Legislature(2013 - 2014)CAPITOL 106

03/04/2014 03:00 PM House HEALTH & SOCIAL SERVICES


Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 324 CONTROLLED SUBST. PRESCRIPTION DATABASE TELECONFERENCED
Heard & Held
+= HB 301 AUTOPSIES AND DEATH CERTIFICATES TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 4, 2014                                                                                          
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Pete Higgins, Chair                                                                                              
Representative Wes Keller, Vice Chair                                                                                           
Representative Lance Pruitt                                                                                                     
Representative Lora Reinbold                                                                                                    
Representative Paul Seaton                                                                                                      
Representative Geran Tarr                                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Benjamin Nageak                                                                                                  
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 301                                                                                                              
"An Act relating to duties and procedures of the state medical                                                                  
examiner and the Department of Health and Social Services; and                                                                  
relating to death certificates."                                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 324                                                                                                              
"An Act relating to the controlled substance prescription                                                                       
database."                                                                                                                      
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 301                                                                                                                  
SHORT TITLE: AUTOPSIES AND DEATH CERTIFICATES                                                                                   
SPONSOR(s): REPRESENTATIVE(s) HERRON                                                                                            
                                                                                                                                
02/07/14       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/07/14       (H)       HSS                                                                                                    
02/20/14       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
02/20/14       (H)       Heard & Held                                                                                           
02/20/14       (H)       MINUTE(HSS)                                                                                            
03/04/14       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 324                                                                                                                  
SHORT TITLE: CONTROLLED SUBST. PRESCRIPTION DATABASE                                                                            
SPONSOR(s): REPRESENTATIVE(s) KELLER                                                                                            
                                                                                                                                
02/21/14       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/21/14       (H)       HSS, FIN                                                                                               
03/04/14       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
LIZ CLEMENT, Staff                                                                                                              
Representative Bob Herron                                                                                                       
Alaska State Legislature                                                                                                        
POSITION STATEMENT:  Introduced the committee substitute (CS)                                                                 
for HB 301 for the sponsor, Representative Herron.                                                                              
                                                                                                                                
RAEBELLE WHITCOMB, Director                                                                                                     
Workforce Development Center                                                                                                    
Bristol Bay Native Corporation                                                                                                  
Dillingham, Alaska                                                                                                              
POSITION STATEMENT:  Testified during discussion of HB 301.                                                                   
                                                                                                                                
MARCIA DAVIS, General Council                                                                                                   
Senior Vice President                                                                                                           
Calista Corporation                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 301.                                                                   
                                                                                                                                
KERRE SHELTON, Director                                                                                                         
Central Office                                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 301.                                                                   
                                                                                                                                
JIM POUND, Staff                                                                                                                
Representative Wes Keller                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 324 for the sponsor,                                                                       
Representative Keller.                                                                                                          
                                                                                                                                
DON HABEGER, Director                                                                                                           
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community & Economic Development (DCCED)                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified and answered questions during                                                                  
discussion of HB 324.                                                                                                           
                                                                                                                                
DIRK WHITE, Chairman                                                                                                            
Board of Pharmacy                                                                                                               
Sitka, Alaska                                                                                                                   
POSITION STATEMENT:   Answered questions  during discussion  of HB
324.                                                                                                                            
                                                                                                                                
BARRY CHRISTENSEN, Pharmacist                                                                                                   
Co-Chair                                                                                                                        
Legislative Committee                                                                                                           
Alaska Pharmacists Association                                                                                                  
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 324.                                                                   
                                                                                                                                
JOHN ZIPPERER, MD                                                                                                               
Zipperer Medical Group                                                                                                          
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:   Testified and answered questions  in support                                                            
of HB 324.                                                                                                                      
                                                                                                                                
RICHARD HOLM, Pharmacist                                                                                                        
North Pole, Alaska                                                                                                              
POSITION STATEMENT:  Testified during discussion of HB 324.                                                                   
                                                                                                                                
PATRICIA SENNER                                                                                                                 
Alaska Nurses Association                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Testified and  answered  questions  during                                                            
discussion of HB 324.                                                                                                           
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:00 PM                                                                                                                    
                                                                                                                                
CHAIR PETE  HIGGINS called  the House  Health and Social  Services                                                            
Standing    Committee   meeting    to   order    at   3:04    p.m.                                                              
Representatives Higgins,  Keller, Tarr, Seaton, and  Reinbold were                                                              
present at  the call to order.   Representative Pruitt  arrived as                                                              
the meeting was in progress.                                                                                                    
                                                                                                                                
            HB 301-AUTOPSIES AND DEATH CERTIFICATES                                                                         
                                                                                                                                
3:04:56 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS  announced that  the first  order of business  would                                                              
be HOUSE BILL NO.  301, "An Act relating to duties  and procedures                                                              
of the  state medical  examiner and the  Department of  Health and                                                              
Social Services; and relating to death certificates."                                                                           
                                                                                                                                
REPRESENTATIVE  KELLER  moved  to  adopt  the  proposed  committee                                                              
substitute  (CS)   for  HB  301,  labeled   28-LS1196\P,  Mischel,                                                              
2/27/14, as the  working draft.  There being no  objection, it was                                                              
so ordered.                                                                                                                     
                                                                                                                                
3:05:43 PM                                                                                                                    
                                                                                                                                
LIZ  CLEMENT, Staff,  Representative  Bob  Herron, explained  that                                                              
the changes  in Version  P were mostly  the result from  questions                                                              
raised by  the committee and the  Department of Health  and Social                                                              
Services.   The  first change  was on  page 2,  line 3,  paragraph                                                              
(3),  which  removed  from  statute  explicit  reference  for  the                                                              
state's responsibility  to cover  the cost  of any embalming  that                                                              
transport  carriers  could  require  for the  transport  of  human                                                              
remains.   She declared  that this would  allow the  department to                                                              
"stand  strong with  the families  with which  they work and  find                                                              
ways around  the families  being required  to pay that  additional                                                              
cost"  should  the  transport  companies   require  embalming  for                                                              
transport.   She  directed attention  to  page 2,  lines 28-29,  a                                                              
change  of  language  to read  "transportation  to  the  community                                                              
closest  to where  the  death occurred  or  to another  location,"                                                              
which now  clarified both of these  options in the  written notice                                                              
from DHSS  to the  family.   She moved  on to  page 3, lines  2-3,                                                              
which  deleted  the requirements  for  temperature  controls,  and                                                              
limited the  temperature control  practice to those  available for                                                              
maintaining  remains shipped  by air.   The  requirement would  no                                                              
longer be in statute.   She stated that Sections 3  and 4 from the                                                              
original bill had  been deleted, and that Sections 5  and 6 in the                                                              
original bill were now renumbered as Sections 3 and 4.                                                                          
                                                                                                                                
3:11:24 PM                                                                                                                    
                                                                                                                                
RAEBELLE   WHITCOMB,  Director,   Workforce  Development   Center,                                                              
Bristol  Bay Native  Corporation,  expressed her  support for  the                                                              
proposed  changes in  Version P,  and,  regarding the  requirement                                                              
for   embalming   prior   to   transport,    she   declared   that                                                              
transportation   carriers   should   not   have   the   right   of                                                              
determination  regarding  the  deceased  over the  rights  of  the                                                              
family.   She  asked about  the process  for the  issuance of  the                                                              
death  certificate, asking  for  clarification  that local  health                                                              
aides  in a  community could  begin  the process.   She  expressed                                                              
appreciation  for  the  proposed   bill  as  it  recognized  "many                                                              
factors  that   are  a  concern   for  both  Bristol   Bay  Native                                                              
Association  and  families."    She pointed  out  that  the  costs                                                              
associated with a  death were still very high, and  she noted that                                                              
there  were  still  concerns for  funeral  homes  controlling  the                                                              
remains  of  the deceased  until  the  family  had the  funds  for                                                              
release of the body.                                                                                                            
                                                                                                                                
MARCIA  DAVIS, General  Council,  Senior Vice  President,  Calista                                                              
Corporation,  echoed  the  sentiments  of  Ms.  Whitcomb  for  the                                                              
obligations of air  transporters.  She asked that  it be clarified                                                              
that, as  the bodies were removed  by the state, it  was necessary                                                              
for the bodies to  be returned by the state, and  it was incumbent                                                              
for the  state to deal  with the air  transporter.   She expressed                                                              
her  confidence  with the  compassion  of the  Medical  Examiner's                                                              
office  for  not allowing  a  body  to  sit "in  purgatory"  while                                                              
waiting   for  solutions.      She   stated  the   necessity   for                                                              
understanding that  "the state takes the body, the  state needs to                                                              
return  the   body."     Referring  to   the  issuance   of  death                                                              
certificates by  local authorities,  she reported that  the system                                                              
had  worked well  with  birth certificates  and  that the  systems                                                              
were in place for  death certificates.  She noted  that the Bureau                                                              
of Vital Statistics was in support of the proposed program.                                                                     
                                                                                                                                
REPRESENTATIVE SEATON,  noting that the  language on page  2, line                                                              
3 had been  changing, asked that  Ms. Davis contact the  local air                                                              
carriers to  ensure they know that  embalming was not  required by                                                              
law.                                                                                                                            
                                                                                                                                
MS.  DAVIS said  that this  information would  go out  on the  web                                                              
pages, and that she would meet with the air carriers.                                                                           
                                                                                                                                
3:19:42 PM                                                                                                                    
                                                                                                                                
KERRE  SHELTON,  Director,  Central  Office,  Division  of  Public                                                              
Health,  Department of  Health and  Social  Services, pointed  out                                                              
that there  was only  one medical examiner  in Alaska,  located in                                                              
Anchorage.    As  there  were  not   enough  cases  for  a  second                                                              
position,  all bodies  requiring  an autopsy  were transported  to                                                              
Anchorage,  inspected, and then  returned to  the community.   She                                                              
stated  that standard  practice was  for the  return transport  to                                                              
any location the  family requested, and that the  family would pay                                                              
any  additional  cost.    She clarified  that  embalming  was  not                                                              
required by law  or by the air transfers, although  there had been                                                              
confusion  regarding its  requirement.   She said  that there  was                                                              
some  temperature  control  for bodies,  including  freezing  when                                                              
necessary,  although  this  was not  done  for  all bodies.    She                                                              
shared  that there  had been discussions  for  a pilot project  to                                                              
study  the feasibility  of  rural examinations  via  telemedicine,                                                              
although there was  still a lot of equipment,  infrastructure, and                                                              
training  to be  determined.   She  acknowledged  the zero  fiscal                                                              
note  for the  proposed bill  [Included in  members' packets]  and                                                              
stated that the  costs would be borne by the  local jurisdictions.                                                              
She  explained that  the  electronic  vital records  system  would                                                              
soon  distribute death  certificates, which  would greatly  reduce                                                              
the time delay for completion.                                                                                                  
                                                                                                                                
3:25:59 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS closed public testimony.                                                                                          
                                                                                                                                
3:26:20 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
3:27:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON pointed  to  a large  study  by the  United                                                              
States  military  regarding suicides,  as  this  was an  issue  in                                                              
rural Alaska.   He reported  that a low  Vitamin D  level resulted                                                              
in twice the at-risk for suicide.                                                                                               
                                                                                                                                
3:29:01 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS said that HB 301 would be held over.                                                                              
                                                                                                                                
3:29:15 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:29 p.m. to 3:31 p.m.                                                                       
                                                                                                                                
         HB 324-CONTROLLED SUBST. PRESCRIPTION DATABASE                                                                     
                                                                                                                                
3:31:07 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS announced  that the next order of  business would be                                                              
HOUSE BILL NO.  324, "An Act relating to the  controlled substance                                                              
prescription database."                                                                                                         
                                                                                                                                
REPRESENTATIVE  KELLER, as the  bill sponsor,  said that  this was                                                              
not an  attempt to state  that there was  an opiate  abuse problem                                                              
in Alaska.  He  explained that the policy in  question was whether                                                              
this data base was  important enough to maintain, and,  if so, how                                                              
to pay  for the data  base.   He pointed out  that there  were not                                                              
general funds to continue payment for the existing data base.                                                                   
                                                                                                                                
3:32:45 PM                                                                                                                    
                                                                                                                                
JIM  POUND,   Staff,  Representative  Wes  Keller,   Alaska  State                                                              
Legislature, introduced  the proposed bill, stating  that it would                                                              
continue  a service  to  help slow  "the  illicit, illegal  opiate                                                              
trade business  in Alaska,"  and that  these prescription  opiates                                                              
are a leading  cause of overdoses  and drug related deaths  in the                                                              
country.   He  noted  that these  are not  considered  to be  "the                                                              
normal drug  culture type deaths."   He reported that  the federal                                                              
government had  provided funding  for a limited  time to  start an                                                              
opiate database  in Alaska,  but there was  no longer  any funding                                                              
in  the state's  Fiscal Year  2015 budget  to continue  operation.                                                              
He  stated that  the proposed  bill would  continue this  database                                                              
for opiate  prescription drugs,  with operation and  funding being                                                              
overseen  by the  Board of  Pharmacy.   He declared  this to  be a                                                              
crucial part in  "slowing the ongoing opiate problem  in the State                                                              
of Alaska."   He reported  that shoppers  would go from  doctor to                                                              
doctor for  prescriptions, and then  go from pharmacy  to pharmacy                                                              
to have the prescription  filled.  He said the  database would act                                                              
as  a  deterrent to  this  action.   Directing  attention  to  the                                                              
attached fiscal  note for $57,000 [Included in  members' packets],                                                              
he estimated  that a full scale  operation for the  database would                                                              
cost about $150,000.                                                                                                            
                                                                                                                                
3:35:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  REINBOLD stated  her belief  that the program  was                                                              
absolutely  critical, and  she asked  for clarification  regarding                                                              
the fiscal note.                                                                                                                
                                                                                                                                
MR. POUND  offered his belief that  the fiscal note would  pay for                                                              
the basic annual operation.                                                                                                     
                                                                                                                                
REPRESENTATIVE  KELLER  said that  the  Department  of Health  and                                                              
Social  Services  (DHSS) was  available  to  speak to  the  fiscal                                                              
note.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  REINBOLD stated  that the  data base was  critical                                                              
as "these people are pretty darn sneaky."                                                                                       
                                                                                                                                
REPRESENTATIVE  KELLER referred  to an amendment  that he  had not                                                              
yet proposed, which  would change the wording on page  4, line 29,                                                              
deleting "provider" and inserting "practitioner."                                                                               
                                                                                                                                
MR.  POUND explained  that providers  "are the  ones who  actually                                                              
provide  the drugs"  which is limited  to the  pharmacist  in most                                                              
cases, whereas  practitioner included  everyone who had  access to                                                              
the database.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  SEATON expressed  concern that  the data  base was                                                              
only for immediate  input and was not immediately  searchable.  He                                                              
surmised that  the purpose of the  data base was to  stop multiple                                                              
prescriptions, which would require an interactive database.                                                                     
                                                                                                                                
MR.  POUND suggested  that there  would be  an input  page on  the                                                              
computer in  the pharmacy  and a staffer  would put  your personal                                                              
information into the  computer and the database.   He compared the                                                              
technology to  that of a search  for the availability of  a vanity                                                              
license plate.   He clarified  that the privacy  information would                                                              
only be available to practitioners and pharmacists.                                                                             
                                                                                                                                
REPRESENTATIVE  SEATON offered  an  anecdotal situation  regarding                                                              
the usefulness of the data base.                                                                                                
                                                                                                                                
MR. POUND  replied that he projected  the data base would  have an                                                              
immediate  response for  any problems.    He allowed  that it  was                                                              
debatable whether the  pharmacist had the authority  to not fill a                                                              
prescription which had been written by a doctor.                                                                                
                                                                                                                                
REPRESENTATIVE  TARR asked for  a comparison  of the proposed  and                                                              
the  existing prescription  drug  databases.   She  asked if  this                                                              
proposed  bill   would  continue  the  funding  for   the  current                                                              
database.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  KELLER replied  that  his  understanding was  that                                                              
the current data  base was not real time, whereas  the goal was to                                                              
have a real time database.                                                                                                      
                                                                                                                                
MR.  POUND added  that, as  technology was  quickly changing,  the                                                              
proposed bill allowed the department more flexibility.                                                                          
                                                                                                                                
REPRESENTATIVE  TARR  suggested  that  this could  be  a  seamless                                                              
transition from one database to the next.                                                                                       
                                                                                                                                
3:44:00 PM                                                                                                                    
                                                                                                                                
DON  HABEGER, Director,  Division of  Corporations, Business,  and                                                              
Professional  Licensing,  Department   of  Commerce,  Community  &                                                              
Economic Development  (DCCED), in response to Chair  Higgins, said                                                              
that  real  time was  subjective,  and  that, by  regulation,  the                                                              
pharmacist in charge  must report dispensed  controlled substances                                                              
every thirty  days and this information  was uploaded into  a data                                                              
base run  by a third  party vendor.   This data was  available for                                                              
immediate use,  and could be  reviewed for previous  prescriptions                                                              
to a  patient.  He  suggested that some  of the larger  pharmacies                                                              
may input on a daily basis.                                                                                                     
                                                                                                                                
CHAIR HIGGINS asked  if this data base was being  shut down due to                                                              
lack of funding.                                                                                                                
                                                                                                                                
MR.  HABEGER replied  that the  database  had been  built using  a                                                              
$400,000 grant from  the US Department of Justice,  with an annual                                                              
operating  cost  of $100,000.    He  relayed that,  although  that                                                              
funding had  stopped in  the previous  year, DCCED and  Department                                                              
of   Health  and   Social  Services   had   combined  funding   to                                                              
temporarily maintain the program through this year.                                                                             
                                                                                                                                
CHAIR HIGGINS asked  if proposed HB 324 was trying  to improve the                                                              
same database.                                                                                                                  
                                                                                                                                
MR.  HABEGER   explained  that   the  database  existed   and  was                                                              
operational;  however, there was  not any  future funding  and any                                                              
improvements  as determined  by the  proposed bill  would also  be                                                              
necessary.                                                                                                                      
                                                                                                                                
CHAIR  HIGGINS asked  if the  cost for  proposed improvements  was                                                              
reflected in the fiscal note.                                                                                                   
                                                                                                                                
MR. HABEGER  replied that there  would be a  new fiscal note.   He                                                              
explained  that  there  was already  existing  Board  of  Pharmacy                                                              
designated  staff, paid  through  receipt  supported services,  in                                                              
the  investigative  section.    He offered  his  belief  that  the                                                              
updated fiscal  note would  be for  $105,000, which would  include                                                              
the existing program and staff.                                                                                                 
                                                                                                                                
CHAIR  HIGGINS declared  that his  use  of the  database had  been                                                              
favorable, that  it "is a very  good commodity that the  state has                                                              
and I  would hate to see  it go away  because we're not  giving it                                                              
money that it should  have."  He had concern for  the lack of real                                                              
time,  and he asked  for the  cost to  make the  database in  real                                                              
time.   He  asked what  would  be the  "reasonable  fee" from  the                                                              
prescribers  to maintain the  data base.   He  said "we  should do                                                              
this."                                                                                                                          
                                                                                                                                
MR. HABEGER said  that he could not guess at  the reasonable cost.                                                              
He expressed  concern for  the cause and  effect of  the licensing                                                              
statute,   as  it  stated   that  non-payment   would  result   in                                                              
forfeiture of  the license.  Directing  attention to Section  7 of                                                              
the proposed  bill,  he asked if  there should  be an  enforcement                                                              
action if the fee was not paid.                                                                                                 
                                                                                                                                
3:52:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked  if any  of these  services would  bill                                                              
Medicaid,  and if  there was  any  other health  care database  to                                                              
integrate with this database.                                                                                                   
                                                                                                                                
MR. HABEGER said  that there were concerns with  the original bill                                                              
for security  and patient  confidentiality.   He did not  know the                                                              
reason for contracting with a third party vendor.                                                                               
                                                                                                                                
REPRESENTATIVE  SEATON asked  if  there were  any pharmacies  that                                                              
did not have  access to this technology,  and if so, was  there an                                                              
exemption if they were not able to comply.                                                                                      
                                                                                                                                
MR. HABEGER  explained that the  pharmacist had to first  access a                                                              
web page, then  sign in, and type  in the information.   He opined                                                              
that larger establishments  could download into the  database, and                                                              
that the use of  an electronic system added clarity.   He surmised                                                              
that no one was using a paper format.                                                                                           
                                                                                                                                
REPRESENTATIVE  SEATON   asked  if  hospitals  and   clinics  were                                                              
included in this requirement to use the database.                                                                               
                                                                                                                                
MR. HABEGER  replied that he  was not certain  and he  deferred to                                                              
the Board of Pharmacy.                                                                                                          
                                                                                                                                
REPRESENTATIVE  SEATON,  in response  to Chair  Higgins,  directed                                                              
attention to page  3, line 9, "other than those  administered to a                                                              
patient at  a health care  facility," which possibly  relieved the                                                              
other facilities  of the responsibility  for use of  the database.                                                              
He  declared  that  he  would  like   clarification  of  what  was                                                              
covered.                                                                                                                        
                                                                                                                                
MR. HABEGER again deferred to the Board of Pharmacy.                                                                            
                                                                                                                                
REPRESENTATIVE   TARR,  noting   that  other   user  groups   paid                                                              
licensing   fees  which   were   typically   used  for   training,                                                              
enforcement, and  certifications, asked if it seemed  unusual that                                                              
this  fee  was paid  by  the  subscribers  for the  service,  even                                                              
though it was a service to the patients.                                                                                        
                                                                                                                                
MR.  HABEGER replied  that  this  was an  anomaly,  as the  normal                                                              
licensing fees  for this structure  were included in Title  8, and                                                              
this proposed bill  inserted the Board of Pharmacy's  necessity to                                                              
collect the  fees into Title  17.  He  stated that this  would not                                                              
be under the auspices of his division.                                                                                          
                                                                                                                                
CHAIR HIGGINS  asked how  many prescribing  doctors were  licensed                                                              
in Alaska.                                                                                                                      
                                                                                                                                
MR. HABEGER replied that there were about 5,500.                                                                                
                                                                                                                                
CHAIR  HIGGINS asked  what would  be a  reasonable fee  if it  was                                                              
only paid by these licensed physicians.                                                                                         
                                                                                                                                
MR. HABEGER  said that the  fee would be  expanded to  include all                                                              
the prescribers  in Alaska,  including nurse practitioners,  among                                                              
others.  He said  the Board of Pharmacy would  make that decision,                                                              
and  he  offered an  assumption  that  the  fee would  be  divided                                                              
equally.                                                                                                                        
                                                                                                                                
REPRESENTATIVE  SEATON  asked  if  the fiscal  note  [Included  in                                                              
members' packets] was being revised.                                                                                            
                                                                                                                                
MR.  HABEGER replied  that  a new  fiscal  note  would change  the                                                              
language to include the new license program.                                                                                    
                                                                                                                                
4:02:18 PM                                                                                                                    
                                                                                                                                
DIRK WHITE,  Chairman, Board  of Pharmacy,  stated that  there had                                                              
originally  been intent  language  that pharmacists  would not  be                                                              
charged  to  maintain  this program,  and  the  pharmacists  would                                                              
prefer to  maintain that  original intent  and find another  means                                                              
to  fund this  program.   He said  that  pharmacists were  already                                                              
under a financial burden to input the data.                                                                                     
                                                                                                                                
CHAIR HIGGINS  pointed to page  4, lines  27-29, and asked  if the                                                              
Board of Pharmacy disagreed with the language.                                                                                  
                                                                                                                                
MR. WHITE  replied that pharmacists  already incurred  a financial                                                              
burden with  having to  gather and  provide the  data.   He agreed                                                              
that the  Board of  Pharmacy would  prefer this  language  was not                                                              
included in  the proposed bill,  as it was  not the intent  of the                                                              
original  legislation for  the pharmacists  to bear the  financial                                                              
burden to maintain the program.                                                                                                 
                                                                                                                                
REPRESENTATIVE  KELLER relayed that  the intent  was "not  to pick                                                              
on  anybody."    He  opined  that  the  House  Health  and  Social                                                              
Services Standing  Committee would do its best,  and would forward                                                              
it to the House  Finance Committee.  He declared  that "it was not                                                              
the intent, it's just that somebody's gotta pay."                                                                               
                                                                                                                                
REPRESENTATIVE  REINBOLD  suggested  that  Mr. White  contact  the                                                              
Administrative Regulation  Review committee, of which  she was the                                                              
chair.                                                                                                                          
                                                                                                                                
REPRESENTATIVE  SEATON directed  attention  to the  aforementioned                                                              
consequence,  and   asked  if  the  Board  of   Pharmacy  had  the                                                              
authority to adopt consequences if the fees were not paid.                                                                      
                                                                                                                                
MR. WHITE deferred to Mr. Habeger.                                                                                              
                                                                                                                                
REPRESENTATIVE  SEATON  suggested  a  need for  clarity  to  this,                                                              
before the proposed bill moved.                                                                                                 
                                                                                                                                
MR. WHITE offered to research the question.                                                                                     
                                                                                                                                
4:08:25 PM                                                                                                                    
                                                                                                                                
BARRY  CHRISTENSEN, Pharmacist,  Co-Chair, Legislative  Committee,                                                              
Alaska   Pharmacists   Association,   stated   that   the   Alaska                                                              
Pharmacists  Association  represented   pharmacists  and  pharmacy                                                              
technicians in  Alaska.  He declared  that this proposed  bill was                                                              
important  to  the  membership.   He  relayed  that  the  original                                                              
intent  of  the  program  was  for it  to  be  voluntary  for  the                                                              
pharmacist  to access,  as it  was necessary  to use  professional                                                              
judgment  to  determine whether  to  access  the  data base.    He                                                              
pointed out that  pharmacists often did not immediately  enter the                                                              
data  for each  prescription, and  that  logistical and  technical                                                              
reasons  had prevented  the  program  from being  real  time.   He                                                              
directed  attention to  page 2,  line 31,  [paragraph] (3),  which                                                              
stated  "in  cooperation  with the  board,  seek  funding  sources                                                              
other than  the state  for operation  of the controlled  substance                                                              
prescription database,"  and he  asked for further  clarification.                                                              
Moving on  to page  4, line  19, he questioned  the delegation  of                                                              
authority  to   access  the   database,  expressing   concern  for                                                              
unlicensed people,  outside a pharmacy, being able  to access this                                                              
database.                                                                                                                       
                                                                                                                                
MR. CHRISTENSEN,  in response to Representative  Keller, suggested                                                              
that  page 4,  line 21,  be changed  to  say "licensed  employee,"                                                              
which would allow greater control over access to the database.                                                                  
                                                                                                                                
REPRESENTATIVE  SEATON asked  for clarification  that it  would be                                                              
an employee, and  not specifically a "practitioner."   He asked if                                                              
all  the  practitioners  with  access to  the  database  would  be                                                              
licensed.                                                                                                                       
                                                                                                                                
MR.  CHRISTENSEN  replied  that  all the  practitioners  would  be                                                              
licensed.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  TARR  asked how  the  database funding  was  being                                                              
addressed in other states.                                                                                                      
                                                                                                                                
MR.   CHRISTENSEN   replied   that  there   were   other   funding                                                              
mechanisms,  which  included payment  by  all the  prescribers  in                                                              
Oregon, Medicaid  settlements, private  donation foundations,  and                                                              
state  general  revenue  funds.    He asked  about  the  cost  for                                                              
collection and administration of the funds.                                                                                     
                                                                                                                                
4:16:15 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS, noting  the difficulty to forge  computer generated                                                              
script  [prescriptions],  asked   whether  there  were  more  hand                                                              
written or computer generated prescriptions.                                                                                    
                                                                                                                                
MR. CHRISTENSEN  replied that there  were more computer  generated                                                              
prescriptions,  and  that  the number  of  forgeries  had  dropped                                                              
significantly.    He declared  that  although  there was  still  a                                                              
problem with people  shopping from office to office,  the database                                                              
program had helped to control this practice.                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  directed attention to page 3,  line 28, and                                                              
he asked if there  was any conflict with maintaining  the database                                                              
in a  secure file and  the requirement on  page 4, line  13, which                                                              
stated that the database should be purged after two years.                                                                      
                                                                                                                                
MR.  CHRISTENSEN said  that federal  law, mirrored  by state  law,                                                              
required  the  two year  controlled  substance  prescription  data                                                              
purge, and he did not see any conflict.                                                                                         
                                                                                                                                
REPRESENTATIVE  SEATON asked  for clarification  for what  portion                                                              
of the data base was purged.                                                                                                    
                                                                                                                                
MR.   CHRISTENSEN   said   that  the   identifications   and   the                                                              
prescriptions were purged.                                                                                                      
                                                                                                                                
CHAIR  HIGGINS  asked if  the  information  was purged  every  two                                                              
years for storage reasons.                                                                                                      
                                                                                                                                
MR. CHRISTENSEN  offered  his belief that  this practice  mirrored                                                              
federal  regulations for  how  long a  prescription  needed to  be                                                              
kept on file  by a pharmacy.   He clarified that the  records were                                                              
actually  kept  by  the pharmacies  for  ten  years  for  Medicare                                                              
regulations.    He opined  that  the  cost  for data  storage  and                                                              
maintenance  could be  the reason  for  the purge.   He  suggested                                                              
that  people  who   were  shopping  for  drugs   were  doing  this                                                              
continually,  and did not  stop for  a few  years, and  then start                                                              
again.                                                                                                                          
                                                                                                                                
CHAIR  HIGGINS noted  that he  was  supposed to  keep records  for                                                              
seven years.                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  expressed his concern for page  4, line 13,                                                              
which said  "shall be  purged from  the database,"  as he  did not                                                              
want there to be conflicting requirements under the law.                                                                        
                                                                                                                                
4:22:40 PM                                                                                                                    
                                                                                                                                
JOHN  ZIPPERER, MD,  Zipperer Medical  Group,  stated his  support                                                              
for  HB  324,  noting  that it  was  an  important  step  forward,                                                              
although  it  could go  even  further.    He  said that  the  most                                                              
essential component  was the ability for providers  to access this                                                              
information, and  that these databases have "done  tremendous good                                                              
in  preventing  diversion  of  these   substances."    He  offered                                                              
several  anecdotes regarding  patients  seeking prescriptions  and                                                              
the  use of  the  prescription database.    He  stressed that  the                                                              
database  was for the  benefit of  the patient,  and access  to it                                                              
was   critical   for   physicians.     He   concurred   that   the                                                              
practitioners  should be charged  a fee for  use of  the database.                                                              
He relayed  a recommendation that  a prescription  drug monitoring                                                              
report should be made on every patient on every visit.                                                                          
                                                                                                                                
REPRESENTATIVE TARR  asked if he  was willing to pay  a reasonable                                                              
fee to  maintain the database,  and if  so, what would  he suggest                                                              
for that fee.                                                                                                                   
                                                                                                                                
DR. ZIPPERER  said that  a subscription  service to the  providers                                                              
for $40 to  $50 each month would  not be burdensome.   He declared                                                              
that the price  for not using the  database was a lot  higher, and                                                              
he suggested  the opportunity  for a physician  to opt out  of the                                                              
service   if  not  they   did  not   prescribe  these   controlled                                                              
substances.    He  declared  that   the  database  was  "extremely                                                              
valuable to the patients and to the citizens of Alaska."                                                                        
                                                                                                                                
4:28:55 PM                                                                                                                    
                                                                                                                                
RICHARD  HOLM, Pharmacist,  reported  that  he was  the  immediate                                                              
past chair  of the Board  of Pharmacy.   He suggested that  it was                                                              
necessary  for  the  practitioner   to  have  the  opportunity  to                                                              
delegate staff to  look up this information.  He  pointed out that                                                              
HIPAA  regulations   necessitated  that  all  pharmacy   staff  be                                                              
licensed  and  regulated   by  the  Board  of   Pharmacy,  and  he                                                              
suggested  a  change  to  the wording  of  the  proposed  bill  as                                                              
previously  mentioned by  Mr. Christensen.   He  stated that  many                                                              
individuals  benefited from  this  program, including  pharmacists                                                              
and prescribers,  as well as system  benefits to the  patients and                                                              
different  agencies of  the  state.   Because  of this  widespread                                                              
benefit,  he suggested  use of  the general  fund to  pay for  the                                                              
program.     He  reminded  the   committee  that  a  fee   on  the                                                              
prescribers was not  fair, as not all prescribers  dispensed these                                                              
substances.   He pointed  out that  the cost  for maintaining  the                                                              
system was  already paid  by the  pharmacists, although  they were                                                              
not  mandated to  use  the system.   He  reported  that there  was                                                              
still some  paper reporting in  the system from  small dispensers,                                                              
veterinarians,  and  dentists.   He  noted  that the  system  also                                                              
covered  out of  state  pharmacies  licensed in  Alaska,  although                                                              
some  would   request  exemptions  as   they  did  not   send  any                                                              
controlled  substances into Alaska.   He  suggested that  it would                                                              
be difficult to pinpoint the exact users of the system.                                                                         
                                                                                                                                
REPRESENTATIVE  REINBOLD asked  for  clarification regarding  mail                                                              
order pharmacies.                                                                                                               
                                                                                                                                
MR. HOLM said that  some out of state licensed  pharmacies did not                                                              
send  controlled   substances  to   Alaska.    He   discussed  the                                                              
difficulties for real  time as it depended on  the definition, and                                                              
he   offered    some   scenarios    regarding   distribution    of                                                              
prescriptions,  declaring that,  until a  prescription was  picked                                                              
up by  the patient, it  was not truly  dispensed.  He  stated that                                                              
the  database was  developed for  informational  purposes, and  he                                                              
offered his belief that real time made it an enforcement tool.                                                                  
                                                                                                                                
4:40:11 PM                                                                                                                    
                                                                                                                                
PATRICIA  SENNER, Alaska  Nurses  Association,  reported that  the                                                              
Alaska Nurses  Association  had testified  in support of  creation                                                              
of  this data  base  in 2008,  while  expressing  concern for  the                                                              
necessary safeguards  for privacy.  At that time,  the association                                                              
had requested  that only licensed  providers be allowed  to access                                                              
the database, and  that personal addresses not be  included in the                                                              
database,  which was  not approved  at that time.   She  expressed                                                              
concern for  the release  of personal  information.  She  reported                                                              
that  nurse practitioners  required  authority from  the Board  of                                                              
Nursing to  prescribe controlled  substances,  and, as these  were                                                              
prescribed on an  intermittent basis, the fees  should reflect the                                                              
actual use  of the database.  She  said that a small  amount could                                                              
be included in  licensing fees, with the various  boards having an                                                              
enforcement role.                                                                                                               
                                                                                                                                
REPRESENTATIVE  TARR asked  about any other  cautionary issues  to                                                              
consider.                                                                                                                       
                                                                                                                                
MS. SENNER  replied that there was  the threat of  blackmail using                                                              
the  database information,  with  the  threat to  release  medical                                                              
records.                                                                                                                        
                                                                                                                                
4:44:02 PM                                                                                                                    
                                                                                                                                
CHAIR  HIGGINS said  that  the bill  would  be held  over, as  the                                                              
sponsor wanted  to continue  work on  the bill.   He suggested  an                                                              
opt out clause,  or a monthly fee to access the  database, so that                                                              
only those who needed  to use it would pay for it.   He declared a                                                              
need  for   more  discussion  regarding   who  could   access  the                                                              
database.   He declared  his support  for the  database, and  that                                                              
general  funds  would  be the  best  route  to  pay  for it.    He                                                              
expressed  understanding for  the pharmacists'  reluctance to  pay                                                              
for  the database,  as  they already  had to  input  the data  and                                                              
maintain it.                                                                                                                    
                                                                                                                                
CHAIR HIGGINS kept public testimony open.                                                                                       
                                                                                                                                
REPRESENTATIVE  SEATON,  in  response  to  Representative  Keller,                                                              
said that he  wanted more clarity for  page 3, line 9,  as to what                                                              
was  included as  "administered  to  a patient  at  a health  care                                                              
facility."   He  opined that  Section 3  was an  opt in  scenario,                                                              
because  if   you  were  not   distributing  any  of   the  listed                                                              
controlled  substances,  you were  not  required  to submit.    He                                                              
suggested that  this could  be the mechanism  to define  those who                                                              
would opt-out, and not be required to pay a fee.                                                                                
                                                                                                                                
CHAIR  HIGGINS   said  that  dentists   were  included   in  these                                                              
schedules for  the controlled  substances, and  that it  covered a                                                              
lot  of  people.   He  stated  that  not everyone  would  use  the                                                              
database, if there  was not a need, as they did  not prescribe the                                                              
controlled substances.  He suggested writing opt-out language.                                                                  
                                                                                                                                
REPRESENTATIVE  SEATON  asked  for   clarification  regarding  the                                                              
purges from  the database after  two years,  and if there  was any                                                              
conflict with the maintenance of these records for ten years.                                                                   
                                                                                                                                
CHAIR HIGGINS shared  that he kept his patient  records and copies                                                              
of prescriptions for  more than seven years.  He  said that he did                                                              
not know how important it was for the two year purge.                                                                           
                                                                                                                                
REPRESENTATIVE  TARR asked  for  clarification  for the  necessary                                                              
speed for  recording the  information and  the definition  of real                                                              
time.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  SEATON  pointed  out  that, as  there  were  still                                                              
written  prescriptions,  it  might   be  necessary  to  include  a                                                              
provision regarding limited prescriptions and rural areas.                                                                      
                                                                                                                                
CHAIR  HIGGINS clarified  that it  was pharmacists  who input  the                                                              
data, not those who write the prescriptions.                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON replied  that he was  referring to  earlier                                                              
testimony for dispensing by rural doctors and veterinarians.                                                                    
                                                                                                                                
4:51:59 PM                                                                                                                    
                                                                                                                                
[HB 324 was held over.]                                                                                                         
                                                                                                                                
4:52:05 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being  no further business  before the committee,  the House                                                              
Health  and   Social  Services  Standing  Committee   meeting  was                                                              
adjourned at 4:52 p.m.                                                                                                          

Document Name Date/Time Subjects
HB0324A.PDF HHSS 3/4/2014 3:00:00 PM
HB 324
HB 324 Sponsor.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB 324 Sectional.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB 324 Sub Abuse AK.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB 324 Prescription painkiller overdoses.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB 324 CDC report.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB 324 Alaska Opioid Prescribing Policies.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB301 Draft Proposed CS - 28-LS1196.O.pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB 301 Supporting Document - FORMER Authorization for Release of Remains form.pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB 301 Supporting Document - CURRENT Authorization for Release of Remains form.pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB324-DCCED-CBPL-02-28-14.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB324-DHSS-MAA-02-28-14.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB324-DOA-HPA-02-28-14.pdf HHSS 3/4/2014 3:00:00 PM
HB 324
HB 301 changes 28-LS1196 .C to .P.pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB 301 Draft Proposed CS - 28-LS1196.P - H HSS 03.04.2014.pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB301 Support Letter - Bristol Bay Native Corporation.pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB301 Support Letter - Calista Corp..pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB301 Support Resolution - Alaska Federation of Natives.pdf HHSS 3/4/2014 3:00:00 PM
HB 301
HB 301 Support Letter - Alaska Commission on Aging.pdf HHSS 3/4/2014 3:00:00 PM
HB 301