and Social
Services (DHSS) and Department of Military & Veterans' Affairs
(DMVA). He said:
The authorities for a public health disaster ... would
be clearly identified with DHSS and that's why it's
written as it is with contaminated material or
infectious waste put together under DHSS-
responsibility. Clearly we can't predict what kind of
a public health disaster we'd have, and whatever the
material is or whatever the disaster is, it would
clearly be a partnership between DEC, DHSS, DMVA, in
terms of dealing with that disaster scenario.
3:44:37 PM
DR. MANDSAGER directed attention to page 14 and pointed out that
the Trust for America's Health considers Alaska to be the only
state in the country that does not have adequate statutory
authority to quarantine in response to a hypothetical
bioterrorism attack scenario.
3:45:30 PM
DR. MANDSAGER presented Amendment 3 and explained that it
addressed some of the concerns voiced by the Office of Public
Advocacy to clarify their role in regards to guardian ad litems
if minors are involved in a quarantine or isolation scenario.
3:46:11 PM
REPRESENTATIVE ANDERSON moved to adopt Amendment 3, labeled 24G-
1, 1/26/05, (2:38 PM), which read:
Page 13, line 28, following "(g)," through page 13,
line 31:
Delete all material.
Page 14, line 1:
Delete "the office of public advocacy to provide
a guardian ad litem for the individual."
Page 17, following line 14:
Insert the following new material:
"Sec. 18.15.389. Representation; guardian ad
litem. An individual who is the respondent in
proceedings under AS 18.15.355 - 18.15.390 has the
right to be represented by counsel in the proceedings.
If the individual cannot afford an attorney, the court
shall direct the public defender agency to provide an
attorney. The court may, on its own motion or upon
request of the individual's attorney or a party,
direct the office of public advocacy to provide a
guardian ad litem for the individual."
There being no objection, Amendment 3 was adopted.
3:46:41 PM
DR. MANDSAGER then presented Amendment 4, labeled 24-GH1002\A.1,
Mischel, 2/10/05. [The committee had previously agreed to split
this amendment into two separate amendments; the other half of
the amendment was adopted as Conceptual Amendment 2.] He
explained that Amendment 4 came out of Senate Health, Education
and Social Services Standing Committee, who dealt with this bill
and adopted this amendment yesterday. He said that senators
wanted to clarify that dead bodies may be transported without
being embalmed because some people may have religious reasons
for not having a body embalmed.
3:47:39 PM
REPRESENTATIVE ANDERSON moved to adopt Amendment 4, which read:
Page 1, line 4, following "amendments;":
Insert "relating to the treatment and
transportation of dead bodies;"
Page 6, line 17, following "bodies;":
Insert ", except that the commissioner may not
require that a dead body be embalmed unless the body
is known to carry a communicable disease or embalmment
is otherwise required for the protection of the public
health or for compliance with federal law"
[The committee members recognized that this was a conceptual
amendment taken from an amendment labeled 24-GH1002\A.1,
Mischel, 2/10/05, which Representative Anderson split into two
separate amendments.]
DR. MANDSAGER pointed out that [the department] has not finished
reviewing interstate statutes, however he said that he thought
that the amendment was fine.
REPRESENTATIVE ANDERSON objected for discussions purposes. He
remarked that many of the committee members are also on the
House Judiciary Standing Committee as well, and can discuss the
amendment further there. He removed his objection.
There being no objection, Amendment 4 was adopted.
3:49:45 PM
MICHAEL MACLEOD-BALL, American Civil Liberties Union (ACLU),
commented on HB 95:
By the very nature of this bill, it contemplates that
individual Alaskans will give up some of their
personal freedoms and permit the government to intrude
on their privacy under certain circumstances. We
agree that under some of the dire circumstances cited
by the administration that such restrictions may be
appropriate. Our concern with this bill, however, is
that as drafted, it contemplates giving the government
the right to quarantine and isolate individuals, and
to inspect and retain private medical records in
circumstances not nearly so dire as the examples
cited. We do not oppose the intent of this bill;
rather, we seek to limit the circumstances when the
government can exercise those intrusions on our
liberty and privacy solely to those dire emergencies
that demand extraordinary government action to
preserve our society. The Alaska Civil Liberties
Union believes we can be both safe and free. We have
not presented a section by section analysis of this
bill so that we can meet with Dr. Mandsager and talk
about our concerns. ... After that I would hope that
we would be able to provide you with some specific
suggestions to ... improve this bill and preserve some
of those individual freedoms.
MR. MACLEOD-BALL continued:
I would like to bring up four broad areas ... where
our concerns exist. First, we believe the
government's right to quarantine or isolate an
individual against his or her will, or to access that
individual's private medical records should only exist
in the very narrowest set of limited circumstances.
As written, we believe the right to access
identifiable private medical records and to quarantine
or isolate an individual against his or her will is
too broad. The department's authority to access
records or isolate derives from [Section 18.15.355,
page 7, lines 21-23] of the bill. There it states
that the department may use the power set out in the
bill "to prevent, control, or ameliorate conditions of
public health importance or accomplish other essential
public health services and functions."
3:52:33 PM
MR. MACLEOD-BALL explained:
By our reading, that will give the department the
right to impose a quarantine or isolation order on an
individual, or to access private medical records based
on nothing more than routine administrative purposes.
"Essential public health services and functions" is
defined [in Section 18.15.390, page 18, lines 11-31]
and includes a list of routine functions, and that
list is not unreasonable in any sense. However that
list of functions should not serve as the basis for
the department's exercising its extraordinary
authority to quarantine or isolate individuals against
their will, or to access their private medical
records. Instead that authority should not be
triggered except in the most unusual circumstances.
The other phrase "conditions of public health
importance" ... is the key phrase here. If the
definition of that phrase were to be very narrow so as
to define extreme public health emergencies, then the
department's right to use the quarantine and isolation
authority would only be available in those extreme
cases. Our concern, however, is that the definition
of "conditions of public health importance" is rather
broad [Section 18.15.390, page 17, lines 19-22].... A
condition of public health importance arrives from "a
threat to health that is identifiable on an individual
or community level, and can reasonably be expected to
lead to adverse health effects in the community."
"Adverse health effects" is not defined anywhere in
the bill.... By that standard, the department could
trigger its ability to restrict individual liberty
interests and to invade personal medical privacy in
the event, for example, that a minor bug runs through
a community, without endangering anyone's lives. We
do not believe that it is the intent of the department
to interpret this bill in this fashion, but the fact
remains that the language of the bill as drafted can
reasonably and fairly be interpreted in this way. We
would strongly recommend that the definition of that
term "condition of public health importance" be
narrowed to reflect only far more serious public
health events, giving due consideration to the nature
of the disease, the level of contagion, the means of
transmission, and the seriousness of the impact on the
individual patient.
MR. MACLEOD-BALL continued:
Our second broad area: the government should be
required to affirmatively protect the privacy of
identifiable medical records and to destroy such
records when no longer needed to address the public
health need. We're concerned that the language
surrounding the government's right to access and
retain identifiable medical records may go too far.
[In Section 18.15.360, page 8, lines 23-25], the
statute contemplates issuance of regulations to govern
the department's access to such private information.
The only standard to limit the regulatory scheme is
set forth [in Section 18.15.365, page 8, line 26-29],
which does mandate that such records be held in
confidence. We would prefer a more rigorous set of
standards to govern the rulemaking process, including,
for example, a specific prohibition on the use of
private medical records for any purpose other than
those in connection with the disease outbreak or
public health crisis; a specific prohibition on the
disclosure of such information to anyone other than
those public health officials involved in the public
health event; the obligation to destroy copies of such
records when they are no longer needed; and an
affirmative statement that such records could not be
used in any civil or criminal proceeding without that
individual's consent.
MR. MACLEOD-BALL continued:
Our third broad area of concern: the bill should
contain affirmative protections that the affected
individuals will not suffer negative impacts in their
civil transactions or criminal proceedings due solely
to the government's action under its authority. We
believe that the law can be improved by adding such
affirmative protections as: that the quarantine,
isolation, or medical records access will have no
impact on their housing, employment rights, parental
rights, or other civil rights; that the action would
have no impact on any civil or criminal proceedings
involving that individual; that the individual be
compensated for any property taken or lost through the
government's exercise of its authority; and that the
action does not act to waive the doctor-patient
confidentiality, and imposes such a restriction on any
medical professional that gains access to that
information through this process.
3:56:40 PM
MR. MACLEOD-BALL continued:
Our fourth and final broad area of concern has more to
do with the procedure side of this. The affected
individual should have access to the legal system
throughout the process and the restrictions imposed
should be narrowly drawn. We appreciate the efforts
of the department to provide a clear process, and
though our concerns are significant, it is clear that
there is a process available to individuals whose
rights have been restricted under this bill. Most of
our concerns in the procedural area could be resolved
by the following three suggestions.
MR. MACLEOD-BALL continued:
First and foremost, remove the availability of an ex
parte proceeding. [Section 18.15.375, page 9]
contemplates a proceeding to which the affected
individual would have no access, but under the statute
that individual would already have been made aware of
the department's concern, and therefore we don't see
the need to bar that person from access to those legal
proceedings and taking part in it actively. Secondly,
the isolation or quarantine order should include a
specific date of determination based upon the
projected course of the public health event and that
individual's contagiousness or disease. The statute
allows an open-ended term, up to 30 days with the
individual having the right to challenge. Instead, we
believe that the burden should be on the state. The
state should have to show how long the order should be
in place at the outset, and then put the burden on the
state to seek an extension if conditions warrant. And
thirdly, under this procedural category, we would like
to see that there be a change to and a heightening of
the standard for issuing a quarantine or isolation
order. As written, the standard for the court is
"substantial risk to public health." Again, I did not
see a definition of that particular term. Instead we
would prefer a defined term ... more closely aligned
with the basis for the action. As before we would
like due consideration given to the nature of the
condition, the level of contagion, the means of
transmission, and the impact on the individual. In
short, because this law contemplates placing
restrictions on individual liberty, and because it
contemplates granting the government access to
someone's most private records, the closest scrutiny
is required. For each element of this bill we would
ask a committee to ask the following four questions:
Is there a compelling state interest? Is the state
action targeted narrowly? Is the state action the
least restrictive that it could be in both time and
scope? And does the individual have an effective
right to object before imposition of the restrictions?
If each of these questions can be answered in the
affirmative, then a bill will better than in its
current form.
3:59:45 PM
CHAIR WILSON commented that those are common sense issues that
the committee needs to be concerned about. However, she
remarked, this committee is really looking at the policy and the
House Judiciary Standing Committee will scrutinize the bill
regarding Mr. Macleod-Ball's concerns.
4:00:34 PM
REPRESENTATIVE ANDERSON commented that he concurred with Mr.
Macleod-Ball's first two points. He asked Mr. Macleod-Ball to
submit his comments in writing. He also pointed out Section
18.15.360 on page 8, lines 9-10, which authorizes the department
to collect any other data needed to accomplish or further the
mission or goals of public health, or provide essential public
health services or functions. He remarked that this is
illustrative of how broad the bill is.
REPRESENTATIVE GARDNER also asked for written copies of the
testimony.
4:02:27 PM
NATHAN JOHNSON, Division Manager, Anchorage Municipal Department
of Health and Human Services, testified in support of [HB 95] on
behalf of the Municipality of Anchorage and the department. He
commented that most of Alaska's public health laws are
antiquated and were created in response to conditions that
existed 50 years ago. He said:
In this age of global travel and increasing number of
drug-resistant infectious diseases, it is imperative
that we be prepared, whether it is for a bioterrorism
event or the occurrence of a particularly virulent and
potentially lethal disease, such as pandemic flu. If
a public health disaster strikes, there won't be time
for the lawyers and the risk assessors to sort out the
extent and scope of the our public health authority
and powers. ... In cases of a biological contagion
[that is] potentially lethal, time is of the essence,
so it's critical that both the state and local public
health be able to act quickly and decisively to
address it. This bill is very important to the
Municipality of Anchorage, as it clarifies ahead of
time the extent and scope of public health powers, and
provides explicit due process to protect individual
rights. It is important to tease out and clarify
these issues before a public health disaster lands in
our lab. The State of Alaska and the Municipality of
Anchorage work in tandem on a nearly daily basis on
infectious disease surveillance, investigation,
prevention, and many other public health measures.
And passing this legislation will only serve to
improve this relationship and further both of our
abilities to work together to protect the health and
well being of the Alaskan public.
4:05:03 PM
REPRESENTATIVE KOHRING asked that the members of the House
Judiciary Standing Committee closely scrutinize this bill. He
voiced appreciation of the testimony from Mr. Macleod-Ball and
concern that the bill was too general in scope.
CHAIR WILSON stated that the legislature will need to find a
balance so that the state can move quickly before an epidemic
can get out of control.
4:07:19 PM
REPRESENTATIVE KOHRING commented:
I can't help but think back to the [USA Patriot Act]
and how that seemed to be an overreaction to what
happened with [the terrorist attacks of September 11,
2001], and I just wonder if perhaps we're going down
that same road with this legislation here, where it's
too comprehensive and it's opening the door too much,
and we may not be realizing what we're getting into
with this bill. I'd just as soon address some of
these issues here at the HES committee level.... I
certainly, at this point, do not support the
legislation.
REPRESENTATIVE ANDERSON moved to [report HB 95 as amended from
committee with individual recommendations and the accompanying
zero fiscal note.]
4:08:26 PM
REPRESENTATIVE KOHRING objected for discussion purposes.
REPRESENTATIVE ANDERSON remarked:
I think with the ACLU working with the public health
division, and I think with more scrutiny occurring at
that level, and by going to [House Judiciary Standing
Committee], we have a pretty good timeframe where we
can work on this over the next month, and analyze it,
and go section to section to see if there are
constitutional issues; to see if language is too broad
and we can narrow it.
4:10:01 PM
REPRESENTATIVE CISSNA asked Dr. Mandsager:
At the end of this bill are the ... repealing of the
[AS] 18.15.149 and the [AS] 18.15.350, and I know that
there's a good explanation for it, but it sure, on the
face of it, looks scary. And I know that there's
plans for how that gets filled in, but would you mind
explaining that?
DR. MANDSAGER deferred to the Department of Law representative.
4:11:06 PM
DAN BRANCH, Senior Assistant Attorney, Civil Division,
Department of Law asked Representative Cissna to restate the
question.
REPRESENTATIVE CISSNA clarified that she was referring to page
24, line 15 of the bill. She explained that this would removed
the tuberculosis and SARS control programs.
4:12:37 PM
MR. BRANCH explained that, except for the repeal of AS 18.05.044
and 18.05.046, all the other repealers would take away the
current law that allows [the state] to quarantine people for
tuberculosis or SARS. He added that AS 18.15.147 is regarding
religious treatment of people with tuberculosis, which is not
needed. He commented, "I just want to reassure the committee
that, ... after working with this bill, I know that they're
looking for the right answer when it comes to due process and
the rights of individuals."
REPRESENTATIVE ANDERSON clarified that AS 18.15.143 refers to
the religious treatment for tuberculosis. He also stated that
AS 18.15.145, screening of school employees, will be removed as
well. He commented on the other bills that would be repealed by
the bill.
4:15:41 PM
REPRESENTATIVE CISSNA asked what will be put in the place of the
repealed sections.
MR. BRANCH responded that the information is in the bill. He
said:
The bill adds an article for public health powers.
[Included] in that is ... a section for quarantine and
isolation, and one also for epidemiological
investigation, which would give us the authority to
test people to find out if they need to be isolated or
quarantined. So the tools that the old law provided
will be replaced with better ones. But the department
will still have the authority, if this bill passes, to
use the quarantine tool that it has now.
4:16:51 PM
REPRESENTATIVE CISSNA requested that Dr. Mandsager answer the
question as well.
DR. MANDSAGER replied that the department has tried to take the
same basic authorities that it has used for tuberculosis for
decades, and generalized it. He said:
As we went through the drafting process ... [with] the
staff that deal with Tb on a weekly and monthly basis,
the internal debate and critique was intense to make
sure that the general provisions in this bill fit with
what they do on a regular basis, with Tb as the most
common condition that we need to use these tools for,
and to make sure that they tested the language against
what they do to make sure that we don't take anything
away ... and that as we go to more generalizable
language that we have all the tools and authorities we
need for any condition. ... So you won't have Tb or
SARS or any other disease identified specifically in
statute anymore, but the tools are there for any
disease.
4:18:19 PM
REPRESENTATIVE KOHRING removed his objection.
There being no further objection, CSHB 95(HES) was reported from
the House Health, Education and Social Services Standing
Committee.
HB 105-MEDICAID FOR ADULT DENTAL SERVICES
4:18:52 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 105, "An Act relating to coverage for adult
dental services under Medicaid; and providing for an effective
date."
REPRESENTATIVE ANDERSON moved to adopt CSHB 105, Version 24-
GH1081\G, Mischel, 2/7/05, as the working document. There being
no objection, Version G was before the committee.
4:19:20 PM
CHAIR WILSON asked if any of the committee members had comments
or questions. There were none.
4:19:52 PM
DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health
Trust Authority (AMHTA), testified in support of HB 105. She
noted that the AMHTA is helping to fund the fiscal note for
this. She commented:
Dental services have been [an] issue for all four of
our beneficiary groups for many years. We do fund
some dental services through what we call mini-grants
already, and we're noticing a trend over the years
that the mini-grants are going more and more to
provide basic dental services because there's no other
funding for people who ... [are] Medicaid-eligible or
lower income and aren't on Medicaid. But our funding
for mini-grants isn't available in a timely manner the
way people that have a dental emergency or are trying
to prevent one would need. And so we've been very
supportive of the department's proposal to invest in a
more preventive action, realizing that it takes a
little time up front to get people to a point where
they aren't having these emergencies, but [in the]
long term we think that it can eventually save us
money and be a much more humane way to provide some of
our beneficiaries with the treatment they need when
they don't have access to other insurance for dental.
4:21:39 PM
PAMELA HAWEK, Anchorage Neighborhood Health Center, testified in
support of HB 105. She pointed out that there are two health
center clinics, and a large population of the patients are
underserved and underinsured, many of who are Medicaid-eligible.
There's a huge gap in the dental care of the adults that are
Medicaid-eligible, she commented. Currently approximately 30
adults a week are seen at the clinic, and because they are only
eligible for emergency care, she said, "we're pulling a lot of
teeth. We're doing very little restorative treatment." HB 105
would allow these patients to make appointments, have exams, and
work on restorative dental treatment as well as preventative
care. She offered to collect more information for the committee
if the members would like.
4:24:07 PM
DIANE DISANTO, Special Assistant to Mayor Mark Begich,
Municipality of Anchorage, stated that the Municipality of
Anchorage was in total support of this bill. She commented that
this bill would expand Medicaid coverage to include preventative
and restorative care. She noted that if dental care is not
taken care of, it can lead to infection and chronic disease, so
in the long run, this bill will save money. AMHTA has
recognized access to dental service as a priority issue and are
willing to commit funding, she said, and the Medicaid matching
funds would apply as well, so the impact to the general fund
wouldn't be too much. She said, "The city is working on other
ways to look at helping the uninsured, and there's over 100
doctors that are now signed up to do pro bono work, and
hopefully in the future we will have dentists."
4:26:13 PM
RICHARD GREEN, Major, Salvation Army, testified in support of HB
105. He pointed out that the Salvation Army has operated a free
dental clinic for the last 15 years to the uninsured working
poor. Last year the clinic saw about 1,300 clients and provided
450 in-chair appointments. He noted that about 90 percent of
the clients have no insurance at all. The Salvation Army dental
clinic does not bill Medicare or Medicaid, he said, so "we're
probably not going to receive any funds from this, but we see
the bill as [meeting] a tremendous need for people who are in
need of medical care and yet have no ability to pay for that."
4:27:50 PM
GEORGE BIRD, M.D., Tanana Chiefs Conference (TCC), stated that
TCC supports HB 105. He commented that the current Medicaid
program has deficiencies in the way that it funds adult dental
services; people need routine preventive dental care, not just
emergency care.
DENA SUMMER PEDEBONE, Tanana Chiefs Conference (TCC) reiterated
that HB 105 would provide a valuable service to those in need.
4:29:55 PM
TOM BORENSTEIN, D.D.S., Director of Dental Services, Southeast
Alaska Regional Health Consortium (SEARHC), stated that access
to dentistry in Southeast Alaska is limited for the underinsured
and the uninsured. He pointed out that SEARHC currently
delivers services through a federal grant to the uninsured in
Haines and on Prince of Wales Island; the demand for those
services is pretty large, he noted. SEARHC opened a clinic in
downtown Juneau last year that provides dental services to
homeless people where "we were oversubscribed the day we opened
and we've applied for an expansion to that grant that provides
those services," he said. He remarked that about four years
ago, SEARHC began a children's dental health program in
conjunction with the Denali Kid Care program, which has been
able to bring pediatric dental specialists to a numbers of
Southeast Alaska communities. Expanding these services to
adults, he said, would be of benefit.
4:33:05 PM
MARIE DARLIN, AARP Capital City Task Force, commented that the
committee already had a letter from her in support of HB 105.
She said, "[HB 105] is really definitely needed. It's a
preventive aspect that we really need to look at, and saves
money down the road."
SUSAN PHIPPS, National Alliance for the Mentally Ill (NAMI),
stated that she serves on the NAMI statewide board. The NAMI
supports HB 105, she said. She mentioned that anxiety disorders
cause people to grind their teeth, which can be harmful
particularly when combined with certain medications.
4:35:51 PM
CHAIR WILSON commented that, though this bill will add a lot to
the Department of Health and Social Services budget, it will
prevent other issues in the long run. She pointed out that
there is a cap included in the bill.
4:37:15 PM
REPRESENTATIVE ANDERSON disclosed a possible conflict of
interest; he is on the fundraising committee for the Anchorage
Neighborhood Health Center.
REPRESENTATIVE ANDERSON moved to report CSHB 105, Version 24-
GH1081\G, Mischel, 2/7/05, out of committee with individual
recommendations and the accompanying fiscal note.
4:38:44 PM
There being no objection, CSHB 105(HES) was moved from the House
Health, Education and Social Services Standing Committee.
HB 106-SENIOR CARE PROGRAM
4:39:12 PM
CHAIR WILSON announced that the final order of business would be
HOUSE BILL NO. 106, "An Act establishing the senior care program
and relating to that program; creating a fund for the provision
of the senior care program; repealing ch. 3, SLA 2004; and
providing for an effective date."
[Although there was no formal motion, CSHB 106, labeled 24-
GH1090\G, Mischel, 2/8/05 was treated as adopted.]
4:39:57 PM
MARIE DARLIN, AARP Capital City Task Force, testified in support
of HB 106 and highlighted the importance of the senior care
program.
4:41:16 PM
REPRESENTATIVE ANDERSON moved to report CSHB 106, Version 24-
GH1090\G, Mischel, 2/8/05, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 106(HES) was reported from the House Health,
Education and Social Services Standing Committee.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:42:40 PM.
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