02/18/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
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| Start | |
| HB214 | |
| Presentation: American Cancer Society Cancer Action Network | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 214 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 18, 2014
3:04 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 214
"An Act relating to mental health patient rights, notifications,
and grievance procedures."
- HEARD & HELD
PRESENTATION: AMERICAN CANCER SOCIETY CANCER ACTION NETWORK
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 214
SHORT TITLE: MENTAL HEALTH PATIENT RIGHTS & GRIEVANCES
SPONSOR(s): REPRESENTATIVE(s) HIGGINS, TARR, GATTIS
01/21/14 (H) PREFILE RELEASED 1/10/14
01/21/14 (H) READ THE FIRST TIME - REFERRALS
01/21/14 (H) HSS, JUD, FIN
02/18/14 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
THOMAS STUDLER, Staff
Representative Pete Higgins
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
MARIO BIRD, Attorney
Ross & Miner, PC
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
FAITH MYERS
Volunteer Mental Health Advocate
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 214.
DORRANCE COLLINS
Volunteer Mental Health Advocate
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 214.
RON HALE, Hospital Administrator
Alaska Psychiatric Institute (API)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
214.
LORRAINE LAMOUREUX
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 214.
JAMELIA SAIED
Mental Health Counselor
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
JIM GOTTSTEIN
Law Project for Psychiatric Rights
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 214.
JOHN TAYLOR KENT
Retired Psychologist
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 214.
DAVID CARLSON
Attorney
Fairbanks, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
DON ROBERTS
Kodiak, Alaska
POSITION STATEMENT: Testified in support of HB 214.
LAURIE HERMAN, Director of Government Relations
Providence Health & Services, Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
EMILY NENON, Alaska Government Relations Director
American Cancer Society Cancer Action Network
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint, "Eliminating Cancer
in Alaska - A Roadmap."
JOHN KILLPACK, Western Region Managing Director
American Cancer Society Cancer Action Network
San Francisco, California
POSITION STATEMENT: Presented a PowerPoint, "Eliminating Cancer
in Alaska - A Roadmap."
ACTION NARRATIVE
3:04:47 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Higgins, Seaton, Reinbold, Pruitt, Nageak, and
Keller were present at the call to order. Representative Tarr
arrived as the meeting was in progress.
HB 214-MENTAL HEALTH PATIENT RIGHTS & GRIEVANCES
3:05:59 PM
CHAIR HIGGINS announced that the first order of business would
be HOUSE BILL NO. 214, "An Act relating to mental health patient
rights, notifications, and grievance procedures."
[Chair Higgins passed the gavel to Vice Chair Keller.]
REPRESENTATIVE HIGGINS, as the sponsor of the proposed bill,
read from the sponsor statement:
HB 214 amends the mental health grievance procedure
provided under AS 47.30.847. This bill governs due
process and grievance procedures in all state and
private mental health hospitals, clinics, and units
which receive public funds. Prompted by the 8,000 to
10,000 admissions to mental health facilities and
units in Alaska each year, this bill requires:
1. Adequate notice
2. Standardized forms
3. Advocate assistance
4. Rapid written administrative response
5. Right to appeal
6. Telephonic access to a state monitored call center to
lodge a complaint immediately.
Mental health patients are among the most vulnerable
in Alaska. There are a number of patient assaults and
staff injuries each year. There are also thousands of
children who are committed each year.
Current statutes and regulations do little to protect
psychiatric patients. State and Federal courts have
consistently ruled that individuals who have not
committed a crime and are locked up for psychiatric
evaluation and treatment should not be treated like
criminals.
REPRESENTATIVE HIGGINS offered his opinion that there was more
care for the rights given to criminals than for the rights of
psychiatric patients. He declared that this was important
legislation that should have been passed years ago, reporting
that it had been presented in the 2011 session as Senate Bill
55. He reported that the earlier bill had a zero fiscal note,
and yet the current, almost identical bill had a $700,000 fiscal
note. He questioned why the fiscal note had increased.
3:10:54 PM
REPRESENTATIVE HIGGINS stated that he had requested the policies
for grievance procedures from the Department of Administration
(DOA).
THOMAS STUDLER, Staff, Representative Pete Higgins, Alaska State
Legislature, explained that the request for the policies and
procedures concerning patients' grievance rights had only just
been received, from "an outside source" and not from the DOA.
REPRESENTATIVE HIGGINS reported that, although DOA had stated
that the [grievance policy] was in place, they had not been able
to present them to his office. He offered his belief that, as
the department had not been able to present the policies, they
were not really in place. He emphasized that proposed HB 214
would offer improved state oversight for grievance procedures.
He repeated that the goal of the proposed bill was to provide
adequate notice, standardize forms, receive advocate assistance,
ensure rapid written administrative response with a right to
appeal, and allow telephonic access to a state monitored call
center to immediately lodge complaints.
3:14:43 PM
[Vice Chair Keller returned the gavel to Chair Higgins.]
The committee took a brief at-ease.
3:16:17 PM
CHAIR HIGGINS opened public testimony.
3:16:49 PM
MARIO BIRD, Attorney, Ross & Miner, PC, stated that he was
testifying on behalf of various clients; however, due to the
confidentiality of the cases, he was not able to speak to any
specifics. He directed attention to some of the broader policy
questions which had arisen as a result of the litigation, and
noted AS 47.30.840(a)(14), which declared the patient right for
a reasonable opportunity to maintain natural support systems,
including family, friends, and help networks. He declared that
his litigation practice had revealed that mental health patients
and their families were under a great deal of pressure, even
without a forced seclusion. He opined that anytime the
government gets larger, there was a tendency for people to be
treated as smaller. He offered his belief that this provision
for patient families in the proposed bill would protect the best
interests of the patient. He relayed that often an analysis by
well-meaning providers acted as a wedge between the patient and
their family, as it did not have any consideration for the
family and support network. He expressed that his experience
indicated that patient contact with family members resulted in
an improvement to the patient's condition. He directed
attention to the preamble of the Constitution of the State of
Alaska which declared the necessity for passing things on to
succeeding generations, which supported this provision to allow
mental health patients to communicate with family members. He
mentioned that although severe organic brain impairment was
considered in the Alaska Mental Health Trust, AS
47.30.056(e)(5), a patient could be subject to indefinite
detainment in a non-designated facility. He directed attention
to the right to privacy litigation which had spurred the
legislature to act in favor of mental health patients. He
pointed out that this provision stated that the legislature
shall implement the right to privacy. He suggested that the
legislature consider the broader policy implications for not
including those patients with severe organic brain impairments,
or similar organic caused impairments, as the same symptoms of
mental illness were often exhibited and the same rights should
be extended. He reiterated that mental health patients were
often "good folks, good Alaskans with families in Alaska, and
lawmakers can help these families maintain those rights." He
asked that the committee consider the right to privacy, as it
was stated in the state constitution.
3:22:17 PM
REPRESENTATIVE SEATON asked for a definition of severe organic
brain impairment and any correlation with mental health issues.
He directed attention to page 2, line 29, paragraph 14, and
asked how it related to, or was different from, page 2, lines
12-14, paragraphs 5 and 6.
MR. BIRD, in response, said that any method of communication
offering reasonable opportunity to maintain natural support
systems should be considered. He allowed that this should be
within the discretion of the person in charge of care.
REPRESENTATIVE SEATON asked if paragraph 14, page 2, was
incorporating paragraphs 5, 6, and 7, page 2, as well as adding
additional parameters, or was paragraph 14 a separate category.
MR. BIRD opined that paragraph 14, page 2 would foreclose any
possibility that someone would be deprived of their support
systems if in a locked evaluation facility or a designated
treatment facility for more than three days.
CHAIR HIGGINS expressed his agreement that this gave the same
rights as those under a 72 hour evaluation process.
3:25:55 PM
REPRESENTATIVE KELLER asked for clarification whether the
providers who separated patients from their natural support
systems had done this for the perceived good of the patient, or
for other priorities.
MR. BIRD, in response, stated that the providers, though well
meaning, often did not consider the natural inclination of the
patient to family members and friends, in lieu of the possibly
therapeutic benefits of seclusion.
REPRESENTATIVE TARR asked for the frequency to his
representation of individuals in these cases.
MR. BIRD replied that he had a number of probate and
guardianship cases which dealt with these issues, and he had
litigated these issues in two or three different cases during
the last six months. He stated that he had become more aware of
this during contact with the multiple families he had
represented.
3:28:35 PM
FAITH MYERS, Volunteer Mental Health Advocate, shared that she
had volunteered as a mental health patient advocate for the past
ten years. She noted that she had also been a patient in
psychiatric institutions, and she declared her support for the
proposed bill. She testified that 90 percent of the 38,000
annual American suicides were considered to have a mental
illness. She reported that 27,000 Alaskans received psychiatric
care each year. The current law and administrative codes used
to establish psychiatric patient complaint or grievance
procedure policy did little to recognize or accommodate a
psychiatric patient's disability. She shared that it was
necessary for a quicker, sometimes urgent, response to these
grievances and complaints. For those in acute crisis, it was
necessary for a written procedure, which was not a requirement
in AS 47.30.847. She emphasized that Alaska was not recognizing
the disabilities of the mentally ill in the grievance and appeal
process, sharing that acute care patients could not wait 7 - 14
days, or longer, for an answer to a complaint. She stated that
the chances for recovery were reduced when a person felt
powerless in the process, and that it was necessary for patients
to have written procedure rules, with a shorter resolution time,
an appeal process, and an urgent grievance procedure. She
opined that the state spent far more money "picking up the
broken pieces after a patient cannot file a grievance in a fair
way than the state would spend providing a good grievance
procedure law that recognizes the patient's disability." She
reiterated her support for proposed HB 214.
REPRESENTATIVE SEATON asked for clarification to her role as
patient advocate.
MS. MYERS explained that she was a private citizen, recovering
from a mental illness, who volunteered to speak in support of
patient rights and an improved grievance procedure law.
REPRESENTATIVE SEATON asked if she was an advocate on patient
behalf in public forums.
MS. MYERS said that was correct.
3:32:43 PM
DORRANCE COLLINS, Volunteer Mental Health Advocate, stated that
he supported HB 214. He reported that there were about 225
patient complaints filed at Alaska Psychiatric Institute each
year, which included denial of basic rights, medication errors,
physical abuse, sexual misconduct, safety concerns, and respect
and dignity. He declared that psychiatric patients could not
file a grievance in a fair way, as Alaska statute simply
directed the institutions and clinics to write a patient
grievance procedure, which could be revised at any time. He
reported that the institutions were also allowed to choose the
impartial body to hear the complaint. He stated that the Joint
Commission for Accreditation of Hospital Organizations had a
poor history for protecting psychiatric patients. He read from
a statement by the Disability Law Center: "if the complaint is
a valid one, the patient advocate may discuss it with the unit
staff," and a second statement, "at some facilities, a formal
grievance procedure may be in place." He relayed that in the
majority of psychiatric facilities, a patient may not be able to
get their complaint past the patient advocate or a low level
staff member in a timely way. He pointed out that psychiatric
patients had a right, by law, to file a grievance; however there
was not a right for an in-facility appeal. He asked that the
legislature improve grievance rights for psychiatric patients.
REPRESENTATIVE SEATON asked about the definition of public
advocate.
MR. COLLINS explained that patient advocates were not employees,
paid their own expenses, and that they spoke with patients on
the telephone. He declared that patient advocates had a lot of
understanding of psychiatric institutions throughout the nation,
and that Alaska institution standards were not very high.
REPRESENTATIVE SEATON directed attention to page 2, lines 25-27,
which described the patient advocate as an employee. He asked
if these criteria could be interpreted to exclude the current
patient advocates in preference for the sole use of an employee.
He offered his belief that this was not the purpose of the
proposed bill.
MR. COLLINS offered his belief that the law would not include
anyone as a patient advocate except the person working for the
institution.
CHAIR HIGGINS stated that this was also his understanding.
REPRESENTATIVE KELLER asked for clarification from a
representative from Alaska Psychiatric Institute.
3:38:48 PM
RON HALE, Hospital Administrator, Alaska Psychiatric Institute
(API), stated that there had been a patient advocate on the API
staff for several years.
3:39:43 PM
LORRAINE LAMOUREUX expressed her hope that she is a voice for
the future and she stated her support for HB 214 as it would
"protect those labeled psychiatric who find themselves deprived
of all civil rights and at the mercy of complete strangers."
She paraphrased from a prepared statement [original punctuation
provided] [Included in members' packets]:
It is my hope the passage & this bill will prevent the
abuse of power for Bret Bohn today at Providence
Hospital.
Bret was a normal, university educated, 26 year old
man with a future when he went to Providence Hospital
on October20, 2013, due to Insomnia caused by stress.
Treatment by Providence Hospital led to admission, and
medication prescribed by the hospital which caused
subsequent seizures and Impairment. Bret is now
imprisoned at Providence Hospital, against his will,
and subject to total hospital control. Within three
weeks of his incarceration at Providence Hospital Bret
was ruled incompetent, and a made ward of the State of
Alaska, with a State appointed guardian. The guardian
has a caseload at 100 and very little time to devote
to Bret. Bret's parents legal Power of Attorney was
summarily dismissed as irrelevant and all parental
rights voided. Bret's parents had objected to the
treatment of their son with powerful, highly addictive
drugs. Today, three months later a young healthy, 26
year old man with life just starting is confined to
tour white walls, is heavily sedated and after three
months of this treatment is probably a drug addict.
Bret now wears a monitor, so can't escape even if he
could. Bret has been denied visitors for two months.
His parents or anyone else did not even get to see him
for Christmas or his birthday. In the days of Hitler
this treatment was called "Brain Washing". There has
been no diagnosis and efforts are being made to send
him to John Hopkins. Does the saying, "Out of sight,
out of mind." seem to apply here? At a session when
Bret's parents were being apprised of Bret's condition
a Dr. told Bret's father that it was possible once
Bret left Providence Hospital "he would NEVER see his
son again".
Bret's parents are spending retirement money in court
fighting for rights that seem to be nonexistent when
you're fighting the states biggest Corporate Hospital
and the complicit State agencies that seem to work
with the hospital.
Questions remain! Did Providence Hospital make a
mistake in Bret's treatment that caused the seizures?
Is the forceful manner in which Providence Hospital
terminated all Bret's and his parents rights a
response to this question? Another question. How
many other people are wards of the State presently at
Providence Hospital with care billed to the State?
The answer and the cost to the state could be
surprising. To date the bills for Bret's care
continue to go to his mailing address and their total
is estimated to be over ONE MILLION dollars. As a
ward of the State, guess who will be paying Bret's
bills?
I ask you to put yourself in Bret's place. How would
you feel if this were someone in your family? Please
legislate for Bret and all unfortunate victims who
have the misfortune to have their future stolen from
them by a corporate bureaucracy like Providence
Hospital.
MS. LAMOUREUX offered her belief that the proposed bill "would
guarantee that Bret could not be treated as he is today at the
hospital." She relayed that this case had recently been settled
in court, his parents were denied guardianship, and he was now a
permanent ward of the state. She stated that Providence
Hospital had denied him any visitations. She asked what would
happen to him.
REPRESENTATIVE REINBOLD encouraged Ms. Lamoureux to call the
governor's office and speak with Nancy Dallstrom.
REPRESENTATIVE PRUITT asked if there would be testimony from
Providence Hospital so that all sides were brought to the table.
He asked if there were instances which required this type of
treatment.
CHAIR HIGGINS declared that there was no intention to pass the
bill today. He expressed agreement that all sides should
testify.
3:48:24 PM
JAMELIA SAIED, Mental Health Counselor, reported that she had
been a mental health counselor for almost 20 years, with a
recent focus on peer support counseling. She stated that she
presented introductory sessions on the Wellness Recovery Action
Plan (WRAP) at API a few times each month. She reported that
patients often expressed frustration for important issues either
not being addressed, or addressed in an unsatisfactory manner.
She stated that these issues frequently revolved around contact
with family, friends, and other natural supports, medication
decisions, length of time at API, and plans after discharge.
She explained that, as she was a contract provider and not an
API employee, she was not able to intervene with assistance.
She expressed her frustration with this policy, especially if
she was aware that the concern had not been addressed by staff.
She offered her belief that some of these issues could be
handled in only a few minutes. She testified in support of HB
214 and its urgent grievous procedure, stating that it would go
a long way toward addressing the grievances of mental health
patients. She declared that individuals deserved to be treated
with dignity and respect, and these rights should not be negated
upon admittance into a mental health facility. Individuals
struggling to overcome mental issues needed support, and not
forced treatment, on the road to recovery.
3:51:32 PM
JIM GOTTSTEIN, Law Project for Psychiatric Rights, declared that
Ms. Lamoureux had described a system that had existed for
decades. He relayed the "Alice in Wonderland" aspect of the
mental health system. He directed attention to provisions in HB
214 which proposed the possible exclusion of other patient
advocates. He suggested addition of a sentence which would
acknowledge the right of people to have their own advocates
working in the behalf. Addressing page 4, he stated that lines
8-9, "as defined by the commissioner" should be deleted. He
expressed a similar concern that page 4, lines 15-16, "if a
written response is not consistent with this section or AS
47.30.840" should be deleted. He pointed out that the right to
appeal was not meaningful unless there was an exemption included
from Civil Rule 82, which provided that a prevailing party
received partial attorney fees against the losing party. He
shared that his experience with the Attorney General's office
was its consistent request for attorney fees, which had "a very
chilling effect on people trying to appeal." He declared that
the right to appeal should include an exemption from this civil
rule. He stated his support for HB 214.
3:57:26 PM
CHAIR HIGGINS asked how many cases Mr. Gottstein had conducted
which were similar to this situation.
MR. GOTTSTEIN, in response, opined that it was often perceived
that people labeled as "crazy" had nothing credible to say. He
offered his belief that there were hundreds of complaints which
were not deemed worthy of being called a grievance; hence, there
were "not even a handful that end up being considered actual
grievances."
3:58:59 PM
JOHN TAYLOR KENT, Retired Psychologist, shared that he had a lot
of experience with mental health patients, stating that there
was not much protection for incarcerated individuals in Alaska.
He relayed an anecdote about work in Bethel and Barrow, where he
was head of the facility. He expressed his concern that the
proposed bill would add to the burden of the providers, although
the rights and livelihoods of the patients was more important.
He stated his support for the proposed bill. He acknowledged
the difficulty for distinguishing between mentally ill and
organically impaired as there was overlap.
4:01:20 PM
DAVID CARLSON, Attorney, offered some personal background, which
included his sought after help from the mental health industry,
which he opined "destroyed my life and they did it for profit."
He offered his belief that the proposed bill did not "go far
enough" and that if the proposed bill were implemented, "the
entire system will fall apart." He acknowledged that he had
received some good help from counselors, and he expressed his
high regard for these professionals.
4:06:14 PM
DON ROBERTS reported that he was "a former consumer of the
mental health system." He declared his support for the proposed
bill. He offered his belief that people had fundamental rights,
which included the right to be heard and to change the outcome
of the events affecting them. He opined that this [mental
health] system was not a place where he felt he would be heard
and he would not return voluntarily. He reported that many
people needed the mental health services, however. He declared
a need for the responsible protection of the fundamental rights
of human beings.
4:11:11 PM
LAURIE HERMAN, Director of Government Relations, Providence
Health & Services, declared that she was not a behavioral health
expert. Referencing earlier testimony regarding Providence
Alaska Medical Center, she stated that she had responded in
writing to an inquiry from a member of the Alaska State
Legislature, and would share that response to the House Health
and Social Services Standing Committee.
CHAIR HIGGINS said that this would be appreciated.
REPRESENTATIVE TARR asked if the [Director] of the Behavioral
Health department [at Providence Alaska Medical Center] would
know about administrative procedures.
MS. HERMAN replied that the director would be aware of these
procedures, and she emphasized that hospitals "do not have the
ability to hold patients against their will."
4:13:15 PM
CHAIR HIGGINS left public testimony open.
[HB 214 was held over.]
The committee took a brief at-ease.
^Presentation: American Cancer Society Cancer Action Network
Presentation: American Cancer Society Cancer Action Network
4:16:50 PM
CHAIR HIGGINS announced that the next order of business would be
a presentation by the American Cancer Society Cancer Action
Network.
EMILY NENON, Alaska Government Relations Director, American
Cancer Society Cancer Action Network, presented a short video
from the American Cancer Society.
JOHN KILLPACK, Western Region Managing Director, American Cancer
Society Cancer Action Network, presented slides 1 and 2,
"Highlights from the first 100 years" from a PowerPoint titled,
"Eliminating Cancer in Alaska - A Roadmap." He declared that
the success in fighting cancer resulted from a mix of different
approaches, especially when the issue of cancer was brought out
into the open and research programs began. He pointed out that
the first successful chemotherapy treatment was used in 1947,
and was now a regular treatment. He reported that the direct
link between tobacco use and lung cancer was established in
1954. In 1971, the National Cancer Act was passed, which helped
set up the federal research programs at the National Cancer
Institute. He pointed out that the first successful use of
genetic research and its impact on cancer in 2000, the link
between obesity and many types of cancer in 2003, and passage of
the [Patient Protection and ] Affordable Care Act with its focus
on cancer in 2010 were all highlights. Moving on to slide 3,
"Where we are today:" he stated that in the last two decades
there were almost 14 million cancer survivors in the United
States, a 20 percent decline in cancer death rates, and a 50
percent decline in smoking rates. He declared that 400 more
lives were now being saved from cancer each day than in 1991.
4:25:17 PM
MR. KILLPACK offered slide 4, "But," and declared that more than
a half million people die each year in the United States from
cancer, while an additional 1.6 million were told they had
cancer. He offered an estimate for Alaska in 2014, that more
than 3700 new cases of cancer would be diagnosed, with 990
deaths from cancer. He reported on slide 5, "ACS Cancer Action
Network launched in 2001," depicting the multi-faceted approach
for beating cancer, which included research, public education,
diagnosis and treatment, and public policy.
MR. KILLPACK referred to slide 6, "The Surgeon General's Report
on Smoking & Health," and shared that this was the 50th
anniversary for the landmark 1964 surgeon general's report on
the link between smoking and lung cancer. He stated that this
report was updated regularly, and in 1988, the report clearly
demonstrated that nicotine was addictive, while in 2006, the
report stated that there was no safe level for exposure to
second hand smoke. Slide 7, "New in the 2014 Report," reported
that stroke had been added to the list of diseases caused by
second hand smoke, while diabetes, colorectal cancer and
rheumatoid arthritis were also linked. Directing attention to
slide 8, "Secondhand smoke kills," he said that 3400 non-smoking
Americans died annually from lung cancer caused by secondhand
smoke, with 46,000 non-smoking Americans dying annually from
heart disease caused by second hand smoke.
MS. NENON reported that during her 13 years with the Cancer
Action Network, there had been "amazing, amazing progress,"
slide 9, "Alaska Milestones." She pointed to 1997 when Alaska
passed the highest tobacco tax in the nation, and 2004, when the
tax was again doubled. She reported that Alaska had been one of
the leads on the tobacco master settlement agreement in 1998,
and that same year, Bethel was the first place in Alaska to pass
smoke free indoor work places. She reported that, in 2007,
Alaska saw the first measureable decline in adult smoking rates.
CHAIR HIGGINS asked how the percentage of decline was defined.
MS. NENON explained that this was based on the Youth Risk
Behavior Survey, which was an anonymous school based survey.
MS. NENON, in response to Chair Higgins, explained that, as
skewered answers would be in the same direction over time, this
would still allow trends to be detected. She shared that 36
percent of high school students smoked in 1995, which had now
declined to 10 percent. She reported that colorectal and breast
cancer death rates had dropped nationally almost 35 percent
since 1991, due largely to early detection from cancer
screening.
4:31:15 PM
MS. NENON mentioned that, since 1996, there were 35,000 fewer
adult smokers in Alaska than previously, with a cost savings of
more than $396 million, slide 10, "Alaska: Lives and Money
Saved." She announced that Alaska had received tremendous
national recognition for its tobacco prevention program and for
its counter marketing campaigns for health communication
interventions, slide 11, "National Recognition." She observed
that, although there was an even greater drop in youth smoking
by Alaska Native than by white youth, the disparity was
shrinking; yet, another 14,000 Alaska youth alive today would
still die prematurely from tobacco use, slide 12, "But:" She
directed attention to slide 13, "New products: Electronic
Cigarettes," and described the alarming growth of electronic
cigarettes, as high school student use had doubled from 4.7
percent to 10 percent in the last year. She stated that this
was a disturbing trend.
4:35:13 PM
REPRESENTATIVE TARR asked about the chemicals in electronic
cigarettes, and if there was any regulation for listing them.
MS. NENON, in response, said that it was not known what was in
the electronic cigarettes, as the ingredients in the 250
different products varied, even within brands. She noted that
there was widely varying amounts of nicotine, as well as other
carcinogenic, toxic chemicals. She said there had not been any
study regarding the aerosol inhalation of propylene glycol, an
ingredient. She shared that there had been discussion for
regulation over electronic cigarettes, but when and what were
still unknown. Although Alaska law did not allow sales to
minors, the sellers of the products were not required to have a
tobacco sales license endorsement, as was required for tobacco
products. Therefore, as there was not any requirement for
registration, compliance officers did not know who were the
sellers.
4:38:35 PM
CHAIR HIGGINS noted that there was not a list of ingredients on
the packages and asked if it was required to post the
ingredients.
MS. NENON, referring to the Family Smoking Prevention [and
Tobacco Control] Act, had not been fully implemented federally,
so there was not enforcement for these ingredients to be listed.
She declared that dog food was more closely regulated than
tobacco products.
REPRESENTATIVE TARR asked if implementation of the new warning
labels on cigarettes was part of the aforementioned act.
MS. NENON replied that new warning labels were being developed,
as the earlier labels had been stopped by a court challenge.
MS. NENON addressed slide 14, "Next Steps," and detailed that
more than 50 percent of the population was covered by the smoke
free workplace law, although it was generally agreed that
everyone had the right to breathe smoke free air. She voiced
support for extension of this right throughout Alaska.
MS. NENON directed attention to slide 15, "Epidemic Underway,"
which depicted that 65 percent of Americans, and Alaskans, as
well as 26 percent of high school students, were overweight or
obese. She moved on to slide 16, "The Cancer Link," and stated
that the first prospective study had been done in 2003, which
definitely linked obesity and cancer death. She said that
almost 33 percent of cancer deaths were related to poor
nutrition, excess body weight, and/or physical inactivity, while
another 33 percent were related to tobacco use. She referenced
the earlier video, and stated that currently evidence made it
possible to prevent 50 percent of all cancer deaths in America.
MS. NENON pointed to slide 18, "Where we are headed..." which
reflected the projected Medicaid spending in Alaska attributable
to obesity without including any matching funds. She declared
that the state will "be in real trouble" if there was not a
change. She said the state was working on prevention of
childhood obesity, and these effects were reflected in the
decline of obesity rates in K - 7th grade, in both the Anchorage
and Matanuska-Susitna Borough School Districts, slide 19,
"Bucking the Trend." She reported that the decline had been
most prevalent in boys, white students, and higher socio-
economic status students, whereas girls, minorities, and lower
socio-economic status students were not having the same decline.
4:44:28 PM
MS. NENON referred to slide 21, "Quality of Life," noting that
pain management was often an issue in dealing with the short and
long term effects of cancer. She reported that Cancer Action
Network was working, at the federal level, on an increase of
palliative care education, as cancer had become a chronic
disease. She shared that, although two out of three people were
now able to survive cancer, there were still long term effects.
MS. NENON offered slide 22, "On the Horizon," declaring that
this was her favorite slide and stating "I love my job when I
get to hear all the exciting advancements in research that are
happening." She shared that the image of the fruit fly on the
slide reflected a link to an article which had declared the
fruit fly to be an answer to curing cancer. She explained that
a fruit fly geneticist had implanted a fruit fly eye with the
tumor cells from a patient with a rare form of thyroid cancer
and diabetes. After giving many drugs to the fruit fly to see
what would work, the researcher was able to begin a very
individualized clinical trial for the patient. She expressed
her excitement for this progress. She reported that there were
much better health outcomes for those able to receive preventive
and primary care, and that society paid the cost for those who
were not able to access care.
4:48:33 PM
CHAIR HIGGINS asked about the European standard compared to the
American standard, stating that "the United States is a death
sentence for cancer patients," as there were only two types of
treatment for cancer, radiation and chemotherapy. He stated
that the European standard offered many avenues for treatment,
and he asked if the United States was moving toward offering
alternative therapies. He asked if Cancer Action Network
advocated this.
MS. NENON, in response, stated that the American Cancer Society
was the second largest funder, behind the United States federal
government, of cancer research in the nation. She reported that
the American Cancer Society tended to focus its research dollars
on younger researchers looking at innovative solutions which
included the whole system and how all the pieces fit together.
She stressed that there were major threats to federal research
funding.
REPRESENTATIVE TARR asked whether the American Cancer Society
was funding any research on the link of personal care products
to cancer.
MR. KILLPACK, in response, said that a lot of work was being
done in California, including an online registry to review the
carcinogenic ingredients in cosmetics. He noted that there was
also a lot of work on air quality and its impact on cancer. He
offered his belief that it was a matter of prioritizing. He
stated that cleaner air, reduction of the smoking rate, and
healthier products would all have an impact. He declared that
the current focus was on the quickest way to save lives.
REPRESENTATIVE TARR suggested that the website for cosmetic
ingredients was "Skin Deep."
4:52:57 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.