Legislature(2009 - 2010)CAPITOL 106
04/09/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB188 | |
| HB168 | |
| HB223 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 188 | TELECONFERENCED | |
| *+ | HB 168 | TELECONFERENCED | |
| *+ | HB 223 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 9, 2009
3:05 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative John Coghill
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 188
"An Act relating to the taxation of moist snuff tobacco, and
amending the definition of 'tobacco product' in provisions
levying an excise tax on those products."
- HEARD AND HELD
HOUSE BILL NO. 168
"An Act relating to state certification and designation of
trauma centers; creating the uncompensated trauma care fund to
offset uncompensated trauma care provided at certified and
designated trauma centers; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 223
"An Act relating to the qualifications for residential
psychiatric treatment center caregiver staff; and providing for
an effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 188
SHORT TITLE: TAX ON MOIST SNUFF
SPONSOR(s): REPRESENTATIVE(s) HERRON
03/12/09 (H) READ THE FIRST TIME - REFERRALS
03/12/09 (H) HSS, L&C, FIN
03/24/09 (H) HSS AT 3:00 PM CAPITOL 106
03/24/09 (H) <Bill Hearing Rescheduled to 03/26/09>
03/26/09 (H) HSS AT 3:00 PM CAPITOL 106
03/26/09 (H) Heard & Held
03/26/09 (H) MINUTE(HSS)
04/09/09 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 168
SHORT TITLE: TRAUMA CARE CENTERS/FUND
SPONSOR(s): REPRESENTATIVE(s) COGHILL
03/09/09 (H) READ THE FIRST TIME - REFERRALS
03/09/09 (H) HSS, FIN
04/09/09 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 223
SHORT TITLE: TRAINING FOR PSYCHIATRIC TREATMENT STAFF
SPONSOR(s): HEALTH & SOCIAL SERVICES
04/08/09 (H) READ THE FIRST TIME - REFERRALS
04/08/09 (H) HSS
04/09/09 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
ROB EARL, Staff
to Representative Bob Herron
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced the proposed CSHB 188, Version
N, for the prime sponsor, Representative Herron.
DR. FRANK SACCO, Chair
Alaska Trauma Systems Review Committee
Anchorage, Alaska
POSITION STATEMENT: Presented a Power Point titled "Trauma Care
in Alaska 2009" and answered questions about the Alaska trauma
system.
DR. REGINA CHENNAULT, Chair
Alaska Committee on Trauma;
American College of Surgeons
Alaska Native Medical Center
Anchorage, Alaska
POSITION STATEMENT: Spoke in support of HB 168.
DR. DANNY ROBINETTE
Northern Alaska Medical Surgical
Fairbanks, Alaska
POSITION STATEMENT: Spoke in support of HB 168.
GERAD GODFREY, Chair
Alaska Violent Crimes Compensation Board
Juneau, Alaska
POSITION STATEMENT: Spoke about HB 168.
DAVID HULL, Chairman
Alaska Council on Emergency Medical Services
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 168.
ROD BETIT, President & CEO
Alaska State Hospital and Nursing Home Association (ASHNHA)
Juneau, Alaska
POSITION STATEMENT: Testified about HB 168.
MARK JOHNSON, Chief (ret.)
Community Health and Emergency Medical Services
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Testified about HB 168.
DR. JAY BUTLER, Chief Medical Officer
Office of the Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 168.
MYRA MUNSON, Attorney
The Boys and Girls Home of Alaska
Fairbanks, Alaska
POSITION STATEMENT: Testified about HB 223.
PAT HEFLEY, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified about HB 223.
STACIE KRALY, Chief Assistant Attorney General;
Statewide Section Supervisor
Human Services Section
Civil Division (Juneau)
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Answered questions about HB 223.
STACY TONER, Deputy Director
Division of Behavioral Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions about HB 223.
BEVERLY WOOLEY, Director
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions about HB 223.
JIM MALEY, President & CEO
Alaska Children's Services (ACS)
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 223.
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority (AMHTA)
Department of Revenue (DOR)
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 223.
KATE BURKHART, Executive Director
Alaska Mental Health Board (AMHB)
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions about HB 223.
FRAN PURDY, Executive Director
Alaska Youth & Family Network (AYFN)
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 223.
ACTION NARRATIVE
3:05:45 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Keller, Herron, Cissna, Seaton, Lynn, and
Coghill were present at the call to order. Representative
Holmes arrived as the meeting was in progress.
HB 188-TAX ON MOIST SNUFF
3:06:01 PM
CO-CHAIR KELLER announced that the first order of business would
be HOUSE BILL NO. 188, "An Act relating to the taxation of moist
snuff tobacco, and amending the definition of 'tobacco product'
in provisions levying an excise tax on those products."
3:07:08 PM
CO-CHAIR HERRON moved to adopt the proposed Committee Substitute
(CS) for HB 188, Version 26-LS0714\N, Bullock, 4/9/09, as the
working document.
CO-CHAIR KELLER objected for the purpose of discussion.
CO-CHAIR HERRON said that his intent was to reduce the use of
snus and moist snuff tobacco, especially by young people, and to
increase the revenue for cessation grants. He said that this
Committee Substitute, Version N, changed the tax on moist snuff
tobacco to a weight based tax, and changed the tax on snus to an
ad valorem tax of 100%. He shared his desire to craft
legislation that impacted the smokeless products, which he
opined was a crisis in his district.
3:09:28 PM
ROB EARL, Staff to Representative Bob Herron, Alaska State
Legislature, read from a prepared statement:
Currently in state law, cigarettes are taxed at 10
cents per cigarette ($2 a pack) and all other tobacco
products (OTP) are taxed ad valorem at 75% of their
wholesale price. Moist snuff tobacco (more commonly
called "dipping tobacco") presently falls under the
OTP tax regime.
HB 188 distinguishes between two types of moist snuff
tobacco (MST): spitless MST and all other MST.
Spitless MST are these new light-weight products that
come in teabag-like pouches and obviate the need for
spitting. (Like the Camel Snus tin we saw a couple
weeks ago when this bill was first heard.) HB 188
taxes this spitless MST at 100% ad valorem. All other
MST (mostly the circular tins) will be taxed on a
weight-based system of $1.88 per ounce. All other
OTPs (everything besides cigarettes and both types of
MST) will remain taxed at an ad valorem rate of 75%.
Taxing MST (excluding spitless MST) at a $1.88 per
ounce is designed to reduce the price disparity
between discount and premium MST products. $1.88 per
ounce is currently roughly equal to what the premium
brands currently pay under the ad valorem system.
With HB 188, the tax on discount brands will increase
dramatically and the tax on premium brands will
initially be about the same. The bill does include a
sunset provision, whereby the $1.88 per ounce tax on
non-spitless MST products, barring further legislative
action, would revert back to a 75% ad valorem rate
after 3 years.
This new taxation system will produce additional state
revenue, mostly by raising the taxes paid by discount
MST brands. The Dept. of Revenue has estimated tax
revenue would increase by $1.1 million, although
that's assuming the same amount of product is
purchased as before the tax increase. Also, some
popular MST companies lowered prices recently, having
the net effect that this bill might result in as much
as $1.8 million in additional revenue.
This bill also increases funding for the tobacco
education and cessation fund by sending 25% of the
annual tax revenue collected on all MST products to
this fund, which may be used for tobacco education and
cessation programs.
Currently, if you order cigarettes for personal use
over the Internet, you must pay state taxes on those
purchases. But in current state law, you do not have
to pay taxes on any OTP products imported for personal
use. HB 188 closes that loophole.
The bill also requires that cigars be sold in packages
of at least five; that loose tobacco be sold in
packages weighing at least one ounce; and that single
dose units be sold in original manufacturer's
packaging.
3:13:34 PM
CO-CHAIR HERRON said that snus was only available on military
bases in Alaska. He said that it was outlawed everywhere in the
European Union, except Sweden.
3:14:55 PM
REPRESENTATIVE SEATON introduced three amendments for
discussion. He began discussion of the first amendment, which
read [original punctuation provided]:
Page 3, line 19 following "sold only in" insert "no
less than units of 10"
He said that this would eliminate very small packages of
smokeless tobacco. He discussed the second amendment, which
read [original punctuation provided]:
Page 3, line 1 following "subsection is" delete "75"
insert "100"
Page 3, line 10 following "subsection is" delete "75"
insert "100"
He referred to this second amendment and explained that this was
an increase to the tax rate from 75 percent of the wholesale
price of the tobacco product to 100 percent of the wholesale
price. He brought attention to the third amendment, which read
[original punctuation provided]:
Page 1 line, 10 insert:
Sec. 11.76.100. Selling or giving tobacco to a minor.
(a) A person commits the offense of selling
or giving tobacco to a minor if the person
(1) negligently sells a cigarette, a cigar,
tobacco, or a product containing tobacco or nicotine
to a person under 19 years of age;
(2) is 19 years of age or older and
negligently exchanges or gives a cigarette, a cigar,
tobacco, or a product containing tobacco or nicotine
to a person under 19 years of age;
(3) maintains a vending machine that
dispenses cigarettes, cigars, tobacco, or products
containing tobacco or nicotine ; or
(4) holds a business license endorsement
under AS 43.70.075 and allows a person under 19 years
of age to sell a cigarette, a cigar, tobacco or a
product containing tobacco or nicotine.
He explained that this would regulate products that contained
either tobacco or nicotine. He said that the issue revolved
around two methods for taxes on tobacco, and he asked the
sponsor to formulate a per nicotine dose tax, so that the
committee could achieve a balanced discouragement to each
nicotine delivery system.
3:19:21 PM
CO-CHAIR KELLER closed testimony.
[HB 188 was held over. Co-Chair Keller's objection to the
motion to adopt the committee substitute (CS) for HB 188,
Version 26-LS0714\N, Bullock, 4/9/09, as the working document,
was left pending.]
HB 168-TRAUMA CARE CENTERS/FUND
3:19:35 PM
CO-CHAIR KELLER announced that the next order of business would
be HOUSE BILL NO. 168, "An Act relating to state certification
and designation of trauma centers; creating the uncompensated
trauma care fund to offset uncompensated trauma care provided at
certified and designated trauma centers; and providing for an
effective date."
3:20:19 PM
REPRESENTATIVE COGHILL stressed that it was a high priority for
Alaska to have an emergency trauma delivery system. He
explained that he would like to incentivize hospitals to attain
trauma center designation, and to direct funding for trauma
uses. He noted that two central issues were for uninsured
patients, and for payment to the hospitals for the new programs.
He suggested that hospitals which increased their trauma
designation would receive repayment for the expenses. He
referred to the "Trauma System Consultation" report from its
November 2-5, 2008, meeting in Anchorage, Alaska. [Included in
the members' packets] He noted that the report contained
suggestions of ways for Alaska to improve its trauma system. He
opined that hospitals would be reluctant, but would support this
program. He summarized that there was an important need to take
care of Alaskans who were hurt, and that there should not be a
question of where the payment would come from.
3:27:48 PM
DR. FRANK SACCO, Chair, Alaska Trauma Systems Review Committee,
said that his report would demonstrate why this was important,
what had been done so far, and what was still needed. He quoted
the former U.S. Surgeon General, C. Everett Koop, "If a disease
were killing our children at the rate unintentional injuries
are, the public would be outraged and demand that this killer be
stopped." He opined that a public health system approach was
the only proven way to make an impact. He stated that the
leading cause of death for individuals up to 44 years of age was
trauma, and yet it was still not recognized.
3:31:15 PM
DR. SACCO referred to slide 5, "Trauma in Alaska," and detailed
the annual impact to Alaskans.
3:31:45 PM
DR. SACCO directed attention to the comparative deaths by trauma
in the U.S. and Alaska on slide 6, "Death from Trauma in
Alaska." He pointed out the high rate for Alaskans and the much
higher rate for Alaska natives, and he noted that the Alaska
trauma death rate was second only to New Mexico.
3:32:21 PM
DR. SACCO explained that the leading causes of traumatic death
in Alaska were motor vehicles and firearms, slide 7, "Trauma in
Alaska." He disclosed that 25 percent of the $73 million cost
for trauma care in Alaska was not compensated.
3:32:53 PM
DR. SACCO compared the time from injury to death on slide 8,
"Death from Trauma." He pointed out that intervention during
the golden hours would improve survival.
3:33:27 PM
DR. SACCO indicated slide 9, "Trauma Systems," and read "A
trauma system consists of hospitals, personnel, and public
service agencies with a preplanned response to caring for the
injured patient."
3:33:51 PM
DR. SACCO considered slide 10, "Trauma Systems," and described
the facilities, the personnel training, the patient transport,
the triage. He said "a trauma system was getting the right
patient to the right place in the right amount of time."
3:34:20 PM
DR. SACCO looked at slide 11, "Facilities-Trauma Centers," and
reviewed the definitions for Levels I-IV of trauma centers.
3:35:28 PM
DR. SACCO spoke about the various trauma related courses, which
included ATLC, TNCC, RTTDC, and ETT, on slide 12, "Personnel."
3:36:07 PM
DR. SACCO directed attention to slide 13, "Transport and
triage," and spoke about the guidelines that take into account
local resources and capabilities.
3:36:35 PM
DR. SACCO referred to "Trauma Systems" on slide 14, and declared
that trauma systems improved survival of the seriously injured
by 15 -25 percent, increased the productive working years, and
enhanced the statewide disaster preparedness.
3:37:25 PM
DR. SACCO spoke to slide 15 "Preventable Deaths: the impact of
trauma systems," and he compared the decrease to percentages of
preventable deaths for three major metropolitan areas.
3:37:47 PM
DR. SACCO continued on to slide 16, "Trauma Systems & crash
mortality," which depicted a state to state comparison for crash
mortality before and after the introduction of trauma systems.
3:37:59 PM
DR. SACCO explained that slide 17, "Trauma systems & crash
mortality" revealed the impact on mortality rates with trauma
systems, seat belt restraint laws, lower allowable blood level
alcohol, and increases to the speed limit.
3:38:21 PM
DR. SACCO spoke about slide 18, "Anchorage Mortality Rate 2005-
2007" which depicted the lower mortality rate for designated, as
opposed to non-designated, trauma centers in Anchorage. He
explained that the next slide reflected the significant
differences for age group mortality rates between the designated
and non-designated trauma centers. He reviewed the next slide,
"Trauma Center and Disaster Preparedness," and noted that a
trauma center maintained its readiness, was staffed for all
types of injuries, had a broad communications network, and had
the resources to facilitate the patient's recovery.
3:39:21 PM
DR. SACCO stated that slide 21 "Trauma Systems and the Public,"
showed that 83 percent of the people wanted a trauma system in
their area.
3:39:47 PM
DR. SACCO said that slide 22, also titled "Trauma Systems and
the Public," affirmed that 75 percent of people interviewed
thought there was a trauma center system in their state, but in
actuality only 15 percent of the people lived in a state with a
comprehensive system.
3:40:17 PM
DR. SACCO explained slide 23, "Alaska Trauma System," and noted
that a 1993 Alaska statute created the EMS authority for
designating trauma centers, set national standards for trauma
centers, and made hospital participation in the trauma system
voluntary. He said that in the 15 years since, there was only
one Level II trauma center and four Level IV centers in Alaska,
which were all listed on slide 25, "Current Status."
3:41:54 PM
DR. SACCO introduced the Site Visit Team on slide 26, and he
described the "Objective," slide 27, which was "To help promote
a sustainable effort in the graduated development of an
inclusive trauma system for Alaska."
3:42:20 PM
DR. SACCO continued on to slide 28, "Advantages & Assets," and
emphasized that Alaska had very committed individuals who served
Alaska, that there was an extensive transport network, that
there were three large medical centers with extensive expertise
in the state, and that there was a very good relationship with
Harborview Medical Center in Seattle for sending trauma
patients. He also listed the Level II facility, with other
small hospitals working toward verification of Level IV. He
said the Alaska Trauma Registry received data from all 24 acute
care hospitals.
3:43:27 PM
DR. SACCO moved on to slide 30, "Challenges and
Vulnerabilities." He declared that Alaska did not have a trauma
system plan, there were no trauma standards, there were limited
human resources, there were few incentives for hospital
participation, and there was not a statewide performance
evaluation.
3:44:24 PM
DR. SACCO directed attention to slide 31, "Trauma Care in Alaska
2009," and concluded: "There are two healthcare systems for
injured patients. One for Alaska natives that adheres to
national standards and another for the majority of the
population." [original punctuation provided]
3:44:32 PM
DR. SACCO referred to the recommendations on slide 32,
"Definitive Care Facilities," and said that a second Level II
Trauma Center had to be established in Anchorage, and that
participation by all acute care hospitals should be mandated
within two years for trauma center designation appropriate to
their capabilities. He continued with slide 33, and declared
that there was a need for pediatric trauma care capability. He
concluded that it was necessary to determine a method of
financial support to trauma centers for uncompensated care.
3:45:30 PM
DR. SACCO noted that slide 36, "Alaska Trauma Systems Review
Committee," reflected that the committee met twice a year and
that its role was to review the Level IV hospitals and the
interfacility transfer guidelines, and make suggestions for
trauma system improvement.
3:45:57 PM
DR. SACCO explained that "Head Injury Guidelines for Rural and
Remote Alaska," were implemented primarily by the tribal health
system and it decreased unnecessary medevacs by 75 percent, with
no adverse consequences.
3:47:10 PM
DR. SACCO commented on slide 38, "Current Activity US," and
compared that both Georgia and Arkansas put millions of dollars
into the trauma system, whereas Alaska was the only state
without a designated Level 1 or Level 2 trauma center, other
than the Native Health Service facility. He added that federal
legislation was currently being considered for help to trauma
centers.
3:48:24 PM
DR. SACCO concluded with slide 39, "Alaska Trauma System: "Where
do we go now?" and said that it was necessary to increase
facility participation for development of an inclusive system.
3:49:08 PM
REPRESENTATIVE CISSNA asked about community emergency response
training.
DR. SACCO, in response to Representative Cissna, explained that
the difference between designated and non-designated hospitals
was determined by the ability to maintain a minimum care level.
He endorsed the need to organize providers and facilities to
ensure that this care level was always available.
DR. SACCO, in response to Representative Cissna, explained that
the mortality rates were adjusted per 100,000 people, and that
Alaskans had the second highest rate.
3:52:30 PM
REPRESENTATIVE CISSNA referred to the need for funding, and
asked what could be done that was not funding related.
DR. SACCO said that there were over 70 recommendations in the
American College of Surgeons report [Included in the members'
packets], many of which did not require any funding. He gave
two examples: mal-practice caps on damages at a designated
trauma center and Medicare and Medicaid allowable billing by
designated trauma centers for the Emergency Room activation of a
trauma team.
3:55:37 PM
CO-CHAIR KELLER opened public testimony.
3:55:55 PM
DR. REGINA CHENNAULT, Chair, Alaska Committee on Trauma,
American College of Surgeons, Alaska Native Medical Center, said
that she agreed with Dr. Sacco, and that a trauma system was
also the best design for handling any disaster. She stated that
appropriate trauma care did reduce mortality.
3:58:26 PM
DR. DANNY ROBINETTE, Northern Alaska Medical Surgical, observed
that there was an increasing manpower shortage for general
surgery. He noted that trauma patients were often under insured
and he suggested that there be incentives for doctors. He said
that it became necessary to medevac a patient to Seattle when
the Anchorage medical system did not have the availability.
4:01:45 PM
GERAD GODFREY, Chair, Alaska Violent Crimes Compensation Board,
related a personal story which reflected the flaws in the trauma
response time. He said that the ad hoc committee had realized
that there was not a standardized procedure for all the
potential variables. He opined that there was unwillingness
from the hospitals to go along with the training, the protocols,
and the start up cost. He supported the pro active approach of
the American College of Surgeons.
4:08:00 PM
DAVID HULL, Chairman, Alaska Council on Emergency Medical
Services, said that trauma care needed to be addressed. He
offered examples of emergency medical systems that had treated
trauma patients, and he advocated for an entire trauma care
system.
4:12:30 PM
ROD BETIT, President & CEO, Alaska State Hospital and Nursing
Home Association (ASHNHA), said that ASHNHA agreed that work
needed to be done on the trauma care system, and that there
should be incentives for initiating the system. He opined that
DHSS needed to agree on its importance before any talks would be
effective. He observed that that there was a significant cost
to guarantee the availability of physicians and nurses for the
required time response. He remarked that it was different for
staff model hospitals, as the physicians worked for that
hospital, than for private hospitals, where the physicians did
not work for the hospital. He agreed that HB 168 was a good
idea.
4:16:45 PM
MR. BETIT, in response to Representative Coghill, said that the
Medicaid disproportionate share funds were available, as these
were often left unused.
4:17:22 PM
REPRESENTATIVE COGHILL agreed that having an already existing
funding stream was optimal.
4:17:27 PM
MARK JOHNSON, Chief (ret.), Community Health and Emergency
Medical Services, referred to the initial legislation passed in
1993, which had set up the aforementioned voluntary system. He
explained that DHSS had co-sponsored the American College of
Surgeons review of eight different hospitals in Alaska. He said
that he participated in the reviews, and that many facilities
were close to designation. He opined that incentives were
necessary for enthusiasm for the designation process. He
stressed that the trauma system would save lives.
4:19:38 PM
DR. JAY BUTLER, Chief Medical Officer, Office of the
Commissioner, Department of Health and Social Services (DHSS),
said that injury deaths could not be controlled like a disease.
He reported that a systematic approach to improve trauma care
had become a DHSS priority. He shared that an American College
of Surgeons recommendation was for each acute care hospital to
seek trauma center designation, appropriate to its capacity,
within the next two years. He affirmed that the goal was to
improve the quality of care for trauma victims. He stated that
HB 168 provided an incentive to become a trauma center. He
cited potential funding sources for reimbursement to hospitals
for underinsured trauma patients. He noted that DHSS recognized
the importance of trauma care, but that there was uncertainty
for fiscal support. He observed that the administration had
taken a neutral stance.
4:22:37 PM
REPRESENTATIVE SEATON asked how many trauma deaths were alcohol
related, and if it was necessary to address the larger problem
of alcoholism.
DR. BUTLER, in response to Representative Seaton, agreed that
alcohol was a component and that the reduction to the legal
limit for blood alcohol was a part of the larger solution.
REPRESENTATIVE COGHILL, in response to Representative Seaton,
said that he was open to the inclusion of other aspects for
prevention, as these also had an impact on the system.
4:25:53 PM
DR. BUTLER spoke about teachable moments, and he shared that
non-fatal incidences of trauma, specifically alcohol related
events, were excellent teachable moments.
4:26:42 PM
DR. SACCO agreed with the use of teachable moments, and he gave
examples to the success with alcohol intervention and education.
He suggested that a requirement for trauma centers was to teach
injury prevention to high risk populations.
4:29:17 PM
REPRESENTATIVE COGHILL, in reference to the bill, reflected that
it was important to "be quick but don't get in a hurry." He
agreed that there were complexities to the issues, but that
people's lives were involved.
4:30:34 PM
CO-CHAIR KELLER closed public testimony.
[HB 168 was held over.]
HB 223-TRAINING FOR PSYCHIATRIC TREATMENT STAFF
4:31:00 PM
CO-CHAIR KELLER announced that the final order of business would
be HOUSE BILL NO. 223, "An Act relating to the qualifications
for residential psychiatric treatment center caregiver staff;
and providing for an effective date."
The committee took an at-ease from 4:31 p.m. to 4:36 p.m.
4:36:57 PM
CO-CHAIR KELLER acknowledged that there had been ongoing
discussion and negotiation about HB 223. He opened public
testimony.
4:39:12 PM
CO-CHAIR HERRON moved to adopt the proposed Committee Substitute
(CS) for HB 223, Version 26-LS0842\C, Mischel, 4/8/09, as the
working document.
REPRESENTATIVE HOLMES objected for the purpose of discussion.
MYRA MUNSON, Attorney, The Boys and Girls Home of Alaska, said
that the Committee Substitute (CS) set a new level of caregiver
qualification for residential psychiatric treatment centers
(RPTC). She noted that there were currently three caregiver
standards, and she explained the requirements for each option.
She reported that HB 223 allowed for a fourth qualification
option.
4:45:47 PM
REPRESENTATIVE HOLMES asked for a clarification for the new
qualification.
4:45:52 PM
MS. MUNSON explained that page 2, line 26 should not contain
(1), and that this would allow someone without the four year
combination of education and experience to work during the hours
that another qualified caregiver with that four year combination
was at work.
4:46:54 PM
MS. MUNSON referred to Section 1 (c) and noted that an amendment
would mirror the regulation except to also allow that the
training be approved by the department, not merely provided.
She pointed to Section 1(d) which provided a definition of
caregiver.
4:48:34 PM
REPRESENTATIVE HOLMES removed her objection. There being no
further objection, Version C was adopted as the working
document.
4:49:08 PM
PAT HEFLEY, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), said that he
recognized that the health care workforce had one of the highest
vacancy rates in Alaska. He emphasized that this bill was for a
residential psychiatric facility for kids, and that these were
very tough kids. He acknowledged that the Bring the Kids Home
program was working very well, and that about 66 percent of the
kids were home in Alaska. He said that many of the facilities
had problems recruiting employees to be in frequent contact with
the kids. He said that DHSS had a concern with the use of
statute for changes in qualification standards. He noted that
the facilities had the ability to ask for a variance, and that
there was not a need to drop the standard. He expressed concern
that incident reports would increase. He said that only
recently had he been apprised of this urgency, though he was
aware of a shortage of staff. He said that DHSS agreed that
there was a problem, but did not agree with a change in statute
as a solution.
4:57:09 PM
STACIE KRALY, Chief Assistant Attorney General, Human Services
Section, Civil Division (Juneau), Department of Law (DOL), said
that she had not seen the CS, but that the primary concern for
DOL was that there were already processes in place to solve the
issues. She opined that there were quite a few legal problems
with the original bill. She reserved any further comments until
she had an opportunity to review the CS.
4:59:01 PM
REPRESENTATIVE SEATON asked what the optimal limitation to the
number of applicants was qualified within Section 1(b)(4).
MR. HEFLEY said that it was important to have experienced staff,
and he acknowledged that experience was learned. He expressed
his concern for having too many inexperienced staff at any one
given time.
5:01:46 PM
STACY TONER, Deputy Director, Division of Behavioral Health,
Department of Health and Social Services (DHSS), in response to
Representative Seaton, opined that no more than 10 percent of
the staff should be this inexperienced.
5:02:09 PM
BEVERLY WOOLEY, Director, Division of Public Health, Department
of Health and Social Services (DHSS), in response to
Representative Seaton, said that it was difficult to determine,
and this allowed for the variance process to work well. She
explained that the variance request came through her office, and
it allowed review for the specific needs and situations.
5:03:44 PM
CO-CHAIR KELLER asked if there was a comparable standard in the
other states where Alaska had sent the youth.
MS. TONER, in response to Co-Chair Keller, said that the Alaska
standard was comparable to other states, but that this was a big
change to the existing requirements. She noted that there was
no reference to supervision in HB 223.
5:05:39 PM
CO-CHAIR KELLER offered his belief that supervision was
addressed in Section 1(b)(4)(C).
MS. TONER noted that the wording, "to work at the center only
during hours in which an individual is on duty at the center,"
did not address supervision.
5:06:24 PM
REPRESENTATIVE CISSNA said that it was her desire to make the
atmosphere at the RPTCs more homelike. She related her
experiences working at Alaska Psychiatric Institute (API). She
described the RPTC current atmosphere as "much more severe,"
with a higher level of violence, and an increased sense of
hopelessness, all of which required a much higher level of
supervision. She stated that she wanted HB 223 to result in
shorter, safer, healthier patient residential placements.
5:10:05 PM
REPRESENTATIVE LYNN remarked that his year teaching severely
emotionally disturbed kids was good preparation for his work at
the legislature.
5:10:41 PM
CO-CHAIR KELLER asked how many kids were in RPTCs outside Alaska
and ready to come back to Alaska if beds were available.
MS. TONER, in response to Co-Chair Keller, said that there were
164 kids still outside Alaska.
5:11:05 PM
REPRESENTATIVE COGHILL referred to Section 1(c), and asked the
cost for the department to provide "training for caregivers."
MS. TONER pointed out that the fiscal note was $400,000.
5:11:59 PM
CO-CHAIR KELLER asked if it was a given that DHSS provided this
training for RPTC staff.
MS. TONER replied that there was a residential care child
certification training for behavioral rehab service facilities
through the Office of Children's Services. She explained that
this training brought staff to the Medicaid standards and
Medicaid treatment requirements. She allowed that the proposed
HB 223 would also use this same "Bring the Kids Home" venue for
training.
5:13:36 PM
REPRESENTATIVE SEATON referred to Section 1(b) and asked if
paragraphs (1), (2), and (3) were each a separate requirement.
MS. WOOLEY said that four different tiers of qualification were
created.
5:15:39 PM
MS. WOOLEY reiterated that the variance process was currently in
place for any immediate needs. She explained that the
regulatory process allowed full public process and input. She
expressed her concern with HB 223 as "a quick fix."
5:16:47 PM
REPRESENTATIVE COGHILL agreed that he was "no big fan of pulling
regulation out and putting in statutes," but that he was
troubled by the difficulties for navigating the system. He
asked for suggestions to a remedy for hiring qualified care.
MS. WOOLEY, in response to Representative Coghill, agreed that
the regulations were overdue for a revision. She offered that
the front line providers should be involved in the process. She
also suggested that the university system could offer classes
for qualification. She noted the difficulty in balancing the
staff qualifications, the safety and protection of the kids, and
the priority to bringing the kids back to Alaska.
5:20:47 PM
REPRESENTATIVE SEATON asked how many current variances there
were throughout the state.
MS. WOOLEY said that about 37-38 were granted over the last few
years.
5:21:48 PM
REPRESENTATIVE SEATON commented that only one variance had been
allowed for a RPTC.
MS. WOOLEY said that there had only been one request, and this
was a reason for the DHSS surprise to this recent crisis.
5:22:12 PM
JIM MALEY, President & CEO, Alaska Children's Services (ACS),
reported that ACS employed 250 staff, with 96 direct care staff,
who would be included under these regulations. He expressed his
disagreement with the statement from DHSS, and he said that this
had been a long standing challenge. He observed that hiring
direct care staff was always a problem, and he gave examples of
staff shortages and the resulting problems. He said that he had
asked DHSS for a variance, but that he was told that it would be
denied. He reported that ACS had developed a competency based
training model for residential child care workers. He offered
the use of this model at no cost to the state. He expressed
discomfort at this venue for discussion, but he offered his
belief that DHSS had not viewed this as a high enough priority
to make changes to the regulation. He reported that staff
shortages diminished the opportunity to bring more kids back to
Alaska.
5:26:48 PM
MR. MALEY, in response to Co-Chair Keller, repeated that he had
approached DHSS about a variance, and was told that it would not
be granted.
5:27:04 PM
REPRESENTATIVE CISSNA asked about the difficulty for hiring and
retaining staff.
MR. MALEY replied that there were a number of factors, which
included staff pay. He said that an intensive training program
could develop the competency for staff to work with kids, and he
opined that there was a difference between this training and
getting an education.
5:30:27 PM
REPRESENTATIVE SEATON asked what the most common Bachelors
degree was for applicants.
MR. MALEY responded that it would be either psychology or social
work, although there were occasional applicants with
environmental and therapeutic recreation degrees.
5:31:15 PM
REPRESENTATIVE SEATON asked if a required degree in social
services would be more restrictive for hiring.
MR. MALEY replied that it would not be a significant
restriction. He commented that he was supportive of
regulations, but that he had been frustrated with the responses
he had received.
5:32:27 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority (AMHTA), Department of Revenue (DOR), expressed
concern with the legislation. He stated that the points were
well taken, and that there was agreement that the licensing and
staff qualification for RPTCs needed to be reviewed. He noted
that the Fairbanks RPTC had not asked for a variance. He
suggested that it was better to work through the regulations
than to change through statute. He said that the full assurance
from DHSS to quickly address these issues was most important.
He expressed concern with the minimum level for staffing in the
current CS. He pledged his support to the Bring the Kids Home
work group.
5:38:23 PM
KATE BURKHART, Executive Director, Alaska Mental Health Board
(AMHB), explained the background of the AMHB, and noted that the
AMHB was also an advocacy group which solicited public comments
on mental health issues. She stated that AMHB could not support
the current version of HB 223. She said AMHB had not received
any comments from parents that they would support lesser
qualified caregivers at the RPTC. She suggested that the
committee solicit consumer discussion. She said that AMHB
recognized the necessity to balance the provider staffing needs
with the need for quality treatment.
5:40:42 PM
MS. BURKHART declared that AMHB supported the regulation
process, which involved the public. She allowed that this
staffing problem was pervasive throughout the mental health
arena. She stated that all the variables involved in work force
shortages, including wages, benefits, and stress, needed to be
addressed.
5:43:22 PM
MR. HEFLEY acknowledged that there was a problem, but he
suggested that resolution not be through statute. He said that
there was not resistance from DHSS. He reiterated that DHSS was
not aware that there was an issue.
5:44:20 PM
FRANCES PURDY, Executive Director, Alaska Youth & Family Network
(AYFN), said that she had solicited comments from parents
involved with RPTCs. She reported that parents had commented
that the turnover issue was related to pay, not qualifications.
She urged the committee to continue with the regulation process.
She stated that this was not an issue of education, but an issue
of competencies. She shared that the university was developing
"best practice standards." She declared that many issues,
including cultural competency, the stigma of mental health, and
de-escalation of confrontations, were new and required ongoing
training.
5:47:53 PM
MS. MUNSON said that she was sympathetic to the DHSS and AMHTA
concerns. She stated that this problem deserved a quick
solution. She allowed that DHSS had set very high standards for
care providers, which could make it difficult to find adequate
caregivers. She questioned whether the high standards created
the best protection for children, as the issues were most often
about: how much protection, how much money to spend, and how to
find workers willing to do this difficult work. She explained
that, prior to drafting this legislation, she had reviewed the
states with Alaskan children enrolled in RPTCs. She stated that
the Alaska standards were higher than any of the other states,
and she offered some comparisons. She declared that she was not
trying to minimize the important and essential role of the
direct care providers. She stated that the original intent of
the bill was to exactly replicate the existing regulation, so
that there would not be any service disruption, and then to add
an additional standard. She referred to the amendment [labeled
C.3] [Included in the members' packets.] and explained that it
included on-site supervision, or mentorship, by someone who met
the specifically listed requirements. She reiterated that it
was the experience of residential child care in the setting, not
the education, which was most critical. She said that these
entry level jobs often led to an increased interest, and
continued education. She noted that the ratio of supervisors to
caregivers was one to six.
5:59:15 PM
MS. MUNSON said that variances were on an individual by
individual basis. She said that any RPTC which was planning to
open could not ask for a variance until they were hiring. She
explained the importance for any new RPTC to be aware of the
qualification guidelines in advance. She acknowledge the desire
of the DHSS to make the regulatory process a priority, but she
noted that the regulations had been in effect since 1998, and
that all the testifiers to the process had suggested that all
the levels of care needed to be reconsidered. She cited the
difficulty for ACS to maintain all of their units, even with a
large workforce to draw experienced personnel from. She
expressed the urgency for action, and she expressed her concern
that Alaska was sending kids to other states with lower
standards than Alaska. She suggested to fix this caregiver
problem immediately, and then to move forward and deal with
other problems. She suggested making this a temporary bill for
one year, with a provision for DHSS to undertake a regulatory
process. She noted that this would allow for uninterrupted
care, and would give guidance for the development of new
standards.
6:07:19 PM
CO-CHAIR KELLER closed public testimony.
6:08:10 PM
REPRESENTATIVE COGHILL noted that there were amendments still to
be proposed which could affect the fiscal note. He stated that
he wanted to keep moving forward with the legislation, but that
he was hesitant about the approach.
6:08:47 PM
REPRESENTATIVE SEATON reflected that there were problems which
had existed for years. He said that the legislature made laws,
not regulations. He did not want to rush forward, but preferred
to hear more suggestions for options within the variance system.
6:10:42 PM
REPRESENTATIVE CISSNA said that the serious problems began
decades ago. She explained that previously when there were no
services in Alaska, the kids were sent out of state. She opined
that, even now, state policy did not give a priority to these
issues. She stated that the preventative approach achieved
great results at a fraction of the cost. She counseled to "take
the time to do this right." She offered her belief that there
was a pressure "to fill those beds." She emphasized that there
was not a rush for quality or for safety of kids. She suggested
that the House Health and Social Services Standing Committee put
pressure on DHSS for solutions.
[HB 223 was held over.]
6:14:13 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 6:14 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CSHB 188 Sponsor Summary version N.doc |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |
| CSHB 188 Version N.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |
| HSS188pkt.PDF |
HHSS 3/26/2009 3:00:00 PM HHSS 4/9/2009 3:00:00 PM |
|
| HB223pkt.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 223 |
| HB168pkt.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 168 |
| HB 188 Sectional Version N.PDF |
HHSS 4/9/2009 3:00:00 PM |
HB 188 |