Legislature(2015 - 2016)CAPITOL 106
04/14/2015 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Presentation: Alaska Section of Epidemiology | |
| HB99 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| += | HB 99 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 14, 2015
3:08 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Louise Stutes
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
Representative Neal Foster
COMMITTEE CALENDAR
PRESENTATION: ALASKA SECTION OF EPIDEMIOLOGY
- HEARD
HOUSE BILL NO. 99
"An Act relating to the voluntary termination of life by
terminally ill individuals; and providing for an effective
date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 99
SHORT TITLE: VOLUNTARY TERMINATION OF LIFE
SPONSOR(s): REPRESENTATIVE(s) DRUMMOND
02/09/15 (H) READ THE FIRST TIME - REFERRALS
02/09/15 (H) HSS, JUD
04/09/15 (H) HSS AT 3:00 PM CAPITOL 106
04/09/15 (H) Heard & Held
04/09/15 (H) MINUTE(HSS)
04/14/15 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JAY BUTLER, MD, Chief Medical Officer/Director
Division of Public Health
Central Office
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the presentation
by the Section of Epidemiology.
JOE McLAUGHLIN, M.D., MPH
Chief and State Epidemiologist
Section of Epidemiology
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint during the
presentation by the Section of Epidemiology.
REPRESENTATIVE HARRIET DRUMMOND
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions about HB 99 as the
sponsor of the bill.
ACTION NARRATIVE
3:08:39 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:08 p.m.
Representatives Seaton, Wool, Talerico, Vazquez, and Stutes were
present at the call to order. Representative Tarr arrived as
the meeting was in progress.
^Presentation: Alaska Section of Epidemiology
Presentation: Alaska Section of Epidemiology
3:09:05 PM
CHAIR SEATON announced that the first order of business would be
a presentation by the Alaska Section of Epidemiology in the
Division of Public Health, Department of Health and Social
Services (DHSS). He emphasized the importance of understanding
the Section of Epidemiology, as it had influence on health in
Alaska.
3:10:02 PM
JAY BUTLER, MD, Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services (DHSS), explained that he would be in a supporting role
in the presentation, noting that Dr. McLaughlin had been the
section chief since 2007, and was the president-elect of the
Council of State and Territorial Epidemiologists.
3:12:10 PM
JOE McLAUGHLIN, M.D., MPH, Chief and State Epidemiologist,
Section of Epidemiology, Division of Public Health, Department
of Health and Social Services (DHSS), introduced a PowerPoint
titled "Epidemiologists-The Disease Detectives." He directed
attention to slide 2, "Definitions," which he declared was the
study of how and why diseases occur in populations. He shared
that epi meant upon, demos meant people, and ology was the study
of, hence the definition being the study of people. He defined
an epidemic as the occurrence of cases of an illness in a
community that are in excess of normal expectancy. He shared
that epidemics that were limited to a more localized increase of
a disease were called outbreaks; whereas larger scale epidemics
that affected many people on multiple continents were referred
to as pandemics. He moved on to slide 3, "Fundamental
Assumptions and Goal," and stated that the primary assumption of
epidemiology was that diseases did not occur at random, and
could, therefore, be studied and described. Once a disease was
understood, it could be mitigated and prevented. He stated that
the main goal of the epidemiologist was to learn about the
distribution and determinance of diseases in populations, by
finding the characteristics of the disease, who it affected in
the population, where and when it specifically occurred, and
what was the problem that actually occurred.
3:15:06 PM
DR. McLAUGHLIN directed attention to slide 4, "Alaska Section of
Epidemiology," and reported that epidemiology was one of the
eleven sections in the Alaska Division of Public Health. He
noted that this was not the only section which did epidemiologic
work, as the Sections of Chronic Disease and Women's, Children's
& Family Health, as well as Public Health Nursing, all routinely
engaged in epidemiologic work. He addressed slide 5, "What
specifically does the Section of Epidemiology do?" He explained
that the Section of Epidemiology consists of six major program
areas, with about 65 staff, fellows, and interns working in the
section. He listed the six program areas, which included
infectious diseases, HIV/STD, and immunization. He stated that
the day-to-day work addressed most of the essential functions of
public health pictured on the slide. He offered to focus in on
the work as a subset of the functions.
DR. McLAUGHLIN directed attention to slide 6, "Essential Service
#1: Monitor," and indicated that monitoring health outcomes was
the first piece of the public health essential functions pie,
which is essentially the role of epidemiologists and public
health in general. The epidemiologic term used for monitoring
was surveillance, which represents the ongoing collection,
analysis, and interpretation of population health data that
forms the backbone of public health practice. This is closely
integrated with timely dissemination of data to key stakeholders
such as health care providers, the public, and many others. He
directed attention to slide 7, "Why Do Surveillance?"
Surveillance allows epidemiologists to directly measure what is
going on in the population with respect to diseases and other
key health outcomes, he stated. The surveillance data enables
us to get answers to the fundamental epidemiologic questions of
who, what, where, why, and when. It further allows assessment
of trends over time to determine the need for public health
intervention, prioritize resources, evaluate effectiveness, and
provide critical feedback to stakeholders.
DR. McLAUGHLIN directed attention to slide 8, "Conditions
Reportable to Public Health in Alaska," stating a number of
conditions that were legally reportable by health care providers
and laboratories in Alaska, including approximately 50
infectious diseases, cancer, and birth defects. These
reportable conditions are summarized in the reportable
conditions manual, which is available online at the Section of
Epidemiology's website at www.epi.alaska.gov.
REPRESENTATIVE TALERICO asked about legally reportable
conditions and whether the Section of Epidemiology was required
to report them.
DR. McLAUGHLIN answered yes.
DR. McLAUGHLIN directed attention to slide 9, "Surveillance
Conditions Reportable," noting the amount of time that health
care providers and labs are given to report depends on the
condition and ranges from an immediate reporting requirement for
public health emergencies as shown on the slide, including
anthrax, botulism, diphtheria, and polio to as long as six
months for other diagnosis, such as cancer.
DR. McLAUGHLIN directed attention to slide 10, "Report Out to
Stakeholders," and noted that all of the Division of Public
Health's sections that collect reportable conditions data report
out their findings to stakeholders in a variety of formats. For
example the Infectious Disease Program provides an annual
summary of reportable infectious disease case counts over the
past two years in an epidemiology bulletin. In addition, some
of the infectious diseases warrant their own specific
epidemiology bulletins that provide more detailed epidemiologic
information, for example, tuberculosis, HIV, and gonorrhea.
Turning to the next slide 11, entitled "Monitor Trends," he
noted that the Section of Epidemiology can track trends over
time, for example, reviewing influenza surveillance data to
determine when the seasonal influenza epidemic is peaking and
when the epidemic will end. In addition, epidemiology can
follow yearly trends to determine variations in diseases from
year to year. He turned to slide 12, "Provide Reassurance,"
stating that sometimes surveillance data provides critical
reassurance to the public. For example, the statewide Hair
Mercury Bio-monitoring Program allows women of child-bearing
ages to submit hair samples to the state public health lab to be
analyzed for mercury content since elevated mercury content in
the blood can affect brain development in their fetuses and
breast-feeding infants. Parents are naturally concerned about
this contaminant in their foods, which is of in particular
importance to people consuming lots of fish and other
subsistence foods. Fortunately the feedback the Section of
Epidemiology can provide mothers and communities indicates that
the vast majority of people whose hair was tested came back far
below the threshold level of concern. This information provides
evidence based reassurance to the public, he said.
3:21:37 PM
DR. McLAUGHLIN directed attention to slide 13, "Detect
Outbreaks," noting that surveillance allows epidemiologists to
detect, respond to, and stop epidemics. This slide depicts an
outbreak of campylobacter bacterial infection associated with
consumption of raw, unpasteurized milk that occurred in 2013.
Since the state public health lab performs molecular
characterization of campylobacter strains, the Section of
Epidemiology was able to quickly determine that the first
several cases in this outbreak were the same strain of
campylobacter. This prompted a quick public health
investigation that uncovered the outbreak and enabled
epidemiologists to encourage people not to drink the infected
milk. Thus shortly thereafter the outbreak stopped. He
directed attention next to slide 14, "Essential Service #2:
Investigate," which means epidemiologists diagnose and
investigate health problems and hazards in the community. These
investigation are often prompted by an unusual clustering of
cases. However, for very serious diseases, only one constitutes
an outbreak and requires prompt investigation, for example, food
borne botulism. He advised that botulism is a life-threatening
illness caused by consumption of food contaminated with
botulinum toxin, which is one of the most potent, naturally-
occurring neurotoxins on the planet. Alaska has the unfortunate
distinction of having one of the highest rates of food-borne
botulism in the world, he said. This bacteria thrives in
oxygen-poor conditions, which are the conditions required for
fermenting and putrefying foods. Many cultures ferment food,
such as some cheeses and sauerkraut. All of Alaska's cases of
botulism have been caused by the consumption of traditional
Alaskan Native foods that were aged or putrefied, for example,
aged fish heads, fish eggs, and seal flipper, as well as
putrefied seal oil.
DR. McLAUGHLIN directed attention to slide 15, "Recent Outbreak
Example, 12/19/14," depicting a botulism case that began on
12/19/14 at 3:30 p.m. when an epidemiology nurse received a call
from the Yukon-Kuskokwim Delta Regional Hospital (YKDRH) and was
informed that botulinum anti-toxin was administered to two
adults who manifested classic signs and symptoms of botulism,
including neuro-paralysis. The two adults shared a meal that
included rendered seal oil consumed in a village at 6 p.m. on
12/18/14. Their symptoms emerged 12-16 hours after consumption.
Both adults with respiratory muscle involvement were medivaced
to Alaska Native Medical Center's intensive care unit. Another
adult and two children, ages 8 and 12, also ate the meal but
were asymptomatic. The seal oil was obtained from a distributor
in another village, he said.
DR. McLAUGHLIN said he was contacted on the same day and he and
the nurse epidemiologist developed an immediate action plan,
including sending additional antitoxin kits to the YKDRH since
at least three other people had been exposed [slide 16]. Public
health nurses were called in to do initial field work and pull
contaminated seal oil from refrigerators and monitor those who
were exposed for any symptoms. The plan included flying an
epidemiology nurse to the village for an onsite investigation
and flying the two exposed children to Bethel.
3:29:54 PM
DR. BUTLER added that the first rule of outbreak public health
was that all outbreaks are identified after 3 p.m. on Friday.
3:30:09 PM
DR. McLAUGHLIN directed attention to slide 17, "12/21/14," which
fell on a Sunday. One of the medical doctors at YKDRH reported
that the foregoing 8-year-old child who consumed contaminated
seal oil had fixed and dilated pupils and excessive thirst,
signs of botulism. The Section of Epidemiology determined the
child probably had botulism and the doctor was advised to
administer antitoxins and continue monitoring both children.
3:31:06 PM
REPRESENTATIVE WOOL asked whether any harm can occur with the
administration of the antitoxin to someone who had not
contracted botulism.
DR. McLAUGHLIN replied that it was not medically indicated to
administer antitoxins in the absence of clinical botulism due to
potential side effects, although the newer anti-toxin has fewer
side effect risks.
3:32:06 PM
DR. McLAUGHLIN directed attention to slide 18, entitled
"12/22/14," noting that specimens of seal oil were sent to the
state lab for testing, the distributor was contacted, and up to
eight other people were identified as potentially being exposed.
Public health nurses had daily contact with everyone who had
consumed seal oil to monitor them for symptoms. By that point
up to 18 exposed individuals had been identified. An itinerant
nurse manager flew to Dillingham to assist follow up on all of
them.
DR. McLAUGHLIN directed attention to slide 19, entitled
"12/23/14," noting that public health nurses were unable to fly
to village B, where the supplier lived due to weather. Lab
results were provided to public health nurses, the YKDRH, and
health care providers in Dillingham. The lab indicated that the
seal oil had the highest percentage of botulinum toxin ever
encountered by the lab. He referred to slide 20, entitled
"12/24/14," stated that another epidemiology nurse who brought
three additional antitoxin kits to assist with surveillance and
monitoring of exposed persons was flown to Dillingham. The
Section of Epidemiology held a meeting with the Bristol Bay Area
Health Corporation and hospital, medical, and clinical staff to
develop a collaborative plan since botulism can incubate in the
system for weeks. The plan included media interviews to inform
people of the outbreak.
DR. McLAUGHLIN directed attention to slide 21, "Summary of
Botulism Surveillance," noting this case involved three cases of
botulism, that all survived, but over 20 additional people
consumed some of the highly toxic seal oil. He expressed
concern over the number of cases and the outcome if more seal
oil was distributed to people and they had consumed the
contaminated seal oil.
3:36:54 PM
REPRESENTATIVE WOOL, in reference to slide 21, asked how two
people in Wasilla had been possibly exposed.
DR. McLAUGHLIN explained that some of the contaminated seal oil
had been shipped to Wasilla.
3:37:17 PM
DR. McLAUGHLIN directed attention to slide 22, "Essential
Service #3: Educate," which provides a nice segue to education,
mentioning a number of ways the division provides information on
botulism to communities, including on the department's website
and in educational talks to medical staff.
DR. McLAUGHLIN directed attention to slide 23, "Working with the
Media," noting the Section of Epidemiology works with media to
keep the public informed. He referred to slide 24,
"Epidemiology," describing the epidemiology website that
highlights current events in Alaska as well as links to
programmatic webpages.
DR. McLAUGHLIN directed attention to slide 25, "Alaska Public
Health Advisory," explaining that the Section of Epidemiology
releases public health advisories when necessary, with the
primary audience being health care providers in order to keep
them informed of any emerging issues of public health
importance. He next directed attention to slide 26, "Epi
Bulletins," which he said he previously mentioned; however, this
slide highlights the bulletins, which are generally widely read.
DR. McLAUGHLIN directed attention to slide 27, "Bulletin
Recommendations and Reports," noting multi-page reports have
been issued and are available. One recent report provided fish
consumption advice for Alaskans, noting that Alaska's fish is
considered very safe, that salmon are low in mercury and high in
nutrients.
3:41:50 PM
DR. McLAUGHLIN directed attention to slide 28, "Phone Calls from
the Public," noting that the Section of Epidemiology fields
numerous calls about public concerns 24 hours a day, 7 days a
week, (24/7) including all holidays, responding to a wide range
of topics such as bedbugs and sexually-transmitted infections.
Referring to slide 29, "Essential Service #4: Mobilize Community
Partnerships," stating that this plays into all of the other
essential services that the Section of Epidemiology does. It
involves collaboration on projects, conducting investigations
and community outreach with key partners out-of-state and in
Alaska, including physicians, hospitals, other state agencies,
and tribal or governmental organizations. The majority of what
the Section of Epidemiology does involves partner collaboration,
recalling one recent far-reaching effort was the Healthy
Alaskans 20-20 Project, which involved leaders from the Alaska
Native Tribal Health Consortium and the Department of Health and
Social Services (DHSS), as well as an advisory team consisting
of stakeholders from across Alaska. The team has considered
hundreds of health priorities and has narrowed them down to 25-
leading health priorities. The purpose was to set up a health
framework that will serve as the foundation for collective
accountability.
DR. McLAUGHLIN directed attention to slide 30, "Essential
Service #5: Develop Policies and Plans that Support
Individual/Community Health," including emergency response
planning. Turning to slide 31, "The 2014 Ebola Epidemic," he
highlighted one recent example of an infectious disease response
planning during the Ebola outbreak - the largest outbreak in
history - primarily affecting three West African countries and
resulting in over 25,000 cases and 10,000 deaths. He reported
that the US had 2 imported cases and one death. This resulted
in a massive burden for state and local health departments to
monitor travelers returning from affected countries. He
directed attention to slide 32, "Case Counts and Deaths," that
list total cases in Guinea, Liberia, and Sierra Leone.
DR. McLAUGHLIN directed attention to slide 33, "Ebola
Preparedness in Alaska," stating a multi-agency Ebola Taskforce
was promptly created in the fall 2014, with representatives and
participation from the House Health and Social Services Standing
Committee, Municipality of Anchorage, law enforcement, the
military, and other governmental agencies. The Section of
Epidemiology informed hospitals about Ebola and provided
education and guidance for preparedness, including developing a
website. In addition, they had ongoing monitoring of travelers.
He noted a total of 20 returning travelers arrived in Alaska
from Ebola-affected countries. The Alaska State Public Health
Laboratory brought Ebola testing on line and successfully
processed specimens. He directed attention to slide 34, "DHSS
Ebola Response Plan," noting that the Department of Health and
Social Services Ebola Response plan contained ten sections that
address the major health concern regarding Ebola preparedness
and response.
3:48:47 PM
DR. McLAUGHLIN directed attention to slide 35, "All Hazards
Example," noting one example was the Fukushima nuclear reactor
accident in northeast Japan on March 11, 2011. When the
Fukushima power plant disaster occurred the Section of
Epidemiology worked with its partners to provide subject matter
expertise to the public by creating a website, publishing a
bulletin, and testifying before the legislature on risk, as well
as providing guidance on food and drinking water safety. He
turned to slide 36, "Where were samples collected?," declaring
to date the FDA has tested 20 composite fish samples from
multiple areas in Alaska, with all samples as "non-detect" for
radiation. He directed attention to slide 37, "Water Samples
Tested for Radiation," which highlighted the sampling sites
depicted on the slide, from the western coast of the US to
Canada and Alaska. All of these samples have come back as "non-
detect" for radiation, he said.
DR. McLAUGHLIN directed attention to slide 38, "Essential
Service #7: Linking People to Needed Services and Assure Access
to Care," highlighting another essential service, linking people
to infectious disease, HIV/STD, and immunization care. Turning
to slide 39, "Tuberculosis Control Program," stating that the
program performs case management for all suspect and active
tuberculosis cases to ensure appropriate follow-up to reduce the
risk of transmission. The epidemiologists also perform contact
investigations for those in close contact with persons with
active tuberculosis, including offering consultations, and
interpreting X-rays. Unfortunately, Alaska has typically been
number one or two in terms of incidence of tuberculosis in the
US, he said.
3:51:34 PM
CHAIR SEATON asked what efforts the epidemiologist makes when
advised of an active tuberculosis case within a community.
DR. McLAUGHLIN explained that after identifying a person with
active tuberculosis, it's important that the patient receives
adequate care. The epidemiologist team performs contact
investigations to identify anyone who has been in contact with
the patient and subsequently screens them, typically with a TB
skin test. If multiple people are identified, the epidemiology
screens everyone in the village or community, he said.
3:53:59 PM
DR. McLAUGHLIN directed attention to slide 40, "Tuberculosis
incidence rates, 1952-70," and spoke about the dramatic
tuberculosis rates in Alaska Native population, which are the
highest in the world. The historical rates still affect today's
rates, he said, noting that Alaska has ongoing challenges due to
a number of factors, including access to care. He referred to
slide 41, "Active TB Rate by year, Alaska," which illustrates
the active cases since 1991. Although the cases have continued
to drop, Alaska's rates are higher than in the Lower 48. About
50 percent of the infectious disease program deals with
tuberculosis, he said. He referred to slide 42, "AK TB Cases by
Race," which shows the highest rates, about 70 percent fall
within the Alaska Native population.
CHAIR SEATON asked whether the proportion of tuberculosis in
rural Alaska is the same or if more tuberculosis has been found
in villages in the Alaska native population.
DR. McLAUGHLIN replied that what seems to contribute to the
problem is the lack of infrastructure and limited access to
care; for example, many homes are small dwellings, housing lots
of multi-generational people. Some villages do not have running
water, which tends to hamper general cleanliness and sanitation.
He wondered if the question was more about whether white cases
occur in Alaska Native villages. In fact, a lot of the white
cases are found in urban settings in the homeless population.
DR. BUTLER stated that there was substantial variability in
incidence year to year so when clusters occur they tend to bias
the figures. He stated in the past 10 years, there have been
more urban cases, as stated earlier. He suggested that perhaps
the Alaska Native population was overrepresented in the homeless
population and he was not certain if he could answer whether it
was urban/rural or a non-Native/Alaska Native issue, but it
tends to be domestic and the disease can reactivate years later.
He suggested that tuberculosis in other states has been driven
more by immigrants.
CHAIR SEATON noticed the relationship between Asian/Pacific
Islanders was higher. He asked for further clarification on the
location of the incidence of tuberculosis in the foregoing
population.
DR. McLAUGHLIN said that vast majority of the Asian/Pacific
Islander population are foreign-born and have immigrated to
Alaska.
4:00:11 PM
REPRESENTATIVE TALERICO asked if tuberculosis was a bacterial
infection.
DR. McLAUGHLIN said that was correct.
REPRESENTATIVE VAZQUEZ asked whether tuberculosis was
contagious.
DR. McLAUGHLIN answered that tuberculosis was contagious, but
not as much as measles, noting tuberculosis typically requires
closer contact.
REPRESENTATIVE VAZQUEZ reflected on a serious case in southern
Florida.
DR. BUTLER replied that certain viral illnesses including
measles and tuberculosis are airborne and the infection can
become airborne and spread through the ventilation systems.
Thus patients are placed in airborne infection isolation rooms
for precaution and the ventilation system does not circulate to
other parts of the hospital. Tuberculosis can be transmitted
via the ventilation systems, he said.
4:02:49 PM
REPRESENTATIVE VAZQUEZ asked how many cases in Alaska required
that type of care.
DR. McLAUGHLIN said the figures varied from 50-70 cases per
year.
4:03:14 PM
DR. McLAUGHLIN directed attention to slide 43, "HIV/STD Program
- Direct Patient Services and Linkage to Care," stating that the
staff performs disease investigative follow-up on HIV, syphilis,
gonorrhea, and chlamydia cases. The epidemiologists also
perform partner notification services to inform people they
potentially have been exposed to the disease. He turned to
slide 44, "Chlamydia Infection Rates - Alaska and the United
States," showing high rates in Alaska, stating that the
chlamydia infection rates in the US continues to climb, with
Alaska having one of the highest rates in the country. The
epidemiologists do follow-up on most of the chlamydia cases,
which means Alaska probably identifies more disease through
active surveillance. He directed attention to slide 45,
"Gonococcal Infection Rates - Alaska and the United States,"
noting that Alaska has been in the middle of the pack in terms
of national rates; however, during 2009, gonorrhea cases has
spiked several times.
4:06:45 PM
DR. McLAUGHLIN directed attention to slide 46, "Primary,
Secondary, Early Latent and Congenital Syphilis Cases, Alaska,"
stating that syphilis cases have increased since 2008, primarily
with men who have sexual contact with other men (MSM). Many of
these cases are anonymous MSM, with Internet and mobile
applications that promote anonymous sexual activity. The
Section of Epidemiology actively works with any new incidence.
Most of these syphilis cases are concentrated in Anchorage and
Fairbanks. He turned to slide 47, "Percentage of HIV Cases by
Region of Diagnosis," slide 48, noting that Alaska has a low
incidence state for HIV, with the highest rates in the Anchorage
and Mat-Su area. He emphasized that HIV was the Section of
Epidemiology's number one priority to help ensure it does not
spread. Referring to slide 49, "2014 Cases of HIV First
Diagnosed in Alaska by Age at Diagnosis," he pointed out the
highest incidence of HIV was in Whites (49 percent, followed by
Alaska Native (26 percent), and the Black population (19
percent). He turned to slide 50, "Linkage to Care (L2C)
Program," which showed the 2014 cases with the highest rate in
the 25-34 years of age and the second highest rate in the 15-24
years of age group. The Linkage to Care (L2C) Program uses HIV
surveillance data to identify individuals newly diagnosed with
HIV and previously diagnosed with HIV who are living in Alaska
and not accessing medical care. The Section of Epidemiology's
goal is to link them to medical care. In 2015, 56 people were
identified as eligible and were offered linkage to care. Of
those, 98 percent subsequently re-engaged or engaged in HIV
medical care. He said that 71 percent of the HIV patients
achieved "viral suppression," meaning that the virus has been
suppressed in their system and making it much less likely for
the disease to progress and for HIV transmission to occur.
4:11:19 PM
DR. McLAUGHLIN directed attention to slide 51, "Immunization
Program Activities that Improve Access to Care," He highlighted
the program as the Section of Epidemiology's largest program.
He reported that this program works to procure and distribute
vaccines to health care providers statewide. He pointed out
several features of the program, VacTrAK, which is Alaska's
immunization registry. All immunizations issued in Alaska must
be entered into the database, which he characterized as a great
tool to help epidemiologists understand the immunization
coverage rates in Alaska. It helps improve portability of care
since all providers can access the history. In addition, the
Section of Epidemiology has an Alaska Vaccine Assessment
Program, which creates a vaccine assessment account, funded by
insurance companies and other payers. It enables the program to
purchase and distribute state-supplied vaccines to improve
access and affordability to life-saving vaccines statewide.
4:13:35 PM
REPRESENTATIVE VAZQUEZ asked if there was any disaster
preparedness done in his office.
DR. McLAUGHLIN answered yes; again referencing the Ebola and
Fukishima efforts, in fact, disaster preparation was one of the
key things the department does. The Emergency Program Section,
an entire section within the Division of Public Health, works
24/7 on preparedness and is responsible for orchestrating
preparedness efforts for the department.
DR. BUTLER offered to do a presentation on disaster preparedness
and emergency programs. He explained that recently the program
held a mock disaster in Homer, working with the Alaska National
Guard, as well as local responders on disasters. The Section of
Epidemiology has been focused on pandemic preparedness control
of infectious diseases.
4:16:01 PM
REPRESENTATIVE VAZQUEZ said she has been impressed with the
Division of Public Health.
REPRESENTATIVE TALERICO commented on the Section of Epidemiology
Bulletin. He said it was impressive amount of information and
is very well done.
DR. BUTLER offered to send the Bulletins by e-mail.
CHAIR SEATON asked to put members on the e-mail alerts.
REPRESENTATIVE VAZQUEZ asked whether he had any Vitamin D
alerts.
CHAIR SEATON pointed to Vitamin D and rickets in Native
Alaskans. He said he shared an article with Dr. Butler on core
symptoms of autism improvements with Vitamin D supplements. It
seemed as if all the data was observational, but the focus of
the committee was on prevention instead of response. He asked
how to implement observational data when looking at prevention
or if that data is solely used when responding to life
threatening situations or outbreaks. He remarked that costs to
treat autism per individual was very high in Alaska.
4:20:03 PM
DR. BUTLER replied that substantial epidemiology is hypothesis
generating looking for association and then causation. He
acknowledged that sometimes the answers are straightforward, but
other times they are more nuanced. In terms of when it was
appropriate to move beyond medical practice toward public health
intervention, cautioned it is necessary to ensure no harm is
done when making a direct jump to intervention. Ultimately the
goal is to determine the right intervention at the right time
with a minimum of cost. He acknowledged the Vitamin D story was
intriguing. He suggested that the health care community has
been struggling through the details. He raised the issue some
have about the efficacy of monthly injections. He acknowledged
there was a pragmatic side to consider, noting it can be
frustratingly slow, but the importance of balancing cost, risk,
and benefit and that decisions are made on the best information
available.
CHAIR SEATON stated that prevention is a key for the committee.
4:23:39 PM
HB 99-VOLUNTARY TERMINATION OF LIFE
DRAFT
4:23:53 PM
CHAIR SEATON announced that the final order of business would be
HOUSE BILL NO. 99, "An Act relating to the voluntary termination
of life by terminally ill individuals; and providing for an
effective date."
4:24:04 PM
CHAIR SEATON explained that there were three amendments to be
introduced, although the committee did not plan to move the
proposed bill at this time.
REPRESENTATIVE WOOL moved to adopt Amendment 1, labeled 29-
LS0112\W.1, Bannister, 4/11/15, which read:
Page 2, line 3:
Delete "an adult"
Insert "21 years of age or older"
Page 4, line 2:
Delete "an adult"
Insert "21 years of age or older and"
Page 12, line 30:
Delete all material.
Renumber the following paragraphs accordingly.
CHAIR SEATON objected for discussion.
REPRESENTATIVE WOOL explained that he was concerned with the
appropriate age for access to the prescription, and offered that
21 years of age was more appropriate for an age to terminate
your life without parental consent.
4:26:21 PM
REPRESENTATIVE HARRIET DRUMMOND, Alaska State Legislature,
stated that she was amenable with the proposed amendment for the
time being. She noted that, should the proposed bill be
forwarded, its next committee of referral was the House
Judiciary Standing Committee and they could also consider the
legal issues. She opined that 18 was the age of legal consent
for medical procedures, which was the reason the bill sponsor
had maintained the age similar to the Oregon law. She offered
her belief that only one person under 30 years of age had taken
the prescription in Oregon. She declared that she would accept
this proposed amendment for the benefit of the committee.
CHAIR SEATON offered his belief that the proposed amendment
would resolve some of the issues that people had.
CHAIR SEATON removed his objection. There being no further
objection, Amendment 1 was adopted.
4:27:43 PM
CHAIR SEATON explained that Amendment 2 had been suggested by
the court system, and that it deleted "a court" on page 2, line
4. He said that this would no longer supersede an individual's
attending physician, as the court did not believe this was
within its purview.
4:28:56 PM
CHAIR SEATON moved to adopt Amendment 2, labeled 29-LS0112\W.2,
Bannister, 4/11/15, which read:
Page 2, line 4:
Delete "a court,"
REPRESENTATIVE TALERICO objected for discussion.
REPRESENTATIVE TALERICO removed his objection. There being no
objection, Amendment 2 was adopted.
4:29:32 PM
CHAIR SEATON moved to adopt Amendment 3, labeled 29-LS0112\W.3,
Bannister, 4/13/15, which read:
Page 13, lines 19 - 20:
Delete "correctional facility owned or
administered by the state;"
Page 13, line 25, following "includes":
Insert "a state correctional facility as defined
in AS 33.30.901 and"
REPRESENTATIVE TALERICO objected for discussion.
CHAIR SEATON explained that this amendment had been proposed by
the correctional system, and changed the way the proposed bill
specified the correctional facilities.
REPRESENTATIVE TALERICO removed his objection. There being no
further objection, Amendment 3 was adopted.
CHAIR SEATON asked if Representative Drummond was supportive of
Amendment 2 and Amendment 3.
[HB 99 was held over]
4:31:14 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:31 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB99 Support - emails 4.13.2015.pdf |
HHSS 4/14/2015 3:00:00 PM |
HB 99 |
| HB99 Opposition - Assorted emails - 4.13.2015.pdf |
HHSS 4/14/2015 3:00:00 PM |
HB 99 |
| HB99 Support -Written testimony - Dechman - 4.9.2015.pdf |
HHSS 4/14/2015 3:00:00 PM |
HB 99 |
| HB99 Proposed amendments - 1-3.pdf |
HHSS 4/14/2015 3:00:00 PM |
HB 99 |
| HB99 Opposition- Written Testimony- Miller - 04-09-15.pdf |
HHSS 4/14/2015 3:00:00 PM |
HB 99 |
| HB99 Version W.PDF |
HHSS 4/9/2015 3:00:00 PM HHSS 4/14/2015 3:00:00 PM |
HB 99 |
| HB99 Sponsor Statement.pdf |
HHSS 4/9/2015 3:00:00 PM HHSS 4/14/2015 3:00:00 PM |
HB 99 |
| HHSS Presentation_Epidemiology_2015Apr14.pdf |
HHSS 4/14/2015 3:00:00 PM |
Presentations by DHSS |
| HB99 Proposed CS Version H.pdf |
HHSS 4/14/2015 3:00:00 PM |
HB 99 |