02/21/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Brain Injury Network | |
| Presentation: Key Coalition | |
| HB90 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 90 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 21, 2013
3:02 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
PRESENTATION: ALASKA BRAIN INJURY NETWORK
- HEARD
PRESENTATION: KEY COALITION
- HEARD
HOUSE BILL NO. 90
"An Act establishing a temporary program in the Department of
Health and Social Services for testing newborns for baseline
vitamin D levels."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 90
SHORT TITLE: VITAMIN D SUPPLEMENTS
SPONSOR(s): REPRESENTATIVE(s) SEATON
01/30/13 (H) READ THE FIRST TIME - REFERRALS
01/30/13 (H) HSS, FIN
02/21/13 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JILL HODGES, Executive Director
Alaska Brain Injury Network (ABIN)
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Brain Injury
Care."
ROLAND TORRES, CHAIRMAN
Department of Neurosurgery
Alaska Native Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified during the brain injury
presentation.
PAT CHAPMAN
Ketchikan, Alaska
POSITION STATEMENT: Shared her personal story during the
presentation on traumatic brain injury.
SETH KELLEY, Executive Director
FOCUS
Eagle River, Alaska
POSITION STATEMENT: Testified during the Key Coalition
presentation.
JIM BECK, Executive Director
ACCESS Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during the Key Coalition
presentation.
LIZETTE STIEHR, Deputy Director
Infant Learning Program Coordinator
FOCUS
Eagle River, Alaska
POSITION STATEMENT: Testified during the Key Coalition
presentation.
TANEEKA HANSEN, Staff
Representative Paul Seaton
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As staff to the sponsor of the bill,
testified during discussion of HB 90.
WARD HURLBURT, M.D., Chief Medical Officer/Director
Division of Public Health
Central Office
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
90.
ACTION NARRATIVE
3:02:05 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:02 p.m.
Representatives Higgins, Reinbold, and Keller were present at
the call to order. Representatives Seaton, Tarr, and Pruitt
arrived as the meeting was in progress.
^Presentation: Alaska Brain Injury Network
Presentation: Alaska Brain Injury Network
3:03:16 PM
CHAIR HIGGINS announced that the first order of business would
be a presentation by the Alaska Brain Injury Network.
3:04:17 PM
JILL HODGES, Executive Director, Alaska Brain Injury Network
(ABIN), introduced the ABIN board members in attendance. She
stated that there was a lack of brain injury care in Alaska.
Directing attention to slide 3, "Because it Happens a LOT!" she
stated that even though the national incidence of brain injury
was dramatically higher than breast cancer, HIV, and multiple
sclerosis, there was "a lot of potential for recovery and for
really improving after they've had a traumatic brain injury."
She said there was also opportunity for cost savings. She
explained that traumatic brain injury occurred when something
hits you, or you hit something, slide 4, "What is Traumatic
Brain Injury (TBI)?" She shared a personal family anecdote.
She noted that there was a spectrum for severity of TBI, which
included sports concussions and military brain injuries.
3:06:49 PM
MS. HODGES moved to slide 5, "What we know" and reported that an
average of 680 Alaskans were hospitalized each year with TBI,
although an average of 3000 Alaskans annually visited the
emergency room with brain injuries, but went home the same day.
She reported that, although 15,000 Alaskans had been
hospitalized with TBI from 1991-2011, the vast majority then
went home with no assistance. She shared that 34 percent of the
recent behavioral health clients were screening positive for
head injury, and that the homeless and corrections population
also had high incidences.
3:08:30 PM
MS. HODGES explained that the "Traumatic Brain Injury Continuum
of Care," slide 6, began with the emergency evaluation and
continued on through the emergency department and the intensive
care unit to in-patient and out-patient rehabilitation care.
She pointed out that TBI care in Alaska stopped with specialty
neurotrauma care. She shared that ABIN had spoken with various
medical service systems in an attempt to develop a continuum for
care, as none currently had post-acute or lifelong services for
brain injury. She highlighted that "brain injury is a medical
condition, but also it's a chronic condition. You can
rehabilitate, you can recover, but for many, it's a lifelong
thing that you're managing." She stressed the importance for
both treatment and understanding. She indicated slide 8,
"Opportunity," and stated that there were experts in Alaska
ready to create this system of care.
3:10:41 PM
MS. HODGES, in response to Chair Higgins, said that
comprehensive neurological rehabilitation and long-term support
services did not exist in Alaska.
ROLAND TORRES, CHAIRMAN, Department of Neurosurgery, Alaska
Native Medical Center, explained that there were no facilities
in Alaska which addressed brain injury after discharge from the
hospital. He expressed his agreement with Chair Higgins that it
was a strong statement that no facilities existed in Alaska.
3:11:20 PM
MS. HODGES said that policy and payment were essential, varying
from mandated insurance payment, traumatic brain injury Medicaid
waivers, or designated funds from fines, slide 9, "Catch."
REPRESENTATIVE REINBOLD asked if Alaska had a Medicaid waiver.
MS. HODGES replied that, although 24 states had specific brain
injury Medicaid waivers, Alaska did not. In response to
Representative Reinbold, she explained that there were four
Medicaid waivers and that with TBI only Alaskans having
significant physical disabilities or a child with complex needs
would qualify. She clarified that these waivers did not always
pay for rehabilitation. She stated that a TBI waiver was
specific to the functional limitations of a person with a brain
injury.
3:12:42 PM
MS. HODGES read from the biography of Lael Venta:
Lael Venta is one of the Board's founding members. He
doesn't like labels and he doesn't like to talk about
himself, so we were all surprised at a meeting at
Alyeska when he off-handedly remarked that he had run
the power lines to the ski resort and all the lifts.
A coincidence? Well, not really. Several decades ago
Lael ran power lines virtually all over Alaska, over
mountains, through valleys, remote communities and
even on the ocean floor. A craving for adventure and
hard work lured Lael to some of the most dangerous and
physically demanding occupations Alaska has to offer -
from fishing to logging to construction to explosives
and everything in between. When one day he dropped
out of a lift and sustained a head injury, he was just
doing his job. Lael misses his ballroom dancing,
speed skating, running and skiing, you name it. But
one thing that didn't change in his life was his drive
to help others.
MS. HODGES stated that this was a reason Lael has supported
ABIN.
3:13:56 PM
MS. HODGES directed attention to the many statewide partners
with ABIN, slide 11 "Statewide Partners." She said there was a
lot of work on prevention, acute care, and post-acute
rehabilitation, slide 12, "Brain Injury HURTS Alaska," as so
many people and their families deserved this care.
3:14:29 PM
PAT CHAPMAN, spoke about her daughter, Jessi, who was in an auto
accident "that eliminated her life... part of her story is that
she is not the same person, she will never be that person, and
she's just now, seven years down the road, realizing that she's
never going to be this Jessi Chapman that was going off to
college to do fabulous things and come back to Alaska," slide
13, "Jessi Chapman, Ketchikan." She emphasized that Jessi,
although she was a quad, mute, with an original diagnosis to
never walk, speak, or use her hands, was still determined to
somehow get an education. She stated that, although the State
of Alaska and private insurance were very supportive for the
physical care as that was an obvious need, Jessi was not able to
get that same support for therapy for her brain. She explained
the difficulty for getting the brain to talk to the rest of the
body. She declared that she had tried to find help in Alaska,
but that there was not any neuro psychological help in the
state. She reported that she had paid for travel to the
University of Washington psychiatric ward, which had determined
that Jessi needed traumatic brain injury therapy. She relayed
that she then took Jessi to Lakeview Specialty Hospital at
Waterford in Wisconsin for 10 weeks, for which her private
insurance paid. She emphasized that this therapy should be in
Alaska, and reported that the state Medicaid would not pay for
this rehabilitation therapy, especially in an out-of-state
facility. She declared that Jessi now "does have some tools,
and I am so proud of those tools because she can come up here to
Juneau, she could go in and testify... where she could not have
before." She strongly encouraged for services to be provided in
Alaska. She declared that "a minor sports injury changes a
whole young person's life," as that young person would then be
on state aid, instead of being part of the state workforce,
because "we did not give them the therapy that they needed when
they were injured."
3:19:59 PM
CHAIR HIGGINS asked what had been done for Jessi at Lakeview
Hospital.
MS. CHAPMAN, in response, explained that there was a complete
therapy program, which included neuro psychology, psychiatric
care, speech therapy, occupational therapy, physical therapy,
and independent living skills.
3:20:39 PM
DR. TORRES shared that he had been the Director of Neuro Trauma
and a Professor of Neurosurgery at Stanford University in
California. He presented a PowerPoint, "Traumatic Brain Injury"
and moved to slide 3, "Trauma Care Fund," stating that this was
a great start. He listed the activities that had enhanced
trauma care since the fund was initiated in 2010, which included
full time trauma care, acquisition of cell save equipment, and
Advanced Trauma Life Support training for many communities. He
stated that a "Think First" Chapter of the national organization
for injury prevention for head and spinal cord injuries had been
started in Alaska to provide educational programs, slide 4,
"ANMC."
3:22:35 PM
DR. TORRES offered slide 5, "6 different examples of "Severe"
TBI?!?" which showed a variety of head trauma. He moved on to
slide 6, "Burden of Neurological Emergencies," which listed the
cost of care in the first year alone for various types of
neurological emergencies, with an average cost of $136,000 for
traumatic brain injuries. Pointing to slide 7, "Payers for
Traumatic Brain Injury," he reported that, in Alaska, from 2007-
2011 there had been about 3400 admissions with a cost of almost
$145 million. He noted that the annual cost of TBI in the
United States was almost $100 billion, slide 8, "Annual cost."
3:23:41 PM
DR. TORRES commented on slide 9, "High Risk Populations," which
listed young people, low-income and unmarried individuals,
residents of inner cities, ethnic minorities, men, and
individuals with a previous history of substance abuse or TBI.
He declared that trauma was the leading cause of death in Alaska
for those under the age of 44, and that Alaska had the second
highest trauma mortality in the United States, slide 10, "Trauma
in Alaska." He reported that there were almost 5000 annual
admissions in Alaska. He detailed the graph on slide 11,
"Trauma Mortality in Alaska," which revealed that the rate among
Alaska Natives was much higher than that of all Alaskans. He
stated that the "incidence rate of identified traumatic injuries
in Alaska is 28 percent higher than the national rate," slide
12, "Traumatic Brain Injury." Each year, about 244 people are
hospitalized for TBI in the Anchorage region, almost one out of
four were under the influence of alcohol, and almost half were
under the age of 30, slide 13.
3:24:51 PM
DR. TORRES stated that an organized trauma system allowed for a
15-20 percent improvement in the survival of the seriously
injured, slide 14, "Trauma Systems." He said that the impact of
trauma systems reflected a dramatic lowering of preventable
deaths, slide 15, "Preventable Deaths: The Impact of Trauma
Systems." He reported on the examination of 1643 trauma
patients in Chicago, stating that those patients taken to a low
volume trauma center had a 30 percent greater chance of dying,
slide 16, "The Impact of Volume on Outcome." Reflecting on
another study from Baltimore, he stated that there was a 50
percent increase in mortality rate when patients went to a non-
trauma center, slide 17, "Traumatic Brain Injury," and a 50
percent increase when patients were not directly transported to
a trauma center, slide 18, "Traumatic Brain Injury Evidence
Based Management." He stated that a study about the impact of a
trauma system on outcome had predicted an 11 percent increase of
survival rate, slide 19, and that those trauma patients directly
transported to a trauma center had shorter total hospital stays
and shorter Intensive Care stays, slide 20.
DR. TORRES moved on to slides 21 and 22, "Impact of TBI
Guidelines," which analyzed the cost benefit for utilizing
guidelines of the trauma system in a hypothetical model of cost,
which presumed a savings of about $4 billion per state.
3:27:34 PM
DR. TORRES offered anecdotes of his various cases from the
previous three months, slides 23-29, "Case Presentation." After
stabilizing each of these patients, the common problem was the
lack of a neuro-rehabilitation center in Alaska. He commented
on slide 30, "Common Methods for Funding Trauma Care Services,"
and noted that the states with the largest trauma care funds
were supported by taxes and traffic fines. He compared the $2
million allocation in Alaska to the $25 million allocation for
trauma care in California.
3:30:23 PM
CHAIR HIGGINS asked what treatments the patients received during
their lengthy hospital stays.
DR. TORRES replied that while the patients received minimal
treatment, it was not a specialized, rehabilitative, or
comprehensive treatment program.
3:31:08 PM
CHAIR HIGGINS asked who coordinated these programs.
DR. TORRES replied that the rehabilitation facilities had
subspecialists.
3:31:31 PM
REPRESENTATIVE REINBOLD asked what percentage of the injuries
was to children.
MS. HODGES offered to supply the information.
REPRESENTATIVE REINBOLD reported that Elmendorf Air Force Base
had a brain injury program.
DR. TORRES said that the Alaska Native Medical Center shared its
specialized center to anyone with an acute injury. He reported
that the center was working to get the state to embrace a true
trauma system, as the Alaska trauma system did not meet the
standard of care. In every state except Alaska, severely
injured patients were sent directly to a trauma center, but in
Alaska, the patient was sent to the closest hospital. He
pointed out that any subsequent transfer would increase the risk
of mortality by 30 percent.
3:33:25 PM
MS. CHAPMAN said that the majority of sport injuries were mild
to moderate with the person sent home within 24 hours. There
was no follow up, as there was not a follow up system in the
state.
DR. TORRES explained that although concussion was defined as
mild head injury, it was not known what the cumulative effect
could be.
3:34:22 PM
REPRESENTATIVE TARR asked what would be necessary to meet the
financial need for a trauma fund in Alaska.
DR. TORRES replied that, as 13 hospitals in Alaska were
attempting to become part of the trauma system, $3-4 million
would be a reasonable figure to build the trauma system in
Alaska.
3:35:19 PM
The committee took an at-ease from 3:35 p.m. to 3:39 p.m.
^Presentation: Key Coalition
Presentation: Key Coalition
3:39:31 PM
CHAIR HIGGINS announced that the next order of business would be
a presentation by the Key Coalition.
3:40:13 PM
SETH KELLEY, Executive Director, FOCUS, said that this was the
twenty sixth year for the Key Campaign Coalition, and that a lot
had been accomplished. He lauded the decisions by the
legislature, specifically support for proposed HB 88, which
would bring a change of language and would treat everyone with
respect. He asked the committee to designate $450,000 to
maintain the Complex Behavior Collaborative Consultation and
Training program. He explained that the program coordinated
experts with people having behavioral issues beyond what the
state agencies could work with. He shared that this not only
decreased the cost of services, but that the experts trained
local staff, which helped to build the infrastructure. He
shared an anecdote about the dramatic successes of a young
woman, and her struggles with autism, through the support of the
Complex Behavior Collaborative.
3:43:44 PM
UNIDENTIFIED SPEAKER spoke about her struggles as a single
mother with two young children with autism. She thanked the
committee for its support to the passage of autism insurance
reform legislation. Even though her two young children were
very different with different issues, they both required
therapies for autism, which were not covered by insurance and
would have cost $3,000 per week per child. She shared that the
previous January, her son had started an in-home therapy
program, and within two weeks he had played patty cake with her
for the very first time, which she described: "patty cake
doesn't seem like a big deal, but in my world, it's huge." She
shared that her son was now using functional play, a first
stepping stone toward learning. She reported that her daughter
had just started this same therapy. She reported that, during
the last week, her son, now 4 years of age, had used sign
language for the first time, to tell her that he loved her. She
declared that the ability for him to sign was the result of this
intensive, effective, expensive therapy treatment. She
expressed her thanks for the wonderful gift that she had just
received.
3:46:11 PM
JIM BECK, Executive Director, ACCESS Alaska, shared his personal
story of a car accident resulting in a spinal cord injury, and
the difficulties for rebuilding your life. He declared that
"employment was the highest expression of independence,"
especially for someone with disabilities. He reported that
there was more than 70 percent unemployment among people with
disabilities in the United States. He requested a $500,000
increment to the Community Developmental Disability system,
which focused on providing supported employment services to
young people with developmental disabilities. He explained that
supported employment services dramatically decreased ongoing,
long term benefit use by those with disabilities, and provided
them with a better, more productive quality of life. He said
that $50,000 of this grant would be for peer support by those
with developmental and intellectual disabilities who already
worked, as role models to show what can be done.
3:48:35 PM
MR. BECK spoke about the Wait List for waivers to people with
developmental disabilities. He lauded the efforts of the
Division of Senior and Disability Services in the Department of
Health and Social Services to reduce this wait list from 1500
individuals to its current 635 individuals. He reported that
these waivers helped to pay for quality services to these
individuals. He shared his desire that the wait list have no
one listed.
3:49:25 PM
LIZETTE STIEHR, Deputy Director, Infant Learning Program
Coordinator, FOCUS, expressed her support for the Infant
Learning program. She declared that the program was evolving,
and she reflected on the brain research for those critical first
three years of life. She discussed research on the critical
impact from trauma, violence, and neglect on a child's brain
development, and she offered an anecdote of the delayed
experiences from a traumatic family situation. She pointed out
that although the motor skills could develop typically after a
traumatic experience, the social, emotional, and speech
development did not develop normally. She said that 83 percent
of children in infant learning programs were speech delayed,
which was often tied to trauma. She declared that it was
necessary to provide resources, support, options, and parent
training for those families to better understand what was
happening with their child. She expressed her appreciation for
the Choose Respect campaign. She lauded the financial support
to the Child Abuse Prevention and Treatment Act (CAPTA) for
substantiated cases of child abuse and neglect to children under
the age of three. She reported on the Adverse Childhood
Experiences (ACE) study of 7000 individuals conducted by Kaiser
Permanente in California. She stated that this study had tied
developmental disabilities and higher early mortality rates with
those childhood experiences. She expressed her thanks to the
committee for the responsibilities each member had accepted.
3:54:31 PM
CHAIR HIGGINS expressed his respect for the work of each of the
presenters.
3:55:13 PM
The committee took an at-ease from 3:55 p.m. to 3:58 p.m.
HB 90-VITAMIN D SUPPLEMENTS
3:58:22 PM
CHAIR HIGGINS announced that the final order of business would
be HOUSE BILL NO. 90, "An Act establishing a temporary program
in the Department of Health and Social Services for testing
newborns for baseline vitamin D levels."
3:58:46 PM
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for HB 90, labeled 28-LS0376\U, Mischel,
2/14/13, as the working draft. There being no objection, it was
so ordered.
REPRESENTATIVE SEATON, as the sponsor of the proposed bill,
offered some background, referring to a handout titled Vitamin
D-HCR 5 [Included in members' packets]. He declared that this
legislation had been unanimously passed by both the House and
the Senate during the 27th Legislature. He explained that this
resolution promoted "vitamin D supplements for pregnant women
and infants to prevent pregnancy complications, preterm births,
type 1 diabetes, and rickets." He pointed out that all of the
studies referred to by the resolution were available through
links on his website. He noted that there was now published
research, February 2012, on an Australian study of 743 mother
and infant pairs, measuring the vitamin D levels from the second
trimester of pregnancy until the children were 17 years of age.
4:01:40 PM
REPRESENTATIVE SEATON directed attention to slide 1, page 11 of
the HB 90 Study-Australia [Included in members' packets] which
identified children ages 5 and 10 in each of four quartiles for
nanograms per liter (ng/ml) of vitamin D. He explained that
Quartile 1 was pregnant women testing below 18 ng/ml of Vitamin
D, while Quartile 4 was women testing above 29 ng/ml of Vitamin
D during pregnancy. He pointed out that the women in Quartile
4, with children age 5, only had 3 percent of children with
moderate to severe language impairment, while women in Quartile
1 had 13 percent of the same age children with this level of
language impairment. He then directed attention to the same
quartiles for children age 10, and noted that the children of
mothers with lower vitamin D during pregnancy had more than
twice as many children with language impairment.
4:04:26 PM
REPRESENTATIVE SEATON directed attention to slide 2, HB 90
Study-Australia page 12-12 of the handout. He explained that
almost all vitamin D was processed through the skin from midday
sun exposure, as the Ultraviolet B was absorbed later in the
day. He noted that there was more overhead sun when closer to
the equator.
4:05:50 PM
REPRESENTATIVE SEATON directed attention to slide 3, HB 90
Support Study-Spain, page 5 of 10 in the handout, which measured
mental and psychomotor development for children at age 14 months
from mothers measured in the second trimester of pregnancy. He
declared that the findings reflected more vitamin D naturally
occurred the closer the latitude to the equator.
4:07:27 PM
REPRESENTATIVE SEATON reported on slide 4, HB 90 Support Study-
Spain, page 6 of 10 in the handout, which graphed the higher
amount of vitamin D during the months with more light exposure.
4:08:10 PM
REPRESENTATIVE SEATON moved on to another mother-infant pair
study on slide 5, HB 90 Study-Pittsburgh, page 1 of 7 of the
handout. He said this study also compared black and white
pregnant women with the same levels of vitamin D in cord blood
at birth. He explained that this study was useful to Alaska, as
the skin pigment blocked ultra violet rays, which influenced the
amount of vitamin D absorbed. He pointed out that both pigment
and the long sleeves worn in Alaska blocked sunshine.
4:10:04 PM
REPRESENTATIVE SEATON referred to the article, "Vitamin D and
Suicide Risk Factors," and the article, "Is low Vitamin D linked
to military suicide?" [Included in the members' packets] He
said that low vitamin D doubled the risk for completing suicide.
4:11:07 PM
REPRESENTATIVE SEATON reported that a study of military basic
training in South Carolina surmised that the vitamin D levels
had dropped dramatically after eight weeks "because of the heavy
clothes" which blocked absorption and manufacture of vitamin D.
4:11:34 PM
REPRESENTATIVE SEATON referred to an intervention study in
Sweden in October, 2012, which divided a group of immune
compromised people for a year. Half of the group received
vitamin D supplements and the other half received a placebo,
with the vitamin D group having a 23 percent reduction in
infection rates. He suggested that Alaska study the impact of
vitamin D on infants.
4:13:04 PM
REPRESENTATIVE SEATON explained that the purpose of proposed HB
90 was to conduct a one year study of the vitamin D baseline
levels of new born children. He suggested that this could
reveal a causality problem of low vitamin D with the second
trimester development of the language center in the brain. He
pointed out the potential severity of the consequences of low
vitamin D. He suggested that the further from the equator, the
lower the amount of Vitamin D.
4:14:20 PM
REPRESENTATIVE SEATON explained that the proposed study to
establish the level for vitamin D in newborns in Alaska would
cost about $300,000. He clarified that the study was not
attempting to determine the proper level of Vitamin D. He
surmised that, if vitamin D deficiency in the second trimester
was found to be causally associated with language impairment,
then, given a similar regional distribution to other studies,
about 400 fewer kids would enter school each year with severe to
moderate language impairment. He said that language impairment
was the second largest disability category in Alaska. He stated
that the proposed bill was intended to establish a baseline for
vitamin D in children in order to promote the ongoing cause for
improvement of health and education in Alaska.
4:17:05 PM
REPRESENTATIVE SEATON directed attention to the letter from Eric
Gebhardt, Superintendent of the Nenana City School District
[Included in members' packets] which described a study of their
vitamin D supplement program. He relayed the statistics for
fewer days absent due to illness by students partaking in the
vitamin D supplement. He reported that returning students who
had continued participation from 2011 had lowered their absent
days by more than 50 percent over the previous year.
4:20:49 PM
REPRESENTATIVE SEATON clarified that the assessment of vitamin D
from new born children would use two drops of the umbilical cord
blood simultaneous to other testing.
4:21:24 PM
REPRESENTATIVE REINBOLD asked if there was already a test
offered for vitamin D.
REPRESENTATIVE SEATON, in response, said that, tests were
currently administered for heritable genetic disorders. He said
that there was not currently a test for vitamin D, as it was not
a heritable condition. He explained that the only condition was
that the mother did not have enough vitamin D.
4:22:52 PM
REPRESENTATIVE REINBOLD asked if there was an attached fiscal
note for proposed HB 90. She opined that a good way to lower
the overall budget for Department of Health and Social Services
(DHSS) would be for an emphasis on prevention. She stated that
she was interested in the "risk benefit cost analysis."
REPRESENTATIVE SEATON replied that the requested $300,000 was
far less than the $287 per test which DHSS would charge. As
this would be a temporary law, there had been a very inexpensive
offer for the tests and initial analysis. He suggested that the
proposed bill be amended to include private testing, and at the
least cost to the state. He added that DHSS had speculated that
further regulations would be necessary, which would necessitate
postponement of the proposed program.
4:24:45 PM
CHAIR HIGGINS asked who had paid for the studies in Australia
and Spain.
4:25:08 PM
REPRESENTATIVE SEATON, in response, said that he would find out.
4:25:32 PM
CHAIR HIGGINS offered his belief that the vitamin D industry
should pay for any studies done on its behalf. He stated that
studies were often for some businesses benefit. He opined that
people could not be forced to take vitamin D, even if the
studies revealed the necessity. He asked "what's the end
product here, what's the end result of what you're trying to
accomplish."
4:26:51 PM
REPRESENTATIVE SEATON replied that the goal was to make Alaskans
and the health system aware of ways to improve health in Alaska.
He stated that people needed to be aware of their personal need
for more vitamin D, pointing to the potential severe impacts for
its lack. He declared that there was not any attempt to
mandate.
4:27:58 PM
CHAIR HIGGINS opined that although many studies would show that
vitamin D was helpful, he questioned the necessity for another
study. He asked "is the state going to foot that bill too, that
campaign to get out there to tell people to get vitamin D." He
acknowledged that the state had a responsibility for good
health, and that it was incumbent to do what was necessary to
ensure that; however, he felt it was the responsibility for any
specific industry to pay for studies to which it benefited.
4:29:03 PM
REPRESENTATIVE SEATON replied that he agreed, but he explained
that, as vitamin D could not be patented, there was no money in
vitamin D studies. He pointed out that a year and a half supply
of vitamin D was $12. He clarified that it was technically a
hormone, not a vitamin. He offered to research the funders for
the vitamin D studies, and he opined that these longitudinal
studies were most often sponsored and funded by governments.
4:31:43 PM
REPRESENTATIVE TARR offered her support for the potential
positive affect to educational outcomes. She suggested a link
with the Department of Education and Early Development and
Department of Health and Social Services to encourage further
research.
4:32:47 PM
REPRESENTATIVE SEATON replied that he had spoken with the
president of the University of Alaska, who would discuss this
further with various departments.
4:33:16 PM
TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State
Legislature, directed attention to the letter from Dr. Abel
Bult-Ito, University of Alaska Fairbanks. [Included in members'
packets]
4:34:00 PM
REPRESENTATIVE KELLER asked to clarify that this was not a
longitudinal study, but was only intended to identify the amount
of vitamin D in new born children. He asked if there was an
accompanying fiscal note.
4:34:52 PM
REPRESENTATIVE SEATON, in response, said that the cost to do the
survey and analyze the samples would be $300,000. He listed
other background information that would be beneficial to the
analysis. He repeated that this was not any attempt to
establish any levels, just to find a baseline. He declared that
people could opt out of the study, and that the study was Health
Insurance Portability and Accountability Act (HIPAA) compliant.
MS. HANSEN noted that the Western Institutional Review board
process would assure that this was all being conducted in
compliance.
REPRESENTATIVE SEATON stated that, as this study was for all
Alaskans, it would include an assessment of the sub populations
in relation to the aggregate.
4:37:39 PM
REPRESENTATIVE KELLER, directing attention to Version U, page 1,
line 11-12, read: "for testing the vitamin D levels of newborns
at birth or as soon after birth as possible." He asked if this
would include a survey of the mother and the family. He
questioned whether the specificity of the language of the
proposed bill would limit the expected breadth of the test.
REPRESENTATIVE SEATON, in response, explained that it was not a
longitudinal study, and would only test for vitamin D at birth.
He mentioned that the levels of vitamin D could vary
dramatically in different regions around Alaska, and how
important that knowledge would be for the communities.
4:39:52 PM
REPRESENTATIVE KELLER asked about the intent for the data after
it was collected.
REPRESENTATIVE SEATON emphasized that the proposed bill was for
one year only, and would provide Alaskans with health care
information in order to make determinations for themselves.
4:40:40 PM
REPRESENTATIVE PRUITT asked to clarify whether this proposed
bill was mandated, unless there was a religious concern.
REPRESENTATIVE SEATON replied that unless a mother opted out,
the attending health care professionals would take the cord
blood sample. He added that the heel stick method for testing
could also be used.
4:42:21 PM
REPRESENTATIVE PRUITT commented that, as there was a lot
happening during birth, it was necessary to ensure that there
was an understanding ahead of birth. He expressed his concern
for any costs associated with the program.
4:43:14 PM
REPRESENTATIVE SEATON explained that this information would be
collected by the health care providers, and he reiterated that
this cord blood test was the same as the other cord blood tests
being performed simultaneously.
4:44:09 PM
REPRESENTATIVE PRUITT asked why the State of Alaska was being
involved instead of the University of Alaska.
REPRESENTATIVE SEATON opined that the University of Alaska or
the Alaska State Hospital and Nursing Association could indeed
be the better "outfit" for this proposed program.
4:45:34 PM
REPRESENTATIVE PRUITT stated that the proposed legislation was
still necessary to mandate the testing, even if the University
of Alaska was conducting the program.
REPRESENTATIVE SEATON expressed his agreement.
4:46:00 PM
CHAIR HIGGINS expressed a desire to see how the study would be
performed. He offered his belief that the amount of vitamin D
would be different in each of the regions around the state. He
declared that a baseline was necessary, otherwise none of the
numbers had any value. He requested to know the methods of the
study in order to ensure the accuracy and reliability of the
results.
REPRESENTATIVE SEATON offered to share a survey draft. He
pointed to the survey information which ensured that there were
baselines, and would be filled out by the mother and the health
care provider. He expressed his agreement that many of the sub
populations could have very different baselines.
REPRESENTATIVE SEATON said that his staff had been working with
doctors and professionals to refine the survey to be applicable,
and to include the proper opt-out clause.
4:49:26 PM
WARD HURLBURT, M.D., Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services, stated that the administration did not have a position
on proposed HB 90. He offered his concurrence with
Representative Seaton that the proposed study would provide data
on vitamin D levels in Alaska. He listed data from many
entities which expressed agreement that vitamin D was essential
and was a factor in bone health. He declared that, however,
there was disagreement for the vitamin D benefits to the other
issues mentioned earlier, which included cancer, diabetes, and
intellectual development. He declared that the data did not
support conclusions for the vitamin D benefit to these other
issues.
4:51:26 PM
CHAIR HIGGINS opened public testimony and announced that it
would be left open. He then announced that HB 90 would be held
over.
4:52:38 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.