Legislature(2007 - 2008)CAPITOL 106
03/06/2007 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB148 | |
| HB136 | |
| HB159 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 148 | TELECONFERENCED | |
| *+ | HB 136 | TELECONFERENCED | |
| *+ | HB 159 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
March 6, 2007
3:02 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Mark Neuman
COMMITTEE CALENDAR
HOUSE BILL NO. 148
"An Act relating to the senior care program; and providing for
an effective date."
- MOVED HB 148 OUT OF COMMITTEE
HOUSE BILL NO. 136
"An Act relating to dental hygienists."
- MOVED HB 136 OUT OF COMMITTEE
HOUSE BILL NO. 159
"An Act relating to the issuance of a certificate of birth
resulting in a stillbirth."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 148
SHORT TITLE: SENIOR CARE
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/21/07 (H) READ THE FIRST TIME - REFERRALS
02/21/07 (H) HES, FIN
03/06/07 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 136
SHORT TITLE: DENTAL HYGIENISTS
SPONSOR(s): REPRESENTATIVE(s) STOLTZE
02/14/07 (H) READ THE FIRST TIME - REFERRALS
02/14/07 (H) HES, L&C
03/06/07 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 159
SHORT TITLE: STILLBIRTH CERTIFICATE
SPONSOR(s): REPRESENTATIVE(s) GATTO
02/28/07 (H) READ THE FIRST TIME - REFERRALS
02/28/07 (H) HES, JUD
03/06/07 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
KARLEEN JACKSON, Commissioner
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented HB 148, at the governor's
request, and responded to questions.
ELLIE FITZJARRALD, Acting Director
Division of Public Assistance (DPA)
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Responded to questions regarding HB 148.
MICHAEL FORD
Alaska Native Health Board
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 148.
HERB SIMON
Nelchina, Alaska
POSITION STATEMENT: Testified in support of HB 148.
PAT LUBY, Advocacy Director
Alaska Chapter
American Association of Retired Persons (AARP)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 148.
JANET CLARKE, Assistant Commissioner
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Responded to questions regarding HB 148.
REPRESENTATIVE BILL STOLTZE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 136, as prime sponsor.
BEN MULLIGAN, Staff
to Representative Bill Stoltze
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 136, on behalf of
Representative Stoltze, prime sponsor.
DELISA CULPEPPER, Chief Operating Officer
Alaska Mental Health Trust Authority
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 136.
SONIA HANDFORTH-KOME, Executive Director
Iliuliuk Health Clinic
Unalaska, Alaska
POSITION STATEMENT: Testified in support of HB 136.
VICKY HOFF
Alaska Dental Hygiene Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 136.
JENNIFER MCELROY, Dental Hygienist
Kenai Peninsula Dental Hygiene Association
Soldotna, Alaska
POSITION STATEMENT: Testified in support of HB 136.
GAIL WALDEN, Dental Hygienist
Member, Alaska Dental Hygienist Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 136.
DAVID LOGAN, Doctor of Dentistry
Chairman, Alaska Dental Society
POSITION STATEMENT: Testified in opposition to HB 136.
REPRESENTATIVE CARL GATTO
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 159, as prime sponsor.
SANDRA WILSON, Staff
to Representative Carl Gatto
Alaska State Legislature
POSITION STATEMENT: Responded to questions on HB 159.
PHILLIP MITCHELL, Section Chief
Bureau of Vital Statistics (BVS)
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 159.
DARRELL LOGULLO, Volunteer
Mothers in Sympathy & Support (MISS) Foundation
(No address provided)
POSITION STATEMENT: Testified in support of HB 159.
RICHARD OLSEN, Founder
National Stillbirth Association
(No address provided)
POSITION STATEMENT: Testified in support of HB 159.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:02:38 PM.
Representatives Roses, Seaton, and Fairclough were present at
the call to order. Representatives Cissna and Gardner arrived
as the meeting was in progress.
HB 148-SENIOR CARE
3:03:13 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 148, "An Act relating to the senior care program;
and providing for an effective date."
3:03:42 PM
KARLEEN JACKSON, Commissioner, Department of Health & Social
Services (DHSS), presented HB 148, paraphrasing from a prepared
statement, which read as follows [original punctuation
provided]:
The SeniorCare program helps low-income seniors in
Alaska by providing cash assistance of $120 a month or
a prescription drug subsidy for Medicare Part D. The
SeniorCare program is due to sunset June 30 of this
year.
More than 7,000 seniors use the program
15 percent of the state's senior population
demonstrating that it is needed and used by Alaska
seniors.
Governor Palin is proposing this legislation to
improve the program and extend SeniorCare for another
five years.
Changes to SeniorCare will help keep it effective and
simplify the administration of the program
includes updating the income limit for eligibility and
eliminating the prescription drug assistance program.
The current SeniorCare income eligibility threshold,
frozen at 135 percent of the 2005 federal poverty
limit, does not reflect the reality of rising costs.
The current, annually adjusted federal poverty level
for Alaska must be used to keep pace with the rising
cost of living, which is what this legislation
proposes.
By tying SeniorCare eligibility to current federal
poverty rates, updated each year, modest cost-of-
living adjustments to seniors' income, such as Social
Security, will not nudge them over the income limit
for eligibility.
The change would raise eligibility levels only
modestly: at the 2007 poverty level, the SeniorCare
income limit would rise to $17,240 for a single person
and $23,112 for a couple (Current SeniorCare
eligibility: $16,133/Single, $17,240/couple). The
liquid assets these seniors would be allowed to hold
would stay the same vidual and
$9,000 for a couple.
There is low demand for the SeniorCare prescription
drug subsidy
that assistance. A statewide survey found many
seniors have access to insurance which covered
premiums and deductibles, or they qualified for other
assistance, which is why we had such low
participation.
Therefore we are eliminating this benefit, and
simplifying the administration of the SeniorCare
program.
3:07:07 PM
REPRESENTATIVE SEATON referred to the annual federal poverty
guidelines, stipulated on page 2, line 7, and asked if these are
published, and available for implementation, when a senior makes
application to the program, or if application is based on the
previous year's poverty guidelines.
3:07:52 PM
ELLIE FITZJARRALD, Acting Director, Division of Public
Assistance (DPA), Department of Health & Social Services (DHSS),
responded that the annual, federal, poverty guidelines are
published at the beginning of each calendar year, and
implemented immediately by the state.
3:08:31 PM
REPRESENTATIVE SEATON clarified that a senior applying at
anytime, during the year, would have a possibility to be
eligible for the program.
MS. FITZJARRALD explained that a senior's renewal process is
based on their income on the date of the application. This can
change any given month, based on the fluctuation of a senior's
monthly income; however, she noted that most of the seniors have
static incomes. To a follow-up question, she stated that, if a
senior's application is denied based on the poverty guidelines,
the senior is counseled to reapply.
3:11:14 PM
CHAIR WILSON established that the state's fiscal year begins
st
annually on July 1, and asked how the federal guidelines
interface with Alaska's budgeting process.
MS. FITZJARRALD answered that the division uses a historical
average for budget requests.
3:12:04 PM
MICHAEL FORD, Alaska Native Health Board, stated support for HB
148, and said that it represents an important aspect of a low
income senior's monthly income. He recommended that an
amendment be considered to remove the sunset date.
3:13:31 PM
HERB SIMON, stated support for HB 148, and asked how the poverty
level is determined.
CHAIR WILSON responded that it is a federally established level,
and the state department decides "what percentage of that we're
going to accept."
MR. SIMON pointed out that the federal employees draw a cost of
living allowance (COLA), and suggested that the federal standard
may be skewed with what the actual living costs are in Alaska.
CHAIR WILSON agreed, and observed this as the reason that Alaska
uses 135 percent of the federal poverty level vs. 100 percent,
when determining eligibility for this benefit.
MR. SIMON inquired how this contrasts with previous senior
benefit levels.
CHAIR WILSON speculated that a set amount was utilized, and
offered to have this clarified by the department.
REPRESENTATIVE FAIRCLOUGH offered that the amount had been
frozen, using the 2005 poverty level, but that has now been
released to allow the benefit to keep pace with cost of living
increases.
CHAIR WILSON opined that this modification should protect
seniors from being denied benefits, if they are borderline
eligible, as happened in the past year.
MR. SIMON commented that a "one size fits all" approach does not
always work in Alaska, with the wide variation of living costs
between the urban and remote areas. He urged passage of the
bill.
3:17:38 PM
PAT LUBY, Advocacy Director, American Association of Retired
Persons (AARP), stated support for HB 148, citing the importance
of the governor's proposal to include annual indexing of the
program based on the federal poverty level. He suggested three
areas that require additional consideration by the legislature:
the assets test limiting the savings of elders; raising the
monthly stipend from $120 to possibly $150; and the gap, which
140 seniors experienced, due to the federal poverty level
adjustment.
3:20:02 PM
CHAIR WILSON closed public testimony.
3:20:14 PM
REPRESENTATIVE SEATON referred to the fiscal note, and asked why
the yearly total for FY 2013 indicates a $7 million increase to
$12 million; the previous 5 year totals are approximately $5
million.
3:20:48 PM
JANET CLARKE, Assistant Commissioner, Department of Health &
Social Services (DHSS), explained how the FY 2013 total is
effected by the five year sunset clause, requiring legislative
action for reauthorization. She described the fiscal note in
further detail.
3:24:52 PM
REPRESENTATIVE ROSES stated that the fiscal note is confusing,
particularly because it is projected for a future budget.
Further, he attempted to establish how the Alaska Longevity
Bonus (ALB) projections and the Senior Care Program costs
interface in the fiscal note analysis.
MS. CLARKE directed the committee's attention to the second page
of the fiscal note, labeled Assumptions, and explained that the
fiscal note is consistent with the established assumptions.
[Further committee discussion ensued to clarify the fiscal note
assumptions in conjunction with the two senior programs.]
3:28:36 PM
REPRESENTATIVE SEATON requested that the committee receive an
analysis for HB 148, without the complication of other issues,
or a contingency based on the passage of another bill. He
referred to page 2, line 4, and asked if the age 65 requirement
should state "must be Medicare eligible," to correspond with any
federal changes that may occur.
MS. CLARKE responded, "This is a state funded program; the state
can set the rules. The current rules are 65." She pointed out
that this is a cash benefit, which sets it apart from a Medicare
health benefit.
3:36:02 PM
REPRESENTATIVE FAIRCLOUGH moved to report HB 148 out of
committee with individual recommendations and the accompanying
amended fiscal notes. There being no objection, HB 148 was
reported out of the House Health, Education and Social Services
Standing Committee.
HB 136-DENTAL HYGIENISTS
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 136, "An Act relating to dental hygienists."
3:37:17 PM
REPRESENTATIVE BILL STOLTZE, Alaska State Legislature,
introduced HB 136, as prime sponsor. He explained that this
bill serves two purposes: allowing dental hygienists to perform
work, which they feel capable of undertaking; and creating a
policy directive that will allow preventative oral health care
in underserved areas of the state.
CHAIR WILSON stated her intention to hear testimony on HB 136,
and hold it in committee for further consideration.
3:40:22 PM
BEN MULLIGAN, Staff to Representative Bill Stoltze, Alaska State
Legislature, presented HB 136, on behalf of Representative
Stoltze, prime sponsor, paraphrasing from the sponsor statement,
which read as follows [original punctuation provided]:
The provisions of House Bill 136 follow the expanded
functions of dental hygienists in other states to
improve access to preventative oral health care.
Specifically, HB 136:
1. Allows a licensed dental hygienist to place
"fillings" into a cavity prepared by a licensed
dentist.
2. Authorizes a licensed dental hygienist to
administer local anesthetic agents under the general
supervision of a licensed dentist.
3. Permits a licensed dental hygienist to enter into
a collaborative agreement with a licensed dentist in
which the dentist authorizes the dental hygienist to
perform certain duties stipulated under HB 136 without
the supervision of the dentist.
MR. MULLIGAN stated that currently a hygienist is allowed to
administer local anesthetic agents under the indirect
supervision of a licensed dentist. Additionally, a
collaborative agreement could be entered into, which would allow
a hygienist to perform the expanded functions, as listed in the
bill.
3:41:19 PM
CHAIR WILSON defined "direct supervision" as having the dentist
in the same room, "indirect supervision" requires that the
doctor be in the same building, and "general supervision" allows
the hygienist to perform procedures under the auspices of a
dentist.
REPRESENTATIVE STOLTZE opined that HB 136 will sanction actions
that already occur, to some degree, in dental offices.
3:43:05 PM
DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health
Trust Authority, Department of Revenue, stated departmental
support for HB 136, stating that it will be "a good move," and
will support efforts to provide dental care throughout the
state. Dental hygienists were licensed to administer local
anesthesia in 1976, she reported, and have been practicing the
procedures with no adverse consequences. Placing fillings in a
prepared [tooth] is something that "nation-wide, dental
hygienists have done for years, and [it has] proven effective."
The collaborative agreement will help to address dental care in
rural Alaska and the hub communities. She also pointed out the
significant support for this bill from various dental agencies.
3:44:57 PM
SONIA HANDFORTH-KOME, Executive Director, Iliuliuk Health
Clinic, stated support for HB 136, and she described the clinic
as a 501(c)(3) non-profit community health center. Prior to the
time when the clinic employed a fulltime dentist, the area was
served by two dentists who traveled to the clinic on a part-time
basis. The hygienist lived in the community but was unable to
serve the "thousands" of patients, preventive or otherwise,
because there was not a dentist in town. Inhibiting the
hygienists from providing continuous, preventive care, does not
keep pace with the mid-level provider concept that is common in
the health care profession. She opined that the practice makes
sense for non-profit, as well as for-profit, practitioners.
This is a cost effective way to increase access to dental care,
and to invoke a habit in people to visit a dental office. With
regular dental care, diabetes and other health issues can be
addressed.
3:48:29 PM
VICKY HOFF, Alaska Dental Hygiene Association, stated support
for HB 136, stressing the importance of the potential impact for
increasing the hygienist's scope of practice. The hygienist
will still be supervised by a dentist, but will have the ability
to provide a local anesthetic and perform involved work. In the
villages, she reported, if a deep cleaning requires a local
anesthetic the hygienist is currently unable to be of service.
3:50:13 PM
JENNIFER MCELROY, Dental Hygienist, Kenai Peninsula Dental
Hygiene Association, stated support for HB 136, and expressed
concern particularly for the senior group, and nursing homes.
She reported that these homes, including ones located in
community hubs, are not visited by dentists, although many of
these seniors are unable to access a dental office. Having
someone who can visit the senior's in group or nursing homes is
important, and cost effective, she opined, and stressed that
oral health is important for total health.
3:53:15 PM
GAIL WALDEN, Dental Hygienist, Member, Alaska Dental Hygienist
Association, stated support for HB 136, paraphrasing from
prepared statement, which read as follows [original punctuation
provided]:
The needs of Alaskans are not being met by the current
oral health care delivery system.
Current statutes and regulations prevent dental
hygienists from providing oral health care to the
public in non-traditional settings.
Dental hygienists receive a comprehensive education,
are licensed, and regulated by the state, we have
mandatory continuing education and CPR requirements.
Ultimately, hygienists are not being utilized to their
full potential.
The Alaska Board of Dental Examiners, which licenses
and regulates dentists and dental hygienists, met in
February and voted to support HB 136. They concluded
that the proposed statute changes are consistent with
their vision to ensure that all Alaskans receive the
best possible care.
In addition to BODE, HB 136 has also received support
from the Oral Health Coalition, Alaska Primary Care
Association, and the AARP.
Restorative Function License Endorsement
Creates an efficient health care delivery system that
increases the number of patients that can be seen in a
limited amount of time.
Procedures would be done under the direct supervision
of a licensed dentist, and by hygienists that are
educated and licensed to provide these additional
services.
The curriculum, examining, and licensing for
restorative functions by dental hygienists has already
been established in such states as Washington-just
needs to be implemented in Alaska.
Local Anesthesia
Statutes since 1981, there has never been disciplinary
action taken against hygienist for administration of
local anesthesia under the current statutes.
Dental Hygienists need and use local anesthesia to
reduce stress and provide pain control in the
treatment of moderate to advanced gum disease.
Under general supervision a dentist is still required
to diagnose and treatment plan the patient's needs:
and whether or not a hygienist administers local
anesthesia without the dentist in the practice remains
at the discretion of the supervising dentist.
There are 40 states where hygienists are licensed to
administer local anesthesia, 2 of those states ID and
OR can deliver local anesthesia under general
supervision.
Collaborative Agreement
Has the potential to provide the greatest impact to
Alaskan communities.
Allows hygienists with experience to enter into a
written agreement with a dentist that must be approved
by the Board of Dental Examiners.
The hygienist would be able to provide services listed
under the agreement without supervision, and prior to
the dentist seeing the patient.
Would allow hygienists access to nursing homes and
hospital facilities, homebound individuals, schools,
Head-Start Programs, and rural areas where dentists
are rarely available.
Intended benefit is to reach individuals that are not
receiving care and provide preventive services that
not only increase oral health but general health and
well being.
In Conclusion
All of these dental hygiene statute changes have been
implemented in other states and have proven to be safe
and effective. All statutes show our continued
professional commitment to working collaboratively
with dentists and providing services to the public by
dental professionals that are formally educated and
licensed by the State of Alaska.
Dental hygienists cannot be self employed therefore,
we cannot hold all liability.
Dental hygienists can purchase liability, $77/yr with
2million per incident, 4 million aggregate.
Dentists still have discretion over whether a
hygienist delivers local anesthesia under general
supervision-not in the office, do not schedule a
procedure or person that requires LA.
With a collaborative agreement, if a dentist isn't
comfortable with taking on the liability of whatever
procedure then don't include it in the agreement.
3:57:09 PM
REPRESENTATIVE STOLTZE pointed out that these witnesses have
offered supportive testimony, representing the various regions
of the state.
3:57:46 PM
DAVID LOGAN, Doctor of Dentistry, Chairman, Alaska Dental
Society (ADS), stated opposition to HB 136, paraphrasing from a
written statement, which read as follows [original punctuation
provided]:
If the goal is to increase services in underserved
areas HB 136, as currently written, will at best
marginally increase those services. The ADS feels,
with some modifications, HB136 could be enhanced to
meet those goals, however. I will address one part of
the bill; also, that we feel should be removed for
public safety.
We support the addition of restorative functions but
feel all qualified auxiliaries (both hygienists and
assistants) should be allowed to perform those
functions.
We would encourage allowing the board set standards
under regulation but do not object to requiring WREB
[Western Regional Examining Board] restorative
endorsement or equivalent.
18 other states allow all auxiliaries to perform
restorative functions; only one state limits this to
hygienists.
We support coronal polishing and scaling by all
auxiliaries under direct or indirect supervision.
This is not currently a provision of HB136 and would
greatly improve the delivery of dental services in
currently underserved areas.
We believe local anesthesia should remain under direct
or indirect supervision
A provision of the medical and dental professions is
"Primum non nocere" - first do no harm - while the
goal of increased delivery is laudable we are bound to
follow this dictum.
The level of training of hygienists is less than
dentists for delivery of anesthetic, recognition of
medical complications and delivery of emergency
services.
If the goal is to increase usage in underserved
locations a caveat is these areas will more often than
not be in remote locations and the farthest from
medical help.
To put it bluntly the procedures we are recommending
be included in this bill are generally safe and even
if performed incorrectly are easily remedied. Local
anesthesia, if performed incorrectly, is one of the
few ways in dentistry you can kill a patient.
Regarding the collaborative agreement
We do not feel development of a collaborative
agreement, and increasing a level of bureaucracy, is
necessary
We feel all qualified auxiliaries, meeting criteria
set by the board, should be able to provide the
following in underserved areas under the general
supervision of a dentist
Coronal scaling and polishing
Placement of temporary restorations
Collection of records for diagnosing and
treatment planning the patient
Application of topical preventative agents
These are safe procedures that do not require a
dentist to render a diagnosis. The remaining
provisions, removal of overhangs, root planning (non
surgical therapy), use of chemotherapeutic agents
beyond topical applications should be done only after
a dentist has accessed, diagnosed and treatment
planned the patient.
Having care delivered under general supervision as
opposed to the collaborative agreement will help
insure continuation of patient care and treatment of
the patient's greatest needs.
What separates a dentist from the remainder of the
dental team is the ability to diagnosis and treatment
plan a patient. Dental procedures can be taught in a
piece meal fashion, the ability to diagnosis and
treatment plan, however, requires the ability to
understand the entire oral structure and how it
interrelates with the rest of the body. This is not
so easily taught and one of the reasons dental school
remains a difficult venture taking twice as long as
hygiene school and the same length of time as medical
school.
The procedures we are recommending be included in
HB136 should be in place for all qualified
auxiliaries. This will allow increased delivery of
dental services in underserved areas. The changes we
are recommending, however, are changes that are safe
for the public, procedures that are reversible in
nature and will not harm the patients. For that
reason we would encourage adopting those changes but
removing the proposed change to allow local anesthesia
under general supervision.
4:03:08 PM
CHAIR WILSON inquired if the intent is to allow the dental
assistant to perform the same procedures as the hygienist.
DR. LOGAN explained that the line of demarcation is whether a
procedure requires work "above" or "below" the gum line. Work
above the gum line is considered a general skill in the dental
field, and easily taught. However, to perform work below the
gum line requires specialized training. In response to a
question he stated that assistants are taught below gum line
procedures by the dentist.
4:04:03 PM
REPRESENTATIVE FAIRCLOUGH referring to previous testimony of the
safe practice of anesthetic delivery by hygienists and asked if
he is aware of any case where a hygienist has caused harm.
DR. LOGAN said, "I do not specifically know of a case. No." He
offered that there are national statistics that report adverse
anesthetic delivery by both doctors and hygienists.
REPRESENTATIVE FAIRCLOUGH inquired whose business license would
"be on the line if there was a mishap" involving administration
of an anesthetic, given the collaborative agreement requirement.
DR. LOGAN interpreted the legislation to indicate joint
responsibility, and liability. He clarified that this would be
borne by the professional licenses of the dentist and the
hygienist.
4:06:07 PM
REPRESENTATIVE FAIRCLOUGH predicted that the subject would
become mute, if the bill requires a collaborative agreement
between a hygienist and dentist, and the dentists maintain
opposition.
DR. LOGAN stated hope that the legislature would alter the
aspect of the bill that requires a collaborative agreement. He
declined to speculate on whether dentists would choose to enter
into a collaborative agreement.
REPRESENTATIVE FAIRCLOUGH pointed out that the current language
would provide the dentist a safeguard to evaluate a hygienists'
abilities, and make a knowledgeable decision whether to enter
into a collaborative oversight agreement, on an individual, case
by case, basis. She expressed surprise that dentists would
oppose such legislation.
DR. LOGAN stressed that he would not personally enter into a
collaborative agreement with anyone whom he does not directly
employ.
4:08:14 PM
REPRESENTATIVE CISSNA summarized the situation of dental care in
the Bush. Comparing it to the level, and availability, of
general health care provided by public health nurses, she said
that dental care has been non-existent. It has been reported
that patients have required Medivac service, due to dental
neglect. She opined that, although dentists may be opposed to
this bill, a moral responsibility exists for the sharing of
knowledge, and professional assistance. She urged that perhaps
the dental association could offer suggestions to solve this
"embarrassment to the state."
4:11:07 PM
REPRESENTATIVE ROSES stated support for HB 136, indicating his
agreement with Representative Fairclough's point that, as it
stands, the language allows a dentist the flexibility to enter
into an agreement or not. Further, he stated accord with
Representative Cissna's concern for providing dental care to the
Bush communities.
4:12:44 PM
REPRESENTATIVE FAIRCLOUGH moved to report HB 136 out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, HB 136 was reported out
of the House Health, Education and Social Services Standing
Committee.
HB 159-STILLBIRTH CERTIFICATE
CHAIR WILSON announced that the final order of business would be
HOUSE BILL NO. 159, "An Act relating to the issuance of a
certificate of birth resulting in a stillbirth."
4:13:44 PM
REPRESENTATIVE CARL GATTO, Alaska State Legislature, presented
HB 159, as prime sponsor, stating that there are national
organizations, which have taken up the matter of acknowledging
stillbirths. These organizations have formed to address the
situation referred to as Sudden Antenatal Death Syndrome (SADS).
Directing attention to the committee packet, he read from "An
Open Letter to Members of the Alaska Legislature," from the
National Stillbirth Society, Inc. [not dated; original
punctuation provided]:
The issuance of a Certificate of Birth Resulting in
Stillbirth does not impact in any way a woman's right
to choose to terminate her pregnancy. Such
certificates are issued only for deliveries following
naturally occurring fetal deaths. Women who choose an
elective termination of their pregnancy would neither
be required to obtain a Certificate of Birth Resulting
in Stillbirth, nor would they even be eligible for the
reason elective terminations don't fall within the
definition of a "stillbirth".
4:15:49 PM
REPRESENTATIVE GATTO offered that the society was established in
2001, and the founder is available to answer the committee's
questions. Recalling his experience of assisting with births,
he said that a live birth is "a joy," that is equally balanced
by the "shear devastation" of a stillbirth. This legislation
asks that the parent's be provided with a certificate to
acknowledge the birth, even though it was a stillbirth, he said,
and noted that this action has no connection to Roe v. Wade.
4:18:07 PM
REPRESENTATIVE ROSES established that the request is for the
issuance of a "certificate of birth", not "live" birth, and
suggested that the issuance of a Permanent Fund Dividend (PFD)
check, could present a problem. Also, an estate may stand to be
inherited by the first born grandchild. If the grandchild has a
certificate of birth, but does not exist, the intent of the
inheritance may be altered. Offering support for the bill, he
asked whether these unintended consequences need to be
addressed.
4:20:25 PM
SANDRA WILSON, Staff to Representative Carl Gatto, Alaska State
Legislature clarified that HB 159 would allow vital statistics
to issue a certificate stipulating a birth that resulted in a
stillbirth. Additionally, it would state that the child not be
counted, statistically, as a live birth; effectively disallowing
them to qualification for a PFD. She opined that the question
of inheritance could be addressed similarly.
4:21:24 PM
REPRESENTATIVE ROSES understanding how the certificate would
read, retracted his concerns.
4:22:26 PM
REPRESENTATIVE FAIRCLOUGH maintained the concern that an issued
certificate represents a quantitative factor, entered into the
statistical birth records, and suggested that unintended
consequences may result.
4:23:01 PM
PHILLIP MITCHELL, Section Chief, Bureau of Vital Statistics
(BVS), Department of Health & Social Services (DHSS), stated
support for HB 159, and offered suggestions for amendment. He
described the current practice of issuing a death certificate
when a child is stillborn, following a gestation of 20 weeks or
more. Current statutes provide for the issuance of a live
certificate of birth, or a death certificate only; however, he
reported the parents often request an official acknowledgement
of the birth. A statutory provision to issue a certificate of
birth would help the parents deal with their loss, he opined.
The information needed to provided a certificate of birth, is
already available to the BVS, contained in the fetal death
certificate. He directed the committee's attention to a copy of
the vital statistics form titled "Certificate of Live Birth."
This form is used to generate a certified copy of birth, issued
to the parents. Directing attention to the bureau form titled
"Certificate of Fetal Death," he described it as a combination
birth/death certificate. He recommended that an additional
vital statistics form would constitute a duplication of effort,
but that a stillbirth certificate could be issued based on the
information gathered on the birth/death certificate. The
ability to issue a stillbirth certificate, he said, is merely a
matter of authorization.
4:26:28 PM
CHAIR WILSON acknowledged the trauma that a parent experiences
with the birth of a still child, and stressed that an official
certificate would be a supportive gesture.
MR. MITCHELL, reiterated that a stillbirth certificate is
currently possible, pending legislative authorization. He
pointed out that the participating states issue a commemorative
certificate, similar to Chair Wilson's description. To a
member's question, he restated that creating, and maintaining
files for, a document titled "Certificate of Birth Resulting in
Stillbirth," would be a duplication of effort.
REPRESENTATIVE FAIRCLOUGH stated, "I support a separate piece of
paper that is indicating a life."
4:31:09 PM
MR. MITCHELL relayed that subsection (g) refers to the issuance
of a "delayed" certificate He suggested that this section be
reworded to allow a parent to request the BVS to issue a
certificate of stillbirth, without regard to whether the fetal
death occurred on, before, or after the effective date of this
act. Subsection (g) is intended to allow parents to
retroactively request a stillbirth certificate, and an amendment
to this subsection would provide BVS clearer authority to issue
a stillbirth certificate, regardless of when the event occurred.
Responding to a question, he stated that about 50 stillbirths
occur each year in Alaska.
4:32:21 PM
REPRESENTATIVE FAIRCLOUGH offered support for an amendment to
allow retroactive certificates, and asked that wording be
provided, for a motion.
4:33:48 PM
REPRESENTATIVE GARDNER maintained a concern for the legal issues
raised previously by Representative Roses.
CHAIR WILSON speculated that legal concerns may exist.
4:34:30 PM
REPRESENTATIVE ROSES asked if statute requires the issuance of a
death certificate.
MR. MITCHELL answered that a death certificate is required for
anyone who dies in the state.
REPRESENTATIVE ROSES inquired if a birth certificate is
required, regardless of whether "a parent requests one."
MR. MITCHELL responded that the bureau is required to create a
birth record; however, a copy is only issued on request.
REPRESENTATIVE ROSES compared the information requested on the
two certificates currently issued by the BVS: Certificate of
Fetal Death, and Certificate of Live Birth.
MR. MITCHELL noted that the Certificate of Fetal Death requests
a "date of delivery" vs. a "date of birth" because currently a
stillborn infant is not recognized as being born live. A
stillbirth certificate would also reflect a date of delivery.
REPRESENTATIVE ROSES pursued a discussion of renaming the
Certificate of Fetal Death, to include "or Stillbirth," and
including appropriate information categories.
4:38:31 PM
REPRESENTATIVE GATTO stressed that the purpose of HB 159 is not
to do clerical and accounting work, or to modify the current
fetal death certificate. A parent already has access to these
records. The intent here is to provide a mother/parents with
something that they don't have, a tangible acknowledgment. He
opined that the legal issues can be addressed to facilitate the
issuance of a certificate of stillbirth.
REPRESENTATIVE FAIRCLOUGH agreed that a grieving family wants a
recognition of the birth of a child, that at some point was
viable.
4:40:27 PM
DARRELL LOGULLO, Volunteer, Mother's in Sympathy & Support
(MISS) Foundation, stated support for HB 159, paraphrasing from
a prepared statement, which read as follows [original
punctuation provided]:
Please create Alaska's "Certificate of Birth Resulting
In Stillbirth." These six words are of vital
importance. Here is why:
'Stillbirth protocols', and the medical courtesies
given to mothers throughout Alaskan hospitals (or lack
thereof) dictate the parents may be given mementos
such as the baby's "crib-card," the wrist or ankle
bands, or the handprints associated with the birth of
their baby. Yet parents of stillborn babies check out
of the hospital with empty arms, broken hearts and
sent home with deep wounds. It's easy to understand
that any "tangible item" from these traumatic events
could be considered essential in the bereavement
process.
Under this bill, parents who lose a child after 20
weeks of gestation would be issued a "Certificate of
Birth Resulting in Stillbirth."
As of this letter, the State of South Dakota has been
th
the 15 state in the United States to adopt such
meaningful legislation. Please support the specific
wording, "Certificate of Birth Resulting in
Stillbirth." If your colleagues have concerns over
pro-choice issues, consider following Florida's law
th
(14 state), and adding clear language, "This
Certificate Is Not Proof of Live Birth," to squash
those concerns.
Please do not allow the wording to be changed, or any
amendments offered to dilute or diminish the issue of
"birth." Birth is a process: Life or death is an
outcome. To no fault of the parents, their child was
born dead. Your great state can deem it very
appropriate to acknowledge all of Alaska's stillborn
children. The fact is: they lived, they died, and
that even in their deaths, all of these children very
much matter.
4:49:12 PM
REPRESENTATIVE FAIRCLOUGH asked how the states, which have
adopted this action, have addressed the legal aspects.
MR. LOGULLO stated that primarily states have made this an
optional document, to assist families in the bereavement
process, not a political mandate. Inheritance, and
transference, concerns have been addressed by including a
disclaimer on the document stating that "this is not proof of
live birth." Additionally, he stressed the need to have a
retroactive provision, to provide the opportunity for "healing,
hope, and help" to every mother who has previously birthed a
stillborn.
4:52:17 PM
RICHARD OLSEN, Founder, National Stillbirth Association, stated
support for HB 159, and underscored that this is not a political
question, but rather a recognition that an event occurred.
Currently, if twins are birthed, one alive and one still, the
stillborn child is not certified. He relayed a story of the
mother who formed the MISS foundation, and the event that
prompted her to action. Prior to the passage of these bills,
mothers have not been able to receive acknowledgment that a
child was born, albeit still. He reported that 80 babies are
born dead, on an average day in America; the mother's have done
nothing wrong, and the cause of death is unknown. It is not a
life style issue, he stressed, and to get past the "unknown"
cause of death, the acknowledgment, and certification, of the
birth is helpful. The numbers of sudden infant deaths, or crib
deaths, are fewer than stillborn, but widely discussed and
acknowledged. He explained, that when his child was stillborn,
and there were no activist groups available, he founded the
National Stillbirth Association. He estimated that over one
million women in the United States have had to deal with a
stillbirth.
4:58:32 PM
CHAIR WILSON closed public testimony.
4:58:50 PM
CHAIR WILSON suggested that the birth certificate could have a
section added to indicate stillbirth, and stressed the need for
the parents to have a certificate made available to acknowledge
the birth.
REPRESENTATIVE GATTO directed attention to the committee packet
and the document examples: "Certificate of Birth Resulting in
Stillbirth," Indiana; and "Certificate of Stillbirth," Iowa.
5:02:50 PM
REPRESENTATIVE ROSES retracted his previous concerns, and stated
that based on testimony heard, and the inclusion on the
certificate that it does not prove live birth, pledged support
for the bill.
5:04:04 PM
REPRESENTATIVE FAIRCLOUGH stated that HB 159 directs the
administration to word the certificate appropriately, and
referring to page 2, line 5, [subsection (d)] she read: "The
department shall prescribe the form and content of a certificate
of birth resulting in stillbirth ..." Further, she offered
Amendment 1, new item [subsection (j)] to read:
Any parent may request that the Bureau prepare and
issue a certificate of birth resulting in stillbirth
without regard to whether the fetal death occurred on,
or before, or after the effective date of this act.
There being no objection, Amendment 1 was adopted.
5:05:33 PM
REPRESENTATIVE GARDNER requested assurance that the unintended
consequences regarding the question of inheritance would receive
legal attention.
5:05:40 PM
CHAIR WILSON announced that HB 159 would be held pending receipt
of a committee substitute.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:05 p.m.
| Document Name | Date/Time | Subjects |
|---|