03/07/2005 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HB95 | |
| HB149 | |
| HB85 | |
| HB148 || HB101 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 85 | TELECONFERENCED | |
| *+ | HB 149 | TELECONFERENCED | |
| *+ | HB 148 | TELECONFERENCED | |
| *+ | HB 101 | TELECONFERENCED | |
| = | HB 95 | ||
ALASKA STATE LEGISLATURE
HOUSE JUDICIARY STANDING COMMITTEE
March 7, 2005
1:13 p.m.
MEMBERS PRESENT
Representative Lesil McGuire, Chair
Representative Tom Anderson
Representative John Coghill
Representative Nancy Dahlstrom
Representative Pete Kott
Representative Les Gara
Representative Max Gruenberg
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 95
"An Act relating to public health and public health emergencies
and disasters; relating to duties of the public defender and
office of public advocacy regarding public health matters;
relating to certain claims for public health matters; making
conforming amendments; and providing for an effective date."
- MOVED CSHB 95(JUD) OUT OF COMMITTEE
HOUSE BILL NO. 149
"An Act relating to further regulation of the sale, possession,
and delivery of certain chemicals and precursors used in the
manufacture of methamphetamine."
- HEARD AND HELD
HOUSE BILL NO. 85
"An Act relating to self-administration and documentation of
certain types of medication prescribed to a child attending
school."
- MOVED CSHB 85(JUD) OUT OF COMMITTEE
HOUSE BILL NO. 148
"An Act relating to trafficking of persons."
- HEARD AND HELD
HOUSE BILL NO. 101
"An Act relating to sex trafficking and tourism."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 95
SHORT TITLE: PUBLIC HEALTH DISASTERS/EMERGENCIES
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
01/21/05 (H) READ THE FIRST TIME - REFERRALS
01/21/05 (H) HES, JUD
02/10/05 (H) HES AT 3:00 PM CAPITOL 106
02/10/05 (H) Moved CSHB 95(HES) Out of Committee
02/10/05 (H) MINUTE(HES)
02/11/05 (H) HES RPT CS(HES) NT 2DP 2NR 1AM
02/11/05 (H) DP: CISSNA, WILSON;
02/11/05 (H) NR: GARDNER, ANDERSON;
02/11/05 (H) AM: KOHRING
03/04/05 (H) JUD AT 1:00 PM CAPITOL 120
03/04/05 (H) Heard & Held
03/04/05 (H) MINUTE(JUD)
03/07/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 149
SHORT TITLE: SALE OF METHAMPHETAMINE AND PRECURSORS
SPONSOR(S): REPRESENTATIVE(S) RAMRAS
02/14/05 (H) READ THE FIRST TIME - REFERRALS
02/14/05 (H) JUD, FIN
03/07/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 85
SHORT TITLE: PRESCRIBED MEDICATION FOR STUDENTS
SPONSOR(S): REPRESENTATIVE(S) MEYER
01/19/05 (H) READ THE FIRST TIME - REFERRALS
01/19/05 (H) HES, JUD
02/15/05 (H) HES AT 3:00 PM CAPITOL 106
02/15/05 (H) Moved CSHB 85(HES) Out of Committee
02/15/05 (H) MINUTE(HES)
02/18/05 (H) HES RPT CS 6DP
02/18/05 (H) DP: CISSNA, GARDNER, ANDERSON, MCGUIRE,
SEATON, WILSON
02/18/05 (H) FIN REFERRAL ADDED AFTER JUD
03/07/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 148
SHORT TITLE: TRAFFICKING OF PERSONS
SPONSOR(S): REPRESENTATIVE(S) KERTTULA
02/14/05 (H) READ THE FIRST TIME - REFERRALS
02/14/05 (H) JUD, FIN
03/07/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 101
SHORT TITLE: SEX TRAFFICKING AND TOURISM
SPONSOR(S): REPRESENTATIVE(S) CROFT
01/21/05 (H) READ THE FIRST TIME - REFERRALS
01/21/05 (H) JUD, FIN
03/07/05 (H) JUD AT 1:00 PM CAPITOL 120
WITNESS REGISTER
MICHAEL "WES" MACLEOD-BALL, Executive Director
Alaska Civil Liberties Union (AkCLU)
Anchorage, Alaska
POSITION STATEMENT: During discussion of HB 95, provided
comments, expressed concerns, and referenced possible
amendments.
Beverly Smith
Christian Science Committee on Publication for Alaska
Douglas, Alaska
POSITION STATEMENT: During discussion of HB 95, provided
comments, expressed concerns, referenced possible amendments,
and responded to a question.
RICHARD MANDSAGER, M.D., Director
Central Office
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: During discussion of HB 95, responded to
questions posed during the bill's prior hearing, and commented
on and responded to questions about the proposed amendments;
During discussion of HB 85, provided comments and responded to
questions.
DAN BRANCH, Senior Assistant Attorney General
Human Services Section
Civil Division (Juneau)
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Responded to questions during discussion of
HB 95 and proposed amendments.
REPRESENTATIVE JAY RAMRAS
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 149.
RONALD J. WALL, Sergeant
Supervisor
Fairbanks Areawide Narcotics Team
Alaska Bureau of Alcohol & Drug Enforcement
Division of Alaska State Troopers
Department of Public Safety (DPS)
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 149.
LIBBY DANNENBERG, State Relations Counsel
Consumer Healthcare Products Association (CHPA)
Washington, DC
POSITION STATEMENT: During discussion of HB 149, provided
comments, expressed a concern about the bill as well as support
for the sponsor's goal, and offered suggestions.
REPRESENTATIVE HARRY CRAWFORD
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: During discussion of HB 149, expressed
concerns, but said he is in favor of the bill and urged its
passage.
DEAN J. GUANELI, Chief Assistant Attorney General
Legal Services Section-Juneau
Criminal Division
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: During discussion of HB 149, provided
comments and responded to questions.
REPRESENTATIVE KEVIN MEYER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 85.
MARGE LARSON, Director of Programs
American Lung Association;
Steering Committee Member
Alaska Asthma Coalition
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 85.
FRANK TURNEY
Fairbanks, Alaska
POSITION STATEMENT: Testified on HB 85.
MICHAEL PAWLOWSKI, Staff
to Representative Kevin Meyer
House Finance Committee
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: During discussion of proposed amendments to
HB 85, responded to questions on behalf of the sponsor,
Representative Meyer.
REPRESENTATIVE BETH KERTTULA
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 148.
REPRESENTATIVE ERIC CROFT
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 101.
ACTION NARRATIVE
CHAIR LESIL McGUIRE called the House Judiciary Standing
Committee meeting to order at 1:13:59 PM. Representatives
McGuire, Anderson, Kott, Dahlstrom, and Gara were present at the
call to order. Representatives Coghill and Gruenberg arrived as
the meeting was in progress.
HB 95 - PUBLIC HEALTH DISASTERS/EMERGENCIES
1:15:26 PM
CHAIR McGUIRE- announced that the first order of business would
be HOUSE BILL NO. 95, "An Act relating to public health and
public health emergencies and disasters; relating to duties of
the public defender and office of public advocacy regarding
public health matters; relating to certain claims for public
health matters; making conforming amendments; and providing for
an effective date." [Before the committee was CSHB 95(HES).]
1:15:43 PM
MICHAEL "WES" MACLEOD-BALL, Executive Director, Alaska Civil
Liberties Union (AkCLU), said he appreciates the efforts Dr.
Mandsager, Department of Health and Social Services (DHSS), made
to address some of the AkCLU'S concerns with HB 95, and relayed
that the AkCLU doesn't have any interest in seeing the bill fail
- rather, the AkCLU agrees with Dr. Mandsager that current law
is ambiguous and should be clarified. He summarized the AkCLU'S
concerns as follows:
We're concerned with three of the items of authority
that are granted to the government under this bill.
... In particular, the government is given the
authority to isolate or quarantine individuals against
their will, and the government's also given the
authority to access identifiable, private medical
records. So with respect to those three items, we're
interested in establishing a separate, higher standard
that the government needs to clear before it can do
any one of those three actions. ... We have offered
some suggestions to the [DHSS] and I believe members
of your committee may have seen some of that language
that we've suggested; we're not particularly wedded to
the language that we have offered as an alternative,
and we think there are different ways to accomplish
that goal. ...
Our concern is that when somebody's liberty interests
are directly restricted by being isolated or
quarantined, whether in their own home or elsewhere,
... the government should have to pass a fairly high
hurdle. Now, that hurdle may be a varying hurdle,
because some diseases are going to be more threatening
than others, and we understand and recognize that. We
would also ... rely on the expertise of the [DHSS] to
try to help us reach a different standard that can
accommodate that kind of a varying range of threat.
... The other issues that we have -- there is a
provision in here for ex parte hearings; in other
words, a hearing before a judge where the [DHSS] would
make its case for an isolation or quarantine order
without giving access to that proceeding to the
affected individual. As it's described in the
original legislation, the individual would already be
aware of the [DHSS's] concern on the public health
issue, and so therefore we don't see any need for
there to be an ex parte hearing that bars the affected
individual from participating.
MR. MACLEOD-BALL continued:
To [its] credit, the [DHSS] does have a subsequent
proceeding that would allow the individual to
participate, but ... there would no reason to exclude
that person from the [first] hearing if [he/she wants]
to participate. The [DHSS], in some of its proposals,
has addressed some of the confidentiality issues we
are concerned with, and depending upon how that
language actually ends up, we appreciate the step in
that direction. In particular, I think one of the
proposed amendments calls for the destruction of the
confidential information, the identifiable medical
information, once the [DHSS's] need for it has passed.
We think that is a good step in the right direction.
... And then finally, we are interested in having some
additional language added to the bill which would
simply protect the affected individual's rights if
they've been subject to one of these isolation or
quarantine orders. For example, we believe that if
somebody is isolated or quarantined against their will
- or otherwise, for that matter - ... that should not
affect their right to housing, ... their job, ... [or]
any pending civil or criminal proceedings adversely.
... The biggest area of concern [pertains to] ...
establishing a separate, higher threshold for the
government to exercise its authority to isolate or
quarantine an individual against his or her will, or
to access their private, identifiable medical records.
1:21:41 PM
Beverly Smith, Christian Science Committee on Publication for
Alaska, indicated that her organization had previously submitted
information in a letter dated 2/24/05, and relayed that she
would be submitting additional information at this time in a
letter dated 3/7/05. In part paraphrasing from the letter dated
3/7/05, she said:
I understand and appreciate the complexities of
balancing individual rights and the common good. I
believe that by hearing and considering all
perspectives, the committee will amend the bill as
needed to achieve that balance. In my capacity as
Christian Science Committee on Publication for Alaska,
one of my roles is to watch legislative proposals to
ensure that Alaskans have the choice to pursue
spiritual means for the prevention and cure of
disease, including Christian Science treatment and
care.
The choice of spiritual means for treatment is by no
means the refusal of treatment. It is a provision of
another effective form of treatment. Christian
Science is one of the religious non-medical forms of
treatment that relies on spiritual means through
prayer to heal illness, injuries, and other
conditions. Christian Science treatment and care has
been systematically practiced, quietly and
successfully, in many Alaskan families for a century.
It is my experience and the experience of those
practicing Christian Science that this spiritual
system of healing has both preventative and curative
effects.
And we all are trying to find ways to prevent and cure
disease, and I wholeheartedly join in that goal.
However, I believe that the mode of treatment should
not be imposed against an individual's wish, but a
competent adult should be able to chose the form of
preventive and curative treatment that he or she deems
best for his or her health and well being, provided
that the individual may be isolated or quarantined.
Now, in the letter I submitted to the Chair dated
[2/24/05], the Christian Science Committee on
Publication [for Alaska] requested an amendment as
follows. In [proposed AS 18.15.375] ... add a new
[subsection] (f) to read [original punctuation
provided]: "The provisions of this section do not
apply to an individual who objects to the testing,
examination or screening because of the individual's
religious beliefs; provided, such individual may be
subject to isolation or quarantine under the
provisions of this Act." Attached to the letter were
copies of statutes from a number of other states
containing language providing the alternative of
isolation or quarantine for those declining medical
examination or testing.
MS. SMITH continued:
And last Friday, March 4, in his testimony before the
committee, Dr. Mandsager mentioned that the [DHSS]
does not feel it is a good idea to exempt individuals
from testing, screening, or examination. And we
understand that he may feel that this is the position
to take but, with all due respect, I'd like point out
that there is a precedent for this request of
accommodation in at least 11 other states. ... To me,
these examples show that you can successfully achieve
the balance between individual rights and the common
good by providing such an accommodation. We
respectfully request that the committee follow these
other state legislatures by recognizing that the
common good of the state's inhabitants is not lessened
by giving accommodation to the right of isolation and
quarantine instead of testing and medical examination.
Our request that this language be included is further
supported by the fact that the proposed bill does not
now mandate testing, if objected to, unless there is a
finding that the individual has or may have been
exposed to a contagious disease that poses a
significant risk to public health. Once there has
been such a finding, isolation or quarantine would as
fully protect the rights of the public as would
testing or examination. Further, with [regard] to
treatment of an individual found to have a contagious
disease, [Christian Science] Committee on Publication
[for Alaska] supports the language of the bill that
does not mandate medical treatment. However, we would
recommend a new section after [proposed AS 18.15.380]
similar to ... AS 18.15.143, [which] ... would be
repealed by the passage of HB 95. And I've attached
to the ... last page of this [letter] ... a copy of
that existing [statute - AS 18.15.143]. ...
MS. SMITH relayed that the Christian Science Committee on
Publication for Alaska's proposed new section would read
[original punctuation as provided in the letter dated 3/7/05]:
Section 18.15.382. Religious treatment for contagious
disease. (a) A person found to have a contagious
disease may utilize spiritual means solely for
treatment of the disease. A state medical officer or
the court may consider the means of treatment as well
as the health of the person in determining whether to
order isolation of that person by the least
restrictive means which may include the person's home,
or other suitable place of the person's choice, in a
manner that will protect the public health.
(b) A person with a contagious disease who is or
might become subject to an order issued under
18.15.385, at any time may request recognition and
consideration of spiritual treatment described in this
section.
(c) In this section "spiritual treatment" means
prayer, or a substantially similar activity, by a
religious practitioner.
MS. SMITH, in conclusion, thanked the committee for considering
her suggested changes to HB 95.
1:28:05 PM
CHAIR McGUIRE, after ascertaining that no one else wished to
testify, closed public testimony on HB 95.
RICHARD MANDSAGER, M.D., Director, Central Office, Division of
Public Health, Department of Health and Social Services (DHSS),
in response to one of Representative Dahlstrom's questions posed
at the bill's last hearing, said that safe water is central to
public health and that it is the state's responsibility - and in
its best interest - to try to ensure, to the maximum extent
possible, safe and clean water for people to drink. That being
said, Alaska has chosen to divide the responsibilities for
public health between the DHSS and the Department of
Environmental Conservation (DEC).
DR. MANDSAGER opined that there are several ways to address the
issue of [safe] water, two of which would be either via
regulation or via a reporting requirement and private testing.
He remarked that there is a "licensing" bill that the DHSS, via
the legislature, introduced last week that proposes to reframe
the licenses of all the institutions for which the DHSS
certifies or licenses. He mentioned that for all the types of
water systems that that the DHSS won't be regulating in the near
future, the DHSS is considering requiring, via regulation, that
the institutions which have such water systems report back to
the DHSS on a periodic basis that they've had their water tested
by a private testing company.
1:30:44 PM
REPRESENTATIVE DAHLSTROM said Dr. Mandsager's comments verify
her concern and she wants to ensure that water testing is
completed and that entities responsible for water supplies are
being regulated.
DR. MANDSAGER, in response to another of Representative
Dahlstrom's previously asked questions, said that the state
medical examiner has three functions: one is providing forensic
services, another is providing public health services, and the
third is providing support to families experiencing the
unexpected death of a loved one. He offered his belief that the
state medical examiner office completes its forensic mission
quite well, completes its public health mission somewhat, and
completes its support of families mission almost not at all. He
noted that the governor's budget requests a small increment [for
the state medical examiner's office] and he characterized this
as a down payment and relayed that he would be back before the
legislature with the goal of slowly building that office up so
that missions two and three are fully funded and met.
DR. MANDSAGER, in response to another of Representative
Dahlstrom's previously asked questions, said that the bill is
silent at the moment with regard to what happens to a business
if an employee is quarantined or isolated. The costs associated
with isolation and quarantine are assumed to be the
responsibility of individual being isolated or quarantined, not
the responsibility of the state. With regard to a previously
asked question of who will take care of the children in cases
where the parents are isolated or quarantined, he said it would
be the same as in other situations where a parent or parents are
hospitalized - parents would have the opportunity to voluntarily
place their children with a relative or friend. The only time
the Office of Children's Services (OCS) would get involved would
be if the children were abandoned in typical abandonment or
neglect circumstances; he said he does not envision that the OCS
would be involved in the vast majority of isolation/quarantine
situations.
CHAIR McGUIRE asked whether there is a procedure outlined in the
bill.
DR. MANDSAGER said no, adding that the Department of Law (DOL)
has researched the issue and believes that the bill would allow
parents to deal with the situation in the way they would
ordinarily if they had to go into the hospital.
1:34:01 PM
DAN BRANCH, Senior Assistant Attorney General, Human Services
Section, Civil Division (Juneau), Department of Law (DOL),
concurred, adding that current law contains a provision allowing
a parent to grant a power of attorney to a friend or relative so
that that person has the authority to make medical or other
decisions for a child.
CHAIR McGUIRE remarked that quarantine/isolation situations can
happen quickly and therefore it is the legislature's intent that
the subjects of quarantine/isolation would be given a reasonable
amount of time to have that power of attorney executed,
particularly given that most Alaskans don't already have such
details worked out.
MR. BRANCH concurred with Dr. Mandsager that the OCS would not
take custody of a child unless he/she were truly abandoned.
1:36:28 PM
DR. MANDSAGER, mentioning that Representative Gara had expressed
concerns at the bill's prior hearing, posited that the DHSS has
come up with a couple of proposed amendments that could satisfy
members' concerns, and said that one of the proposed amendments
by Representative Gara would be acceptable to the DHSS. Dr.
Mandsager referred to a proposed amendment to page 11, line 23,
which would create another subsection to clarify that isolation
and quarantine shall only be used if they are the least
restrictive alternative necessary to prevent the spread of [a]
contagious or possibly contagious disease. In other words, in
the hypothetical example posed at the bill's last hearing
regarding someone with acquired immunodeficiency syndrome
(AIDS), the DHSS would seek other alternatives first, and would
only resort to isolation and quarantine if all alternatives
proved unsuccessful. Additionally, if that proposed amendment
were to be adopted, he remarked, then a definition of "least
restrictive" could be included in the definition section of the
bill.
DR. MANDSAGER noted that another proposed amendment by
Representative Gara would alter page 11 by adding the caveat
that a person could choose confinement in his/her home absent
exceptional circumstances that would jeopardize public health.
In response to a question, he said he has not yet had a chance
to review the changes suggested by the Alaska Nurses Association
(AaNA).
CHAIR McGUIRE mentioned that one of the AaNA's suggestions would
be to add a caveat that person would not have to submit to
involuntary treatment if he/she voluntarily takes steps outlined
by the state medical director to prevent the spread of a
communicable disease.
DR. MANDSAGER relayed that in response to a concern expressed by
the AaNA regarding the isolation/quarantine of a person exposed
to hazardous materials that could cause serious illness or
injury via transmission, one of the DHSS's proposed amendments -
which would alter page 15 by adding a subsection (m) - would
allow the DHSS to isolate or quarantine such a person. He
predicted that such a provision would only apply in situations
involving irradiation or chemical toxins that could potentially
be hazardous to others.
1:40:25 PM
REPRESENTATIVE GARA said he still has a major concern regarding
the possibility that the bill, perhaps even with the DHSS's
proposed amendment, would allow a person with AIDS - which could
be considered a substantial risk to public health because of its
contagious nature - to be isolated, sent through an ex parte
hearing, and then quarantined. So although the proposed
amendment would allow someone with AIDS to be quarantined at
home, the determination regarding whether that is appropriate
would happen only after the person is isolated, sent through an
ex parte hearing, and been issued a quarantine order. He said
he doesn't ever want to allow the state to bother individuals
who are dealing with AIDS responsibly. He opined, therefore,
that the bill should only address diseases that don't include
things like AIDS or other diseases that aren't of concern.
DR. MANDSAGER remarked:
The problem as a public health practitioner is, we
start into these journeys with "a suspicion or
probable and not knowing." If I was God and knew what
the cause was going to be, this would be a much
simpler bill to write, because then it would be much
easier to write exclusions as Representative Gara is
suggesting. We start into an outbreak investigation
or we start out with concerns, and then, over the next
few hours to days, it becomes clear whether those
concerns were real or not. And as time goes by, it
becomes more and more clear [what] the appropriate
next steps [are], how [long] a time limit [there]
should be, and so on.
One of the [AkCLU's] concerns initially ... is, we
ought to time limit this, and I pushed back against
that saying, again, for the same reason, it's more
appropriate, in our view, that we end quarantine or
isolation as soon as possible rather than put a time
limit on it, because of the uncertainty on the front
end. Now, I concur 100 percent with what
Representative Gara is saying, ... we don't want to
put people into quarantine and isolation unless
they're a risk to public health - their individual
medical problems are not a cause for quarantine or
isolation or any of the other tools that this bill ...
[provides]. ...
So we're only talking about this in situations in
which there is a risk. So the situation you
described, in which somebody is dealing responsibly
with [his/her] illness, [he/she] is not a risk to
public health. Now ... somehow we have to find a way
that we can all be comfortable, that we allow for
uncertainty on the front end but yet we don't end up
"where you want to be" on the back end. Now, the only
other thing I would say is ... this [has] been our
practice, here, for 50 years, and it's not been
abused.
DR. MANDSAGER assured the committee that the bill will not
expand or limit the practices the DHSS has been using to deal
with concerns to public health, and suggested that the committee
keep in mind that the DHSS has historically used its authority
responsibly.
1:44:57 PM
MR. BRANCH suggested that there needn't be concern that the DHSS
would isolate a person just for having AIDS, and noted that
proposed subsection (d) of the quarantine/isolation provision -
located on page 12, line 15 - says in part: "Before
quarantining or isolating an individual, the department shall
obtain a written order from the superior court". He also noted,
though, that subsection (e) of that same provision gives the
department extraordinary authority to quarantine or isolate
somebody, but pointed out that a very high standard is required
- there has to be a clear and immediate threat to public health
for the department to isolate or quarantine an individual
without a court order. He said that according to his
understanding, the DHSS will be working in incremental steps,
and so isolation and quarantine would be the last steps in a
long process wherein the DHSS tries to examine an individual but
may then have to reject lesser restrictive alternatives. The
aforementioned proposed amendment is designed to "kick in at the
superior court level," adding a new burden of proof that
isolation and quarantine is necessary in order to [prevent] the
spread of contagion.
REPRESENTATIVE GARA indicated that that possibly addresses his
concern, but opined that a lesser standard of proof is required
if isolation and quarantine via a court order is the alternative
chosen. The bill doesn't currently specify that the goal is to
address diseases that are communicable through airborne means,
through touch, or through casual contact with someone's sweat,
he remarked, adding that he would be much more comfortable if
the bill did specify that goal, if it were narrowed to only
those diseases the DHSS really wants to address. He opined that
under the parameter currently proposed in the bill - a disease
that poses a substantial risk to public health - one could argue
that AIDS qualifies as such.
MR. BRANCH offered his belief that Dr. Mandsager already
addressed most of those points, and predicted that with regard
to people with AIDS, it will be unnecessary, most of the time,
to use isolation or quarantine because most people are dealing
with that disease responsibly. However, there may still be
times when a person with AIDS will choose not to act responsibly
and thus place other people at risk; such circumstances would
warrant isolation or quarantine.
CHAIR McGUIRE suggested that perhaps the language being proposed
as an addition to page 11 - regarding the use of isolation and
quarantine only if they are the least restrictive alternative -
could also be added to the aforementioned subsection (e) located
on page 13, so that the caveat would apply in situations where a
court order is bypassed, thus requiring the DHSS to perform one
more step in proving that isolation or quarantine is warranted.
She acknowledged the difficulty of defining things that might
pose a threat to public health, since it is hard to predict what
types of diseases they will face in the future, and indicated
that the proposed amendments give her some comfort.
MR. BRANCH said he didn't believe the administration would
object to Chair McGuire's suggested additional change.
1:50:06 PM
DR. MANDSAGER, referring to a question asked at the bill's prior
hearing regarding civil penalties for an employee, said that the
DHSS's preference would be to leave [the bill] as is, that being
that the state already has immunity for quarantine and the bill
would extend immunity to instances of isolation. However, if
the committee prefers to change the provision such that it
becomes similar to changes recently made to the statutes
pertaining to the OCS, then the DHSS would consider that.
CHAIR McGUIRE asked what the "OCS penalty" is.
DR. MANDSAGER said, "It's a fine [and] a class B misdemeanor, I
think, and it uses language like 'willful misconduct.'"
1:51:12 PM
REPRESENTATIVE GARA said that the language on page 12, lines 28-
29, does comfort him somewhat; that language says that a
petition for isolation or quarantine must include an allegation
that "the individual is unable or unwilling to behave so as not
to expose other individuals to danger of infection". He asked
whether it will be mandatory that the state prove such an
allegation.
MR. BRANCH offered his belief that it would be mandatory.
CHAIR McGUIRE noted that the bill uses the term "must".
REPRESENTATIVE GARA pointed out, however, that in the bill, the
term "must" applies to the term "allege".
MR. BRANCH opined that such would be interpreted to mean that
the allegation must be proven.
REPRESENTATIVE GARA asked whether all of the stipulations
outlined in proposed subsection (d) must be proven before an
order authorizing isolation or quarantine is granted. If such
is the case, he remarked, then perhaps the language on page 12,
line 19, should be changed to say, "(1) allege and prove" or
"(1) allege and establish".
MR. BRANCH noted that page 14, lines 16-29, stipulates that a
clear and convincing evidence standard must be used by the court
when issuing a finding that committing an individual to
isolation or quarantine is warranted. He opined that the court
would be given the flexibility to make a finding that isolation
or quarantine is necessary and appropriate after considering all
the factors set out in the petition. He offered his belief that
amending the bill as Representative Gara just suggested could
prevent the court from issuing an order for isolation or
quarantine in cases where such an order would actually be
warranted to protect the public health if the DHSS wasn't able
to allege and prove all of the factors outlined in proposed
subsection (d).
1:54:54 PM
CHAIR McGUIRE said she doesn't see a single factor in proposed
subsection (d) that she wouldn't want addressed by the court;
the factors include:
(A) the identity of each individual proposed to be
quarantined or isolated;
(B) the premises subject to isolation or quarantine;
(C) the date and time the isolation or quarantine is
to begin;
(D) the suspected contagious disease;
(E) that the individual poses a substantial risk to
public health;
(F) whether testing, screening, examination,
treatment, or related procedures are necessary;
(G) that the individual is unable or unwilling to
behave so as not to expose other individuals to danger
of infection; and
(H) that the department is complying or will comply
with (b) of this section
CHAIR McGUIRE opined that although discretion by the court is
desirable, the court ought to find all of the factors in
proposed subsection (d) before granting the DHSS the authority
to isolate or quarantine someone.
MR. BRANCH, acknowledging Chair McGuire's point that all of the
aforementioned factors are important, said his concern is that
the public health will be endangered just because one of the
factors outlined is not proven. For example, he noted, proposed
subsection (d)(1)(D) - which says, "the suspected contagious
disease" - does not constitute a factual finding strictly
speaking; instead, the DHSS would merely have the burden of
saying what it thinks the disease is. Upon further review, he
acknowledged that perhaps changing page 12, line 19, to say,
"(1) allege and prove" would not really be a problem.
CHAIR McGUIRE suggested that perhaps the language on line 19 of
page 12 could be altered say, "(1) must allege these set of
factors" or "(1) allege those factors listed". She posited that
there are two separate questions, one being, should the
allegation include all the factors, and the next being, should
the factors have to be proven, not just alleged. She said she
doesn't see the danger in requiring the allegation to include
all of the factors.
MR. BRANCH concurred and noted that language in proposed
subsection (d)(2), which starts at the top of page 13,
stipulates that the allegations must be accompanied by an
affidavit attesting to the facts asserted in the petition.
1:57:47 PM
REPRESENTATIVE GARA said that in looking at the factors
stipulated in proposed subsection (d), he doesn't see a one that
the DHSS wouldn't be able to establish if it were seeking to
isolate or quarantine a citizen.
MR. BRANCH agreed. However, he added, the problem for him is
that proposed subsection (d)(1)(F) - "whether testing,
screening, examination, treatment, or related procedures are
necessary" - for example, "is not a standard of proof"; instead
it is a question the court would like to know the answer to - in
other words, is the DHSS also seeking an order for treatment or
examination.
CHAIR McGUIRE noted that clear and convincing evidence, as
required via proposed subsection (h), located on page 14, is a
high standard of evidence. She posited that the Alaska State
Constitution's right of privacy will also be taken into
consideration by the courts in determining whether to issue
authorization for isolation or quarantine.
2:00:48 PM
REPRESENTATIVE KOTT asked Dr. Mandsager to comment on the
suggested change regarding an exemption from testing,
examination, or screening because of religious beliefs; this
suggestion was offered by Ms. Smith, Christian Science Committee
on Publication for Alaska.
DR. MANDSAGER noted that the bill already allows a person to
exempt himself/herself from medical treatment, but pointed out
that in certain situations, such as those involving TB, it could
be difficult for the DHSS to determine whether a person is
really infected if it cannot perform screening or testing.
2:02:36 PM
CHAIR McGUIRE indicated that the committee would now be focusing
on proposed amendments. She turned the committee's attention to
Amendment 1, which read [original punctuation provided]:
Page 11, following Line 23, insert:
"Isolation and quarantine shall only be used if they
are the least restrictive alternative necessary to
prevent the spread of a contagious or possibly
contagious disease to others;
Page 20, following line 22, insert
"(17) "least restrictive" means the policy or
practice that least infringes on the rights or
interests of individuals.
[RENUMBER Following definitions]
CHAIR McGUIRE said that as part of Amendment 1, she would like
to include, conceptually, on page 13, line 9, after
"individuals", the language in the first part of Amendment 1 -
"Isolation and quarantine shall only be used if they are the
least restrictive alternative necessary to prevent the spread of
a contagious or possibly contagious disease to others". She
noted that this additional change would apply to the provision
allowing the DHSS to isolate or quarantine someone without a
court order.
CHAIR McGUIRE made a motion to adopt Amendment 1, as amended in
the aforementioned fashion. There being no objection, Amendment
1, as amended, was adopted.
CHAIR McGUIRE turned the committee's attention to Amendment 2, a
handwritten amendment which, with handwritten corrections, read
[original punctuation provided]:
Insert @ p.11 line 29 after "premises"
". Absent exceptional circumstances that would
jeopardize public health, a person shall be allowed to
choose confinement in their own home."
REPRESENTATIVE GARA made a motion to adopt Amendment 2. There
being no objection, Amendment 2 was adopted.
CHAIR McGUIRE turned the committee's attention to Amendment 3,
which read [original punctuation provided]:
Page 15, following line 18, insert
"(m) The department may quarantine or isolate
individuals who have been exposed to hazardous
materials that can cause serious illness or injury by
transmission of the hazardous material to others. The
provision of this section concerning isolation and
quarantine of individuals to prevent the spread of
contagious or possibly contagious diseases shall apply
to isolation or quarantine of individuals who have
been exposed to hazardous materials."
CHAIR McGUIRE made a motion to adopt Amendment 3. There being
no objection, Amendment 3 was adopted.
2:05:45 PM
CHAIR McGUIRE again referred to the AaNA's suggested change that
would add the caveat that a person would not have to submit to
involuntary treatment if he/she voluntarily takes steps outlined
by the state medical director to prevent the spread of a
communicable disease.
DR. MANDSAGER indicated that the DHSS would not have a problem
with such a change, but noted that the AaNA's suggestion in its
entirety is intended to alter language that would first be
altered via another of the DHSS's proposed amendment that has
not yet been addressed.
2:06:54 PM
CHAIR McGUIRE turned the committee's attention to Amendment 4,
labeled 24-GH1002\G.1, Mischel, 3/3/05, which read:
Page 8, line 29, following "information":
Insert "under this section"
Page 8, following line 31:
Insert a new section to read:
"Sec. 18.15.362. Acquisition and use of
identifiable health information; public health
purpose. The department may acquire and use
identifiable health information collected under
AS 18.15.355 - 18.15.390 only if the
(1) acquisition and use of the information
relates directly to a public health purpose;
(2) acquisition and use of the information
is reasonably likely to contribute to the achievement
of a public health purpose; and
(3) public health purpose cannot otherwise
be achieved at least as well with nonidentifiable
health information."
Page 20, following line 24:
Insert a new paragraph to read:
"(18) "public health purpose" means the
prevention, control, or amelioration of a condition of
public health importance, including an analysis or
evaluation of a condition of public health importance
and an evaluation of a public health program;"
Renumber the following paragraphs accordingly.
CHAIR McGUIRE made a motion to adopt Amendment 4.
REPRESENTATIVE DAHLSTROM objected for the purpose of discussion.
DR. MANDSAGER explained that Amendment 4 defines "public health
purpose" and establishes standards that the DHSS would have to
achieve before being able to acquire, access, and use
identifiable health information for a public health purpose. He
referred to another of the AaNA's proposed changes, one that's
intended to alter Amendment 4, and said that the DHSS would not
agree with that modification because it believes that Amendment
4, as currently written, provides a balance between the privacy
of an individual's health information and the DHSS's need to do
outbreak investigations.
2:08:53 PM
REPRESENTATIVE COGHILL referred to Amendment 4's proposed
paragraph (3) and asked for clarification regarding the term
"nonidentifiable health information".
DR. MANDSAGER said that much of the time, the DHSS does work
involving nonidentifiable health information, and provided an
example of such.
REPRESENTATIVE DAHLSTROM removed her objection.
REPRESENTATIVE GRUENBERG referring to the aforementioned
suggestion, by the AaNA, to change Amendment 4, asked why the
DHSS wouldn't be willing to locate and receive permission from
the persons it wishes to access the records of.
DR. MANDSAGER said he is hesitant to answer that question
without further review, but indicated that the DHSS would be
locating individuals and obtaining permission to access records
in most situations anyway.
CHAIR McGUIRE mentioned that the committee could give further
consideration to the AaNA's suggested changes after the DHSS's
proposed amendments are addressed.
2:11:06 PM
CHAIR McGUIRE asked whether there were any further objections to
Amendment 4. There being none, Amendment 4 was adopted.
CHAIR McGUIRE made a motion to adopt Amendment 5, labeled 24-
GH1002\G.2, Mischel, 3/4/05, which read:
Page 9, line 2, following "information":
Insert "collected under AS 18.15.355 - 18.15.390"
REPRESENTATIVE DAHLSTROM objected for the purpose of discussion.
DR. MANDSAGER indicated that Amendment 5 would clarify that the
[information security safeguards in the bill apply only to
information being collected under Section 8 of the bill].
REPRESENTATIVE DAHLSTROM removed her objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 5. There being none, Amendment 5 was adopted.
CHAIR McGUIRE [made a motion to adopt] Amendment 6, labeled 24-
GH1002\G.3, Mischel, 3/4/05, which read:
Page 9, line 1, following "safeguards.":
Insert "(a)"
Page 9, following line 4:
Insert a new subsection to read:
"(b) The department shall expunge, in a
confidential manner, identifiable health information
collected under AS 18.15.355 - 18.15.390 when the use
of the information by the department no longer
furthers the public health purpose for which it is
required."
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
DR. MANDSAGER indicated that Amendment 6 is intended to
addresses concerns that the DHSS would hold information
unnecessarily; Amendment 6 would put in statute a stipulation
that information no longer needed for a public health purpose
will be confidentially expunged as soon as possible.
2:12:16 PM
REPRESENTATIVE DAHLSTROM removed her objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 6. There being none, Amendment 6 was adopted.
CHAIR McGUIRE made a motion to adopt Amendment 7, labeled 24-
GH1002\G.4, Mischel, 3/3/05, which read:
Page 14, line 19:
Delete "substantial"
Insert "significant"
Page 15, line 3:
Delete "substantial"
Insert "significant"
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
DR. MANDSAGER explained that Amendment 7 would clarify that the
DHSS must prove to the court that a situation poses a
"significant" risk to public health.
REPRESENTATIVE DAHLSTROM removed her objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 7. There being none, Amendment 7 was adopted.
2:13:12 PM
CHAIR McGUIRE made a motion to adopt Amendment 8, labeled 24-
GH1002\G.5, Mischel, 3/3/05, which read:
Page 11, line 20, following "treatment.":
Insert "However, an individual who exercises the
right to refuse treatment under this subsection is
responsible for paying all costs incurred by the state
in seeking and implementing a quarantine or isolation
order made necessary by a refusal of treatment by the
individual. The department shall notify an individual
who refuses treatment under this subsection that the
refusal may result in an indefinite period of
quarantine or isolation and that the individual will
be responsible for payment of the costs of the
quarantine or isolation."
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
DR. MANDSAGER indicated that the change proposed by Amendment 8
has been suggested in previous committees, and would provide
that if someone refuses treatment in favor of quarantine or
isolation, then he/she is responsible for the costs incurred.
He mentioned that this is the language that one of the
aforementioned changes suggested by the AaNA proposes to alter.
REPRESENTATIVE DAHLSTROM removed her objection.
CHAIR McGUIRE, in response to comments and questions, clarified
that the question of whether to adopt Amendment 8 - labeled 24-
GH1002\G.5, Mischel, 3/3/05 - was before the committee.
REPRESENTATIVE GARA objected [for the purpose of further
discussion]. Mentioning that a person might refuse treatment
for a variety of reasons, he said that Amendment 8 appears to
not be drafted narrowly enough.
DR. MANDSAGER relayed that the language of Amendment 8 was
adopted in the Senate. Acknowledging that one could refuse
treatment for a number of reasons, he offered his understanding
that Amendment 8 merely says that if one does refuse treatment,
regardless of the reason, that one is responsible for the costs
incurred.
REPRESENTATIVE GRUENBERG said he is concerned about the impact
Amendment 8 could have on those who live a subsistence lifestyle
and may not have the cash to pay for quarantine or isolation;
Amendment 8 could have devastating consequences if that lack of
funds results in people [being subjected to treatment
unwillingly]. He opined that there should be some discretion to
waive the costs of isolation and quarantine.
DR. MANDSAGER offered his interpretation of Representative
Gruenberg's concern.
REPRESENTATIVE GRUENBERG made a motion to adopt a conceptual
amendment to Amendment 8, "to allow the department to waive that
cost requirement if ... there are sufficient equities to
requirement."
2:17:49 PM
REPRESENTATIVE KOTT suggested instead that they simply alter
Amendment 8 in two places so that it says in part: "an
individual who exercises the right to refuse treatment under
this subsection may be responsible for paying all costs
incurred" and "that the individual may be responsible for
payment".
CHAIR McGUIRE opined that such a change would be a better way to
accomplish Representative Gruenberg's goal.
REPRESENTATIVE GRUENBERG, in response to a question, withdrew
his previous amendment to Amendment 8, and [made a motion to
adopt Representative Kott's suggestion as] a new amendment to
Amendment 8.
CHAIR McGUIRE asked whether there were any objections to the
amendment to Amendment 8. There being no objection, Amendment 8
was amended.
CHAIR McGUIRE asked whether there [were any further objections]
to Amendment 8, as amended. There being none, Amendment 8 as
amended, was adopted.
CHAIR McGUIRE made a motion to adopt Amendment 9, labeled 24-
GH1002\G.6, Mischel, 3/4/05, which read:
Page 11, lines 27 - 28:
Delete "or hazardous material"
Insert "that poses a significant risk to public
health"
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
DR. MANDSAGER indicated that Amendment 9 is in order because the
issue of hazardous material is now addressed by the new
subsection (m) inserted via Amendment 3, and that Amendment 9
also attempts to elevate the standard for isolation or
quarantine.
REPRESENTATIVE DAHLSTROM removed her objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 9. There being none, Amendment 9 was adopted.
CHAIR McGUIRE made a motion to adopt Amendment 10, labeled 24-
GH1002\G.7, Mischel, 3/3/05, which read:
Page 11, following line 15:
Insert a new subsection to read:
"(b) A state medical officer may direct an
individual who has or may have been exposed to a
contagious disease that poses a significant risk or
danger to others or to the public health to complete
an appropriate prescribed course of treatment for the
contagious disease, including medication and directly
observed therapy, if appropriate, and to follow
measures to prevent the spread of disease."
Reletter the following subsections accordingly.
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
REPRESENTATIVE GARA objected.
DR. MANDSAGER indicated that Amendment 10 addresses a problem
that the DHSS has had internally with current tuberculosis
statutes, specifically regarding what the role of the state
medical examiner is in directing someone to get treatment.
Amendment 10 would clarify in statute that giving notice to
someone that he/she should be treated is just a step in the
journey, and recognizes that the individual can always refuse
treatment.
CHAIR McGUIRE noted that Amendment 10 does specify "may".
REPRESENTATIVE GARA offered his understanding that Amendment 10
would allow a state medical officer to tell somebody that he/she
has to take the state medical officer's "appropriate prescribed
course of treatment". He said his concern with this is that for
some diseases - for example, AIDS - there are some experimental
drugs that are appropriate, some that are "likely" appropriate,
some that may not be safe at all, and some that have unwanted
side effects. Amendment 10, as currently written, he opined,
would allow the state to tell someone to take what it considers
to be a prescribed course of treatment even if the person is
unwilling to do so.
CHAIR McGUIRE, referring to proposed AS 18.15.380(a) - located
on page 11, lines 12-15 - posited that this language already
addresses the DHSS's concerns; thus amendment 10 is not needed.
2:22:47 PM
DR. MANDSAGER concurred.
CHAIR McGUIRE suggested that Amendment 10 would create more
problems than it solves, and mentioned that she agrees with
Representative Gara's comments on this issue.
CHAIR McGUIRE withdrew Amendment 10.
2:23:53 PM
CHAIR McGUIRE - indicating that the next amendment would be
called Amendment 11 - referred to the AaNA's suggested changes,
one of which recommends the following language [original
punctuation provided] for proposed AS 18.15.380(c), which has
already been amended via Amendment 8, as amended:
Sec. 18.15.380(c) shall read: An individual has the
right to refuse treatment and may not be required to
submit to involuntary treatment so long as they are
voluntarily willing to take steps outlined by the
state medical director to prevent the spread of a
communicable disease to others. An individual who
exercises the right to refuse treatment under this
subsection is responsible for paying all costs
incurred by the state in seeking and implementing a
quarantine or isolation order made necessary by a
refusal of treatment by the individual. The
department shall notify an individual who refuses
treatment under this subsection that the refusal may
result in an indefinite period of quarantine or
isolation and that the individual will be responsible
for payment of the costs of the quarantine or
isolation.
DR. MANDSAGER opined that this recommended change is a good one.
CHAIR McGUIRE made a motion to adopt the foregoing as Amendment
11.
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
CHAIR McGUIRE recapped the AaNA's comments from the bill's
previous hearing regarding wanting individuals to accept
responsibility for taking steps to prevent the spread of a
communicable disease.
REPRESENTATIVE DAHLSTROM removed her objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 11. There being none, Amendment 11 was adopted.
CHAIR McGUIRE offered her belief that the other changes
suggested by the AaNA have either been addressed via other
amendments already adopted or are objected to by the DHSS, such
as the one that proposes to alter the language added via
Amendment 4, and which pertains to locating and receiving
permission from persons it wishes to access the records of.
REPRESENTATIVE GRUENBERG opined that if there isn't an eminent
threat of an emergency, the DHSS should make a reasonable effort
to contact the individuals whose records it wishes to access.
DR. MANDSAGER said his only concern pertains to those reportable
conditions that fall under other parts of the public health law,
such as those included in reports from hospitals and for which
individuals are not ordinarily notified.
CHAIR McGUIRE suggested that Representative Gruenberg consider
researching this issue more after the bill moves from committee
but before it is heard on the House floor.
REPRESENTATIVE GRUENBERG agreed to do so.
2:27:40 PM
REPRESENTATIVE GARA made a motion to adopt Amendment 12, which
read [original punctuation provided]:
At Page 15, Line 19
Insert a new section:
"18.15.386 Penalty for Violation. Notwithstanding AS
09.50.250, a person who knowingly violates a provision
of 18.15.365, 18.15.375, 18.15.380 or 18.15.385, is
liable in a civil action for compensatory damages and
is liable for a fine of up to $1000 per violation."
At Page 2, line 31
After "18.55.390" insert ", except in the
circumstances provided in AS 18.15.386."
REPRESENTATIVE DAHLSTROM objected.
REPRESENTATIVE GARA made a motion to amend Amendment 12, to
delete the reference to AS 18.15.375. There being no objection,
Amendment 12 was amended.
REPRESENTATIVE GARA offered his belief that Amendment 12, as
amended, would impose a necessary safeguard. He relayed that it
has been explained to him that Alaska is currently the only
state that does not have a comprehensive quarantine law, and
that this is due to the state's history of forced and improper
quarantines of its Native population during pre-statehood years.
He opined that [HB 95] will be an appropriate law only if
[agency personnel] do not purposely violate it in order to
quarantine people. He said that Amendment 12, as amended, will
say that if [agency personnel] knowingly violate proposed AS
18.15.365, which pertains to information security safeguards;
18.15.380, which pertains to allowing someone to refuse medical
treatment; or 18.15.385, which pertains to the standards that
allow for isolation and quarantine, then the violator "and the
state" will be liable for any damages that result.
CHAIR McGUIRE asked whether the penalty proposed via Amendment
12, as amended, mirrors that of Representative Coghill's "CINA
[child in need of aid] bill."
REPRESENTATIVE COGHILL indicated that some of the language
regarding civil liability is similar but it doesn't specify a
particular penalty.
CHAIR McGUIRE indicated that she wants to know what the mental
intent is in Representative Coghill's bill.
[The response was inaudible.]
CHAIR McGUIRE raised the issue of "wilful misconduct" and asked
Dr. Mandsager to comment.
DR. MANDSAGER said he'd originally thought that perhaps the
Senate had adopted some language regarding that issue, but now
he is not sure that such is the case.
2:31:55 PM
CHAIR McGUIRE asked him to comment [on Amendment 12, as
amended].
DR. MANDSAGER replied:
On one hand, I'm kind of personally ambivalent because
I think we ought to hold our employees to a high
standard, and I think that's what you're after,
Representative Gara, is that employees should know
that they can't do something wrong. On the other
hand, if it opens up [employee] actions to a whole
series of legal actions in the which the state's sued
-- we're trying to find a balance point in there, and
I can only speak personally here because I don't think
we in the department have taken a position on this.
REPRESENTATIVE COGHILL surmised that certain of the
aforementioned violations would occur before a quarantine order
is sought from a judge, and suggested that this might provide a
safeguard against any violation of proposed AS 18.15.380. He
mentioned aspects of his aforementioned CINA bill.
CHAIR McGUIRE asked why Amendment 12, as amended, provides for a
mental state of knowingly as opposed to intentionally.
REPRESENTATIVE GARA said he would be amenable to having
Amendment 12, as amended, say "intentionally" rather than
"knowingly". He remarked that his thought was that "knowingly"
is the term used with regard to criminal law, and that it would
provide for a very high burden before one could be held civilly
liable under Amendment 12, as amended.
2:34:04 PM
MR. BRANCH offered his belief that anyone [adversely] impacted
by quarantine, isolation, or medical treatment already has
recourse under the bill, even in cases involving emergency
orders. He surmised that the main concern pertains to violating
the provision regarding confidentiality of information, and
opined that such a violation would more appropriately be
addressed as a criminal offense rather than as a cause for civil
action.
REPRESENTATIVE COGHILL asked what a person's recourse is under
the bill if his/her confidentiality is knowingly violated.
MR. BRANCH relayed that [Section 2 of] the bill amends the
waiver of liability provision in Title 9, and that such
insolates the department from liability.
REPRESENTATIVE COGHILL said that is a concern, adding that he is
interested in ensuring that the state be held liable for misuse
of information. He asked at what point can an individual get
satisfaction for such a violation.
CHAIR McGUIRE noted that the bill pertaining to the collection
of deoxyribonucleic acid (DNA) samples provides for a criminal
penalty if a person's confidentiality is violated.
2:38:34 PM
DR. MANDSAGER mentioned that "the model Act" suggests a standard
of gross negligence or wilful misconduct.
CHAIR McGUIRE made a motion to amend Amendment 12, as amended,
to say "intentional". There being no objection, Amendment 12,
as amended, was again amended.
CHAIR McGUIRE expressed disfavor with using a standard of "gross
negligence."
REPRESENTATIVE GARA said he did not want to use a standard of
gross negligence. He offered his belief that "this whole
system" is predicated upon an honest affidavit from a state
employee, and he did not want a [state employee] to make
something up in an affidavit.
CHAIR McGUIRE agreed.
REPRESENTATIVE DAHLSTROM withdrew her objection to Amendment 12
[as amended].
CHAIR McGUIRE asked whether there were any further objections to
amendment 12, as amended. There being none, Amendment 12, as
amended was adopted.
REPRESENTATIVE GARA made a motion to adopt Amendment 13, a
handwritten amendment which, with handwritten corrections, read
[original punctuation provided]:
Insert at p. 13 line 2
after "in the petition"
as follows:
"including specific facts supporting the
allegations required by AS 18.15.385(d)(1)(D) & (G)."
CHAIR McGUIRE objected for the purpose of discussion.
REPRESENTATIVE GARA relayed that Amendment 13 provides that the
affidavit required by proposed AS 18.15.385(d)(2) cannot just
include general allegations but must specifically state facts
pertaining to the suspected contagious disease and to whether
someone is unable or unwilling to behave so as to not expose
other individuals to danger of infection.
CHAIR McGUIRE withdrew her objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 13. There being none, Amendment 13 was adopted.
REPRESENTATIVE GRUENBERG referred to the aforementioned
Christian Science Committee on Publication for Alaska's proposed
new section, AS 18.15.382 [text provided previously], and made a
motion to adopt it as Amendment 14.
DR. MANDSAGER characterized Amendment 14 as simply further
clarification "about the treatment side."
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
REPRESENTATIVE GRUENBERG said that Amendment 14 "allows these
people to practice their religion without particularly impinging
on the public health, and I think it's important to a number of
Alaskans."
REPRESENTATIVE DAHLSTROM indicated that she was maintaining her
objection to Amendment 14.
2:44:55 PM
A role call vote was started but interrupted for the purpose of
further discussion.
MS. SMITH, in response to a question, said that the concern of
the Christian Science Committee on Publication for Alaska is
that the existing statute addressing treatment by spiritual
means in cases involving tuberculosis, AS 18.15.143, will be
repealed via passage of HB 95, and Amendment 14 simply proposes
to reinsert a similar accommodation regarding treatment of a
contagious disease by spiritual means.
DR. MANDSAGER opined that adoption of Amendment 14 will not make
a practical difference because provisions in the bill already
allow someone to exempt himself/herself from treatment,
regardless of the reason. Amendment 14 just clarifies that a
person can exempt themselves from treatment for religious
reasons.
REPRESENTATIVE GRUENBERG again made a motion to adopt Amendment
14.
REPRESENTATIVE GARA objected. He said it seems that Amendment
14 provides that one has the absolute right to treatment by
spiritual means even if the accepted science is that such
treatment won't keep one from becoming contagious. That being
the case, he remarked, he understands the conflict between those
who, for religious reasons, don't accept western science and
those who do, but opined that state law should go with one or
the other.
REPRESENTATIVE GRUENBERG pointed out, though, that Amendment 14
says that although a person may utilize solely spiritual means
for the treatment of disease, the state may order isolation of
that person. So the person has the right to do with his/her own
body as he/she wishes, and the state may order isolation to
protect society. Amendment 14 stipulates that a person has the
right to control his/her own body, he opined.
DR. MANDSAGER reiterated his belief that Amendment 14 is no
different than provisions already in the bill, but will create a
separate section. He surmised that Representative Gara's
concern is that doing so may create an absolute right.
2:50:15 PM
A roll call vote was taken. Representatives Kott and Gruenberg
voted in favor of Amendment 14. Representatives McGuire,
Anderson, Coghill, Dahlstrom, and Gara voted against it.
Therefore, Amendment 14 failed by a vote of 2-5.
2:50:54 PM
REPRESENTATIVE GARA indicated that he wanted to offer a
conceptual amendment that would address the AkCLU's points
regarding the ex parte hearing issue.
REPRESENTATIVE GARA made a motion to adopt Amendment 15, which
"would say that you can't make your decision ex parte, that is
without any participation by the person who you want to isolate,
... if participation by the person is feasible". He said he is
not sure whether [the bill's] language already provides
protection, but characterized ex parte decisions as very
dangerous because only one side gets to present its story. "I
don't think you want to have an ex parte hearing, where you get
to quarantine somebody, unless its impossible to ... [let] that
person participate," he concluded.
MR. BRANCH offered his belief that the AkCLU misspoke, because
the ex parte provision only applies to testing, not quarantine
or isolation. He noted that in unusual situations, the
department can act on its own, but would then still have to
bring the person before the court for a hearing. Referring to
language on proposed 18.15.375(d) - beginning on page 10, line
29 - he offered that the key point of this provision is that it
allows the department to get a search warrant and test someone,
but if the person refuses to be tested, then testing won't occur
until he/she has gone before the court, though the department
can isolate the person meanwhile to prevent the spread of
disease. He characterized this as a timesaving device, allowing
the department to act quickly to protect the public health.
MR. BRANCH, in response to a question, noted that proposed AS
18.15.375(e) - beginning on page 11, line 6 - says in part that
an individual subject to an ex parte hearing must be given a
form to request a hearing to vacate the ex parte order.
REPRESENTATIVE GARA withdrew Amendment 15, adding that he would
research the issue further before the bill is heard on the House
floor.
REPRESENTATIVE ANDERSON moved to report CSHB 95(HES), as
amended, out of committee with individual recommendations and
the accompanying zero fiscal note. There being no objection,
CSHB 95(JUD) was reported from the House Judiciary Standing
Committee.
HB 149 - SALE OF METHAMPHETAMINE AND PRECURSORS
2:54:22 PM
CHAIR McGUIRE announced that the next order of business would be
HOUSE BILL NO. 149, "An Act relating to further regulation of
the sale, possession, and delivery of certain chemicals and
precursors used in the manufacture of methamphetamine."
REPRESENTATIVE ANDERSON moved to adopt the proposed committee
substitute (CS) for HB 149, Version 24-LS0596\L, Luckhaupt,
3/4/05, as the work draft. There being no objection, Version L
was before the committee.
2:55:04 PM
REPRESENTATIVE JAY RAMRAS, Alaska State Legislature, sponsor,
characterized methamphetamine as a scourge on society, noting
that it is very prominent in today's world. House Bill 149 will
increase criminal penalties for manufacturing and delivering
methamphetamine; it will make it a crime of manslaughter if a
person manufactures or delivers a controlled substance to
another person who then dies from the controlled substance; and
it will make the manufacture of methamphetamine in a building
where one or more minor children under the age of 18 resides or
stays a class A felony. He noted that the manufacture of
methamphetamine involves and creates toxic chemicals, which
contaminate the building or structure in which it is
manufactured; such buildings and structures can include homes,
apartment complexes, campers, vehicles, and hotel rooms, to name
a few. Many such locations are where children live - sleeping,
eating, breathing, and drinking while being exposed to these
toxic environments.
REPRESENTATIVE RAMRAS mentioned that every pound of
methamphetamine manufactured creates seven pounds of [toxic]
waste. He relayed that he is very interested in reducing the
exposure of children to these substances by creating deterrents.
The bill also addresses the issue of supply by limiting the
amount of drugs containing [ephedrine, pseudoephedrine, or
phenylpropanolamine], or the amount of iodine or iodine crystals
that can be purchased or possessed by an individual. Noting
that he did not want to disturb commerce, he relayed that the
bill would require that a logbook be signed and that
identification be provided by those purchasing the
aforementioned substances. He opined that such a requirement
will inhibit manufacturers of methamphetamine and those that
purchase methamphetamine ingredients for them.
REPRESENTATIVE RAMRAS mentioned that Oklahoma has seen nearly an
80 percent drop in methamphetamine laboratories ("labs") - and
other states have similar statistics - because of efforts to
"choke down" the supply of methamphetamine ingredients. He also
indicated that the bill will add certain anabolic steroids to
the list of schedule VA controlled substances. He relayed that
an article from Oklahoma relayed that Pfizer Inc. - a
manufacturer of Sudafed - has stated it does not oppose
restrictions on "the medication," and that a spokesman for the
company is quoted as saying, "Every state has got to get the
balance right between access to legitimate consumers and
preventing access to criminals." Representative Ramras offered
the following which he indicated was a quote by [a
representative from the National Association of Chain Drug
Stores (NACDS)]:
The National Association of Chain Drug Stores does not
necessarily believe the Okalahoma law is the way to
go. ... Customers miss out on hundreds of
pseudoephedrine products that cannot be displayed
behind a pharmacy counter, and the group believes the
law's apparent success may have more to do with
impeding backdoor sales of cases of pseudoephedrine by
rogue retailers.
REPRESENTATIVE RAMRAS offered his belief that in Alaska, small
groups of people are buying, for example, $20 worth of
ingredients, which are then used to produce several hundred
dollars' worth of "street-valued" drugs. He opined that Alaska
is suffering from small methamphetamine labs everywhere,
including rural areas. He characterized methamphetamine as
insidious because small amounts of it can be sold to generate
just enough money to create more. He mentioned that the
commissioner of the Department of Public Safety (DPS) relayed to
him that just a few weeks ago, a methamphetamine lab was
"busted" right above the district attorney's office in
Fairbanks.
3:03:57 PM
RONALD J. WALL, Sergeant, Supervisor, Fairbanks Areawide
Narcotics Team, Alaska Bureau of Alcohol & Drug Enforcement,
Division of Alaska State Troopers, Department of Public Safety
(DPS), relayed that the DPS is very supportive of HB 149,
believing that the restrictions regarding ephedrine and
pseudoephedrine, as well as iodine, will provide a dramatic step
forward in reducing methamphetamine labs. The DPS also feels
that controlling and documenting sales of the aforementioned
methamphetamine ingredients will enhance the ability of law
enforcement to locate and limit methamphetamine labs. He
mentioned that the DPS has worked with the Department of Law
(DOL) in providing support and guidance [to the sponsor] on the
issues of selling and restricting amounts of necessary
methamphetamine precursors, as well as on the issue of requiring
the identification of those purchasing such ingredients. He
added, "We also believe that by requiring these items to be
stored behind counters, it will prohibit the theft [of such
items]."
3:05:27 PM
LIBBY DANNENBERG, State Relations Counsel, Consumer Healthcare
Products Association (CHPA), after noting that the CHPA
represents manufacturers of over-the-counter medicines and
nutritional supplements, relayed that the CHPA is supportive of
the sponsor's goal of attempting to find solutions to the
problem of methamphetamine labs, but does have a concern with
the bill in that it would place all pseudoephedrine products
"behind the counter." She went on to say:
[The] CHPA understands the scope and complexity of the
methamphetamine problem [and supports the] need for
comprehensive, multi-disciplinary legislation. We
believe such legislation should include a mix of the
following. A retail sales limit of six grams for
products that contain pseudoephedrine - and that would
be per transaction. Rather than placing
[pseudoephedrine products] behind a counter, we
believe in-store placement options for retailers would
be a better solution; that allows retailers to monitor
... their pseudoephedrine drug products and know
what's coming in and out of their store, and do it in
a way that doesn't place a burden on them. There
should also be a "notice of intent to sell
pseudoephedrine" requirement, and that would just be a
simple notice that says you're going to sell that
product.
There should be increased criminal penalties for
[methamphetamine] traffickers; authorization and
funding for community "Meth Watch" programs; funding
for environmental cleanup, law enforcement, education,
and training; community demand reduction programs; as
well as strong laws protecting drug-endangered
children. As Representative Ramras mentioned, a lot
of states have taken ... different approaches. I'm
happy to hear that you're not interested in going to
the [schedule VA controlled substances], which we
believe is very restrictive and reduces access. We
believe that there are other ways than placing things
behind the counter, as well.
MS. DANNENBERG added:
I wanted to highlight just a couple of states quickly
that have taken less restrictive measures and have
seen significant drops in their number of
[methamphetamine] lab incidents. California is one
example. In 2002, [California] law enforcement
reported 1,769 [methamphetamine] lab incidents, and by
2004, they were down to 639 [methamphetamine] lab
incidents. California places a three-package or nine-
gram limit on each retail transaction, and they also
take significant steps toward tracking the supply
chain of pseudoephedrine - and that is tracking
through manufacturers, wholesalers, and distributors
so that law enforcement in the state, [the] state
pharmacy board in particular, can be aware of what
products are coming in and out of their state and be
aware of any discrepancies in numbers.
Washington State has also taken a similar approach.
They adopted [anti-methamphetamine] legislation [in]
2001; they've seen a very (indisc.) reduction in the
number of [methamphetamine] lab incidents. In 2002,
they recorded 1,409 [methamphetamine] lab incidents;
by the end of 2004, they were down to 687. Like
California, ... [Washington places] restrictions on
sales - and that's a three-package or nine-gram limit
per retail transaction, and they prohibit an
individual from purchasing more than nine grams in a
24 hour period.
MS. DANNENBERG continued:
Washington also has done quite a bit in tracing the
path of pseudoephedrine into their state. Reports
must be submitted to the state board of pharmacy by
manufacturers, wholesalers, and retailers on the sales
and transfers and ... receipt of pseudoephedrine
products from out of state sources. ... Washington
also requires manufacturers and wholesalers to report
suspicious transactions in writing to the board of
pharmacy, and are required to maintain records of
their pseudoephedrine sales. They use a number of
different approaches without placing the products
behind a counter.
Additionally, we believe demand reduction and
education are essential towards ... trying to prevent
[methamphetamine] labs from occurring and then
reoccurring. [The] CHPA has been working on a number
of programs - one is a voluntary program with
retailers and law enforcement, called "Meth Watch" -
and [the] CHPA helps provide grants to the state to
set up training programs and distribute materials -
those are materials that would go in stores and on the
shelves by ingredients that are used to make
[methamphetamine], not just pseudoephedrine, but
actually any of the ingredients - so that if the
retailer or clerk is working in the store and they've
had the training, their going to know what to watch
for, for suspicious transactions ... - [for example],
a high volume of pseudoephedrine purchase or other
items - and know how to safely report that to law
enforcement to follow up on it.
[The CHPA] also works with the Partnership for a Drug
Free America and the American Academy of Pediatrics on
a program that right now is in [the] early stages -
it's been test-marketed in Phoenix, Arizona, and St.
Louis - that tries to get at the education of both
parents and young people, to learn more about
[methamphetamine] and what the dangers are. We've
been successful in that program; the Partnership for a
Drug Free America and the American Academy of
Pediatrics both feel it's been successful and have
asked [the CHPA] ... as well as [the U.S. Drug
Enforcement Administration (DEA)] to help them expand
that program into a lot of other major markets in the
U.S.
MS. DANNENBERG concluded:
We certainly understand and support your efforts in
trying to find a way to contain the [methamphetamine]
problem within your state, but we also believe that
the legislature should balance the need to restrict
access to these [methamphetamine] precursor chemicals
against a family caregiver's need to purchase cost-
effective, over-the-counter cough and cold medicines.
Certainly there's no quick fix to [the] problem, but
we look forward to working with this committee to try
[to] hopefully find a reasonable balance. Thank you.
CHAIR McGUIRE mentioned that the committee is in receipt of the
CHPA's written remarks.
3:12:07 PM
REPRESENTATIVE HARRY CRAWFORD, Alaska State Legislature, said he
is very much in favor of HB 149, and relayed that he has
sponsored a very similar bill. However, he remarked, HB 149
still lacks a reporting requirement with a centralized database,
and so therefore lacks the teeth with which to accomplish its
goal of addressing the "scourge" of [methamphetamine labs]. He
added:
We need a place for all of this information to come
to, and when we first started working on this bill,
the [DPS] was telling us that we're already going
after [methamphetamine and methamphetamine] labs and
so it shouldn't cost any extra, that it would, in
fact, give them a tool to work with to try to stop
this methamphetamine craze that's going across the
state.
REPRESENTATIVE CRAWFORD noted that currently, HB 149 just
requires businesses to maintain a logbook that details who is
buying which products, and then the DPS would have to go out to
each business and get that information from the logbooks. If
this information was simply mailed in every six months or once a
year, he suggested, the information could be stored in a
centralized location. He opined that such a reporting
requirement would not place too big a burden on business owners.
In conclusion, he characterized HB 149 as a wonderful bill, and
urged the committee to pass it.
REPRESENTATIVE GARA thanked Representatives Ramras and Crawford
for addressing this issue.
3:15:01 PM
DEAN J. GUANELI, Chief Assistant Attorney General, Legal
Services Section-Juneau, Criminal Division, Department of Law
(DOL), said that the administration supports any efforts to stem
the tide of methamphetamine being used and produced in Alaska.
He posited that the primary thrust of HB 149 is to place
limitations on purchasing and possessing pseudoephedrine, and
opined that such limitations will be particularly effective in
Alaska; additionally, the DOL considers this limitation to be
appropriate. He recapped Representative Ramras's comments
regarding the success other states have experienced in lowering
the number of methamphetamine labs. He offered the DOL's belief
that pseudoephedrine products are the primary source of the
ingredients used by Alaska's small methamphetamine labs.
MR. GUANELI relayed that the DOL also believes that the public
will support the proposed limitations on pseudoephedrine product
sales, and mentioned that a survey conducted in Iowa showed that
the majority of people buy only one package of pseudoephedrine
products at a time and do so only a few times a year, though a
very small percentage of people do buy two packages of
pseudoephedrine products at a time - again, only a few times a
year. The aforementioned survey also showed that two out of
three people thought that limiting the amount of pseudoephedrine
products that could be bought at any one time wouldn't pose any
inconvenience, and only one out of five people thought that such
a limitation might pose just a slight inconvenience;
additionally, there were similar statistics pertaining to how
inconvenient people thought it would be if pseudoephedrine
products were kept behind the counter. He indicated that the
aforementioned study showed that a majority of people at least
moderately supported limitations on pseudoephedrine product
sales, as well as the maintaining of records pertaining to such
sales and requiring purchasers to show ID.
MR. GUANELI opined that the changes the bill proposes will be
effective, and reiterated his belief that the public will
support such changes. He remarked, however, that it is also
fair to say that from the DOL's viewpoint, the bill needs work.
One of the issues that needs to be addresses is, what is it,
exactly, that is being restricted. Some of the bill's
provisions speak to restricting pseudoephedrine, while others
speak to also restricting ephedrine and phenylpropanolamine, and
still others speak to restricting iodine. There should be more
consistency in the various provisions with regard to what
exactly is being restricted and what the limitations will be for
possession, he opined.
MR. GUANELI indicated that another issue that should be
addressed is, are there exceptions in the bill that will result
in loopholes; Version L, for example, includes an exception for
pediatric products, wherein the recommended dosage is about half
that of the adult dosage. He opined that this exception will
create a loophole that will be exploited. Other issues that
should be addressed further are, how much of the drug can be
purchased and how much can be in someone's possession; he opined
that the amounts the bill currently allows for purchases - six
grams - and for possession - nine grams - is far more than
people typically buy [or keep] for personal use, that it is
instead the amount that is typically found in a lot of
methamphetamine labs, and therefore he thinks that the bill's
limitations should specify smaller amounts.
MR. GUANELI relayed that the bill raises questions in his mind
regarding what the obligations of retailers and legitimate
businesses are; he offered his view that a strict reading of the
bill's provisions could cause legitimate businesses some
concern. For example, one of the bill's provisions exempts a
licensed pharmacist from the proposed six-gram limitation, but
no such exemption exists for others who work for that same
pharmacy; therefore, he opined, there should be exemptions for
employees of pharmacists. He noted that there is also
inconsistency with the language pertaining to retailers, and
surmised that perhaps the bill's inconsistencies are a result of
the different provisions being taken from laws in other states.
MR. GUANELI said that there is also ambiguity regarding the
limitations on iodine, and that a question is raised in his mind
regarding whether the provision requiring businesses to register
with the DPS is necessary, since businesses involved in
pseudoephedrine distribution, wholesaling, and retailing are
already required to register with the Board of Pharmacy or some
other state agency. He said that from his standpoint, the
criminal provisions of the bill that speak to knowingly selling
and delivering precursors of methamphetamine and listed
chemicals uses too high a standard; instead the standard should
be reckless disregard, he opined, because law enforcement is
noticing that a lot of manufacturers of methamphetamine are
getting their ingredients from those whom they turn around and
sell the finished product to.
MR. GUANELI, in conclusion, offered his belief that the bill
needs more study and its drafting and inconsistency problems
fixed. He also offered his belief that the bill will not pose
any constitutional problems. He said he did not think that the
governor's bill that addresses this issue should be held up in
favor of HB 149, because HB 149 still needs more work.
REPRESENTATIVE GARA noted that Representative Crawford has
suggested that information from the aforementioned logbooks be
sent into the DPS periodically, while HB 149 requires the DPS to
contact business to get that information. He asked whether the
DOL has a preference.
MR. GUANELI posited that keeping in mind the state's limited
resources, the state must strike a balance between what can be
accomplished from a practical standpoint by the DPS and what
constitutes a reasonable burden for the retail industry; he
suggested that finding this balance is ultimately what the bill
must do. He surmised that much of the data collected by
retailers will not be [of interest] to the DPS. He predicted
that the DPS will probably do spot checks with retailers and
focus investigative efforts on suspicious activities, and
offered his belief that the DPS favors the approach proposed in
the bill.
REPRESENTATIVE GARA asked whether either current statute or the
bill as written will allow pharmacists to voluntarily provide
information regarding suspicious activity to the DPS.
3:29:51 PM
MR. GUANELI said the bill doesn't address that issue
specifically, but remarked that the DOL's hope is that such
cooperative information sharing would occur.
REPRESENTATIVE GARA said he didn't think that businesses would
be allowed legally to share customers' healthcare information
without there being a specific provision in the bill authorizing
such.
MR. GUANELI opined that since the bill requires retailers to
maintain a logbook and check ID, it isn't a big leap to ask
retailers to volunteer information about suspicious activity to
the DPS. Though if the committee thinks the bill should include
specific authorization of such, then such a change would be
appropriate, he ventured.
CHAIR McGUIRE noted that Washington requires that type of
reporting. She offered her hope that the DOL will offer
specific suggestions for improving the bill.
CHAIR McGUIRE said that HB 149 [Version L] would be held over.
HB 85 - PRESCRIBED MEDICATION FOR STUDENTS
3:33:23 PM
CHAIR McGUIRE announced that the next order of business would be
HOUSE BILL NO. 85, "An Act relating to self-administration and
documentation of certain types of medication prescribed to a
child attending school." [Before the committee was CSHB
85(HES).]
REPRESENTATIVE KEVIN MEYER, Alaska State Legislature, sponsor,
informed the committee that it's estimated that 9.2 million
children have asthma in the United States, and that young people
with asthma miss approximately 14 million days of school each
year. In fact, according to a national survey of nurses,
asthma- or allergy-related absences have a significant impact on
school performance and that asthma is more disruptive to school
routines than any other chronic condition. However, he opined,
being disruptive to school routines is of secondary concern
because asthma can be fatal to schoolchildren.
REPRESENTATIVE MEYER said that school children have died in
schools due to asthma attacks and schools have been held liable
for millions of dollars because of these deaths. Therefore,
Congress passed the Asthmatic Schoolchildren's Treatment and
Health Management Act of 2004, which requires that the Secretary
of the U.S. Department of Health and Human Services (DHHS)
provide preference when awarding grants to those states that
allow students to self administer their asthma medication. He
highlighted that HB 85 brings Alaska into compliance with the
provisions of the aforementioned federal law and provides
schools, parents, and children protection from potentially life-
threatening conditions and consequences by requiring schools to
allow self-administration of medication by a student if the
school receives written authorization from the parent or
guardian and written certification from the student's healthcare
provider that the student has the health condition, has a
written treatment plan, has received instruction on how to
properly use the medication, and is able to self-administer the
medication.
REPRESENTATIVE MEYER said that HB 85 places the decision for
self-administration of medication by a student squarely on the
shoulders of parents and healthcare [providers]. The student
could carry his/her own inhaler so that he/she would have access
to treatment without having to go to the nurse. He noted that
HB 85 also exempts schools from any liability related to the
self-administration of medication. In conclusion, he specified
that the real purpose behind HB 85 is to provide parents,
doctors, and schools the ability to ensure that children are as
safe as possible at school and have medication when necessary.
3:36:48 PM
REPRESENTATIVE GARA inquired as to why this is not currently the
law.
REPRESENTATIVE MEYER informed the committee that there isn't a
statewide policy on this matter, and therefore each school's
policy seems to be a bit different with regard to asthma
medication, though many schools want all medications to be kept
with the school nurse.
3:37:29 PM
MARGE LARSON, Director of Programs, American Lung Association;
Steering Committee Member, Alaska Asthma Coalition, informed the
committee that she is an asthmatic as well as the parent of an
asthmatic child. She further informed the committee that asthma
is on the rise and no one knows why or what causes asthma, and
that there is no known cure. Ms. Larson echoed Representative
Meyer's testimony regarding the fact that asthma is the leading
cause of missed school days, which negatively impacts school
performance, and regarding the fact that an asthma attack at any
age can be fatal. Ms. Larson relayed that the Centers for
Disease Control and Prevention Asthma Control Program recommends
that states build and sustain a statewide asthma coalition in
order to address this growing public health issue.
MS. LARSON noted that the Alaska Asthma Coalition began work in
2004 and is developing a statewide plan to address asthma,
including scientific interventions that are clinically and
environmentally based. She relayed that HB 85 is supported by
the following organizations: Association of Alaska School
Boards; the Alaska Nurses Association; the Allergy and Asthma
Network Mothers' of Asthmatics; the National Association of
School Nurses; the Alaska Chapter of the American Academy of
Pediatrics; the Asthma and Allergy Foundation of America -
Alaska Chapter; the American Lung Association - Alaska Chapter;
and the Alaska Asthma Coalition. In conclusion, Ms. Larson
urged the committee to join all these organizations in
supporting this asthma-friendly policy for Alaska's students.
3:39:41 PM
FRANK TURNEY offered his understanding that HB 85 has no bearing
on the Child Medication Safety Act, H.R. 1170, which was passed
in U.S. House of Representatives, regarding psychiatric drugs.
He noted that Senator Bettye Davis has introduced SB 48
regarding psychiatric drugs as well. Mr. Turney asked if he is
correct that HB 85 only applies to a child's ability to self-
administer [asthma- and other allergy-related] medication in
school.
CHAIR McGUIRE concurred with Mr. Turney's understanding.
REPRESENTATIVE COGHILL specified that the parents must give
written permission for a child to self-administrator asthma
medication. In further response to Mr. Turney, Representative
Coghill confirmed that the aforementioned [receipt of the
written permission] will be documented.
MR. TURNEY expressed hope that the House would sponsor
legislation similar to that sponsored by Senator Davis. He
relayed his concern with the reports that there are an
overwhelming number of children on anti-depressant drugs and
other drugs such as Ritalin.
3:43:41 PM
RICHARD MANDSAGER, M.D., Director, Central Office, Division of
Public Health, Alaska Department of Health and Social Services
(DHSS), remarked that as a pediatrician he believes the
legislature would be well advised to pass HB 85. He said that
he has been fortunate to practice in Anchorage where the school
district is usually cooperative with school nurses, physicians,
and parents when children are ready to self-administer
medication. This legislation will establish a state law that
will protect school districts, he opined, and posited that the
threat of litigation is one of the reasons why granting
permission to self-administer medication isn't the practice
already. This legislation is written such that if the child
misuses the medication, he/she will lose the right [to self-
administer the medication], he noted, and characterized HB 85 as
a huge advance. Dr. Mandsager opined that asthma medicines are
so advanced that children shouldn't miss any school because of
asthma.
3:44:49 PM
CHAIR McGUIRE after ascertaining that no one else wished to
testify, closed public testimony on HB 85.
CHAIR McGUIRE asked about an amendment that she offered in the
House Health, Education and Social Services Standing Committee
that would allow the school nurse to keep, if the child and
parents agreed, autoinjectable epinephrine ["Epi Pen"] or an
inhaler in the nurse's office in the event that the child
forgets his/her medication.
MICHAEL PAWLOWSKI, Staff to Representative Kevin Meyer, House
Finance Committee, Alaska State Legislature, sponsor, offered
his understanding that Chair McGuire's suggestion was not
offered as a formal amendment in the House Health, Education and
Social Services Standing Committee. He mentioned that one of
the concerns regarding that suggestion centered on whether
certain families could afford two of the same inhaler or two Epi
Pens.
CHAIR McGUIRE indicated that she would be offering her
suggestion as an amendment in this committee. She said that it
would not be mandatory that families keep extra medication with
the school nurse; rather, it would be an option.
REPRESENTATIVE GARA asked whether the original bill included
"the same rights with regard to insulin for kids who have
diabetes."
REPRESENTATIVE MEYER said that after the discussion in the prior
committee, he felt that diabetes is such a different disease
that it [shouldn't be] incorporated into HB 85.
REPRESENTATIVE GARA asked whether different school districts
have different rules with regard to children self administering
insulin.
MR. PAWLOWSKI offered his understanding that different school
districts do have different rules regarding insulin.
CHAIR McGUIRE mentioned that there was discussion in the prior
committee regarding needles and the difficulty in getting an
insulin dose just right.
CHAIR McGUIRE made a motion to adopt Conceptual Amendment 1, to
say that if the parents and the child agree, they can have an
Epi Pen or an inhaler on hand in the nurse's office in case the
child forgets his/her medication and needs it.
3:48:29 PM
REPRESENTATIVE MEYER characterized Conceptual Amendment 1 as an
excellent idea.
CHAIR McGUIRE asked whether there were any objections to
Conceptual Amendment 1. There being none, Conceptual Amendment
1 was adopted.
CHAIR McGUIRE made a motion to adopt Amendment 2, which read
[original punctuation provided]:
To page 2, lines 27
Insert: "pharmacist," following "village health aide,"
REPRESENTATIVE COGHILL objected for purposes of discussion. He
asked whether [pharmacists] wouldn't already be covered
elsewhere in the bill.
REPRESENTATIVE MEYER said that Amendment 2 was engendered by the
discussion that occurred in the House Health, Education and
Social Services Standing Committee.
MR. PAWLOWSKI indicated that the explicit list in the healthcare
provider provision of the definition section does not yet
include pharmacists, and noted that it's often the pharmacist
who does most of the training, who shows a child how to use the
medication. Therefore, when the bill specifies that a
healthcare provider must certify that a child is able and
competent to administer a medication, the pharmacist often plays
a very important role in that process.
REPRESENTATIVE COGHILL removed his objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 2. There being none, Amendment 2 was adopted.
3:51:18 PM
CHAIR McGUIRE referred to Amendment 3, which read [original
punctuation provided]:
To page 2, lines 20-25
Delete:
"as long as the pupil does not endanger any
person through the misuse of the inhaler. Misuse
of an inhaler includes exceeding the prescribed
dosage of the medication. An inhaler includes
metered-dose, breath-activated, and dry powder
inhalers, and spacers and holding chambers.
(d) The school may confiscate a self-
administered medication if a pupil misuses the
medication."
Insert:
".
(d) If a student uses his/her
prescribed medication in a manner other than
as prescribed, disciplinary action according
to school codes may be imposed upon him/her.
The imposes disciplinary action cannot limit
or restrict the students' immediate access
to his/her prescribed medication."
CHAIR McGUIRE offered her understanding that Amendment 3 is
intended to address the concern that the language currently in
the bill regarding confiscation of medication could be "a death
sentence for child." She noted that the bill is now limited to
Epi Pens and inhalers.
CHAIR McGUIRE made a motion to adopt Amendment 3.
REPRESENTATIVE DAHLSTROM objected [for the purpose of
discussion].
MR. PAWLOWSKI relayed that the national organization, Allergy &
Asthma Network Mothers of Asthmatics (AANMA) had a concern with
the original version of the bill because it made a broad policy
statement that confiscation of medication due to misuse could be
appropriate. And although the House Health, Education and
Social Services Standing Committee limited the bill in that
regard, it is believed that there is still an oversight in the
bill because action more appropriate than simply confiscating a
lifesaving medication can be taken. "Taking the medication away
from a child gets to the root of the reason we were offering the
bill in the first place," he remarked.
CHAIR McGUIRE clarified that Amendment 3 removes confiscation as
a disciplinary action but allows for other disciplinary action
to be taken in the case of medication misuse.
REPRESENTATIVE DAHLSTROM removed her objection.
CHAIR McGUIRE asked whether there were any further objections to
Amendment 3. There being none, Amendment 3 was adopted.
3:53:12 PM
REPRESENTATIVE GRUENBERG referred to page 2, lines 27-28, and
asked why the bill doesn't just say "licensed nurse" instead of
specifying advanced nurse practitioners and public health
nurses.
REPRESENTATIVE MEYER remarked that a change to "licensed nurse"
sounds logical.
MR. PAWLOWSKI asked that Dr. Mandsager be allowed to comment.
DR. MANDSAGER indicated that using the term "licensed nurse"
would be acceptable.
REPRESENTATIVE GRUENBERG made a motion to adopt Amendment 4 to
strike "advanced nurse practitioner" and "public health nurse"
from page 2, lines 27-28, and insert "licensed nurse". There
being no objection, Amendment 4 was adopted.
REPRESENTATIVE GRUENBERG asked whether anything else ought to be
included in the definition section, for example, institutions or
naturopaths.
[No response was audible.]
3:55:33 PM
REPRESENTATIVE COGHILL moved to report CSHB 85(HES), as amended,
out of committee with individual recommendations and the
accompanying zero fiscal notes. There being no objection, CSHB
85(JUD) was reported from the House Judiciary Standing
Committee.
HB 148 - TRAFFICKING OF PERSONS
HB 101 - SEX TRAFFICKING AND TOURISM
3:56:22 PM
CHAIR McGUIRE announced that the final order of business would
be a hearing on two bills: HOUSE BILL NO. 148, "An Act relating
to trafficking of persons."; and HOUSE BILL NO. 101, "An Act
relating to sex trafficking and tourism."
REPRESENTATIVE BETH KERTTULA, Alaska State Legislature, sponsor
of HB 148, said that both she and Representative Croft have
introduced legislation relating to human trafficking, which, at
its fundamental root, she opined, is human slavery. She went on
to say:
It's a pretty shocking thing to realize that in this
day and age, we have slavery, and it's a sad truth.
The [U.S. Department of State] estimates that between
600,000 to 800,000 men, women, and children are
trafficked across international borders each year, and
somewhere in the range of 20,000 to 100,000 are
brought into the U.S. We have the first case that was
prosecuted under the federal Act here in Alaska:
Ukrainian women brought under the pretense of folk
dancing and then held at a home in Chugiak and ...
brought into the Crazy Horse [Saloon] where they were
forced to strip for money. And luckily a really
astute [Immigration and Naturalization Service (INS)]
agent caught an ad in the newspaper and went and
investigated, and it resulted in the prosecution of
[three] men who went to jail. So it's a sad truth.
My husband was in Vladivostok last summer, ... [and]
people approached him and said it was an increasing
problem, ... [that of] Russian women being brought to
Alaska.
REPRESENTATIVE KERTTULA relayed that members' packets contain
examples [of human trafficking] and that experts will be on hand
to testify at the bills' next hearing, and noted that the
Department of Law (DOL) has been working with she and
Representative Croft, but it has not been a completely easy task
to come up with the right language. She indicated that a
proposed change [suggested by the DOL] to HB 148 has been handed
out. In conclusion, she opined that [human trafficking] is
everyone's problem and thus shouldn't necessarily be left solely
up to the federal government to address.
REPRESENTATIVE ERIC CROFT, Alaska State Legislature, sponsor of
HB 101, offered the following quote from President George W.
Bush's address to the UN General Assembly in September 2003:
There's a special evil in the abuse and exploitation
of the most innocent and vulnerable. The victims of
sex trade see little of life before they see the very
worst of life - an underground of brutality and lonely
fear. Those who create these victims and profit from
their suffering must be severely punished. Those who
patronize this industry debase themselves and deepen
the misery of others. And governments that tolerate
this trade are tolerating a form of slavery.
REPRESENTATIVE CROFT noted that members' packets include a
federal report that was the basis of federal legislation, but
added that he agrees with Representative Kerttula that this
issue is not something that should be left solely to the federal
government to address, that there should be appropriate state
laws in place as well. He offered his understanding that
Representative Kerttula's legislation focuses on the importation
of people under fraudulent or threatening pretenses, and
explained that although his legislation addresses that issue
too, it also - via the latter portion of Section 1, proposed AS
11.66.410 - addresses the issue of organized tours for the
purpose of having sex with children in other countries.
Although it is not yet known how prevalent or how well
advertised this practice is, it is known that it does exist
because there have been reports from the "subject" countries
that say that people, mainly men, from industrialized countries
enter into [the subject] countries for the purpose of having sex
with children.
REPRESENTATIVE GRUENBERG indicated that he has three issues of
concern [with the DOL's proposed change]. One, why does it only
address situations that involve people coming into the state -
shouldn't it also address situations involving people who are
already in the state.
REPRESENTATIVE CROFT indicated that his bill does not have the
transportation element that the DOL has expressed a preference
for including, and surmised that the issue will be addressed
further at the bills' next hearing.
REPRESENTATIVE GRUENBERG said the second issue of concern is the
language pertaining to labor in the state by a promise. He
offered his belief that such language could interfere with
legitimate labor disputes. The third issue of concern pertains
to the language, "if the person obtains a benefit from the
commission". He opined that "benefit" should be defined.
REPRESENTATIVE CROFT suggested to Representative Gruenberg that
before the bills' next hearing, he compare Sections 1 of HB 101,
HB 148, and the DOL's proposed change.
[HB 148 and HB 101 were held over.]
ADJOURNMENT
4:04:26 PM
There being no further business before the committee, the House
Judiciary Standing Committee meeting was adjourned at 4:04 p.m.
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