04/11/2005 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HB14 | |
| HB12 | |
| SB105 | |
| HJR9 | |
| HB150 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 246 | TELECONFERENCED | |
| = | HB 14 | ||
| * | HB 257 | ||
| + | HJR 9 | TELECONFERENCED | |
| += | HB 150 | TELECONFERENCED | |
| HB 53 | |||
| += | HB 12 | TELECONFERENCED | |
| += | SB 105 | TELECONFERENCED | |
| += | HB 96 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE JUDICIARY STANDING COMMITTEE
April 11, 2005
1:14 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
OTHER LEGISLATORS PRESENT
Senator Ralph Seekins
COMMITTEE CALENDAR
HOUSE BILL NO. 14
"An Act relating to disclosure of information about a child or a
child's family to a legislator or a member of a legislator's
staff; and making conforming changes."
- HEARD AND HELD
HOUSE BILL NO. 12
"An Act relating to televisions and monitors in motor vehicles."
- MOVED CSHB 12(JUD) OUT OF COMMITTEE
CS FOR SENATE BILL NO. 105(L&C)
"An Act relating to the retrospective application and
applicability of the overtime compensation exemption for flight
crew members; and providing for an effective date."
- MOVED CSSB 105(L&C) OUT OF COMMITTEE
HOUSE JOINT RESOLUTION NO. 9
Urging the United States Congress to honor the process and
judgment of the federal courts in the case of the Exxon Valdez
disaster and to refrain from enacting legislation that would
affect the outcome of the courts' resolution of the case.
- MOVED HJR 9 OUT OF COMMITTEE
HOUSE BILL NO. 150
"An Act requiring licensure of occupations relating to
radiologic technology, radiation therapy, and nuclear medicine
technology; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 96
"An Act making findings relating to marijuana use and
possession; relating to marijuana and misconduct involving a
controlled substance; and providing for an effective date."
- SCHEDULED BUT NOT HEARD
HOUSE BILL NO. 246
"An Act requiring a member to opt into a class action; and
amending Rule 23(c), Alaska Rules of Civil Procedure."
- BILL HEARING POSTPONED TO 4/12/05
HOUSE BILL NO. 257
"An Act relating to a procurement and electronic commerce tools
program for state departments and instrumentalities of the
state; and providing for an effective date."
- BILL HEARING POSTPONED TO 4/13/05
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 53
"An Act relating to child-in-need-of-aid proceedings; amending
the construction of statutes pertaining to children in need of
aid; relating to a duty and standard of care for services to
children and families, to the confidentiality of investigations,
court hearings, and public agency records and information in
child-in-need-of-aid matters and certain child protection
matters, to immunity regarding disclosure of information in
child-in- need-of-aid matters and certain child protection
matters, to the retention of certain privileges of a parent in a
relinquishment and termination of a parent and child
relationship proceeding, to eligibility for permanent fund
dividends for certain children in the custody of the state, and
to juvenile delinquency proceedings and placements; establishing
a right to a trial by jury in termination of parental rights
proceedings; reestablishing and relating to state citizens'
review panels for certain child protection and custody matters;
amending the duty to disclose information pertaining to a child
in need of aid; authorizing additional family members to consent
to disclosure of confidential or privileged information about
children and families involved with children's services within
the Department of Health and Social Services to officials for
review or use in official capacities; relating to reports of
harm and to adoptions and foster care; mandating reporting of
the medication of children in state custody; prescribing the
rights of grandparents related to child-in-need-of-aid cases and
establishing a grandparent priority for adoption in certain
child-in-need-of-aid cases; modifying adoption and placement
procedures in certain child-in-need-of-aid cases; amending
treatment service requirements for parents involved in child-in-
need-of-aid proceedings; amending Rules 9 and 13, Alaska
Adoption Rules; amending Rules 3, 18, and 22, Alaska Child in
Need of Aid Rules of Procedure; and providing for an effective
date."
- BILL HEARING POSTPONED TO 4/12/05
PREVIOUS COMMITTEE ACTION
BILL: HB 14
SHORT TITLE: DISCLOSURES BY FOSTER PARENTS
SPONSOR(S): REPRESENTATIVE(S) ROKEBERG
01/10/05 (H) PREFILE RELEASED 12/30/04
01/10/05 (H) READ THE FIRST TIME - REFERRALS
01/10/05 (H) HES, JUD
03/31/05 (H) HES AT 3:00 PM CAPITOL 106
03/31/05 (H) Scheduled But Not Heard
04/05/05 (H) HES AT 3:00 PM CAPITOL 106
04/05/05 (H) Moved CSHB 14(HES) Out of Committee
04/05/05 (H) MINUTE(HES)
04/06/05 (H) HES RPT CS(HES) NT 6DP
04/06/05 (H) DP: CISSNA, GARDNER, KOHRING, MCGUIRE,
SEATON, WILSON
04/11/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 12
SHORT TITLE: TVS AND MONITORS IN MOTOR VEHICLES
SPONSOR(S): REPRESENTATIVE(S) GRUENBERG, LYNN, GARDNER, MCGUIRE
01/10/05 (H) PREFILE RELEASED 12/30/04
01/10/05 (H) READ THE FIRST TIME - REFERRALS
01/10/05 (H) STA, JUD, FIN
03/01/05 (H) STA AT 8:00 AM CAPITOL 106
03/01/05 (H) Scheduled But Not Heard
03/05/05 (H) STA AT 9:30 AM CAPITOL 106
03/05/05 (H) Heard & Held
03/05/05 (H) MINUTE(STA)
03/17/05 (H) STA AT 8:00 AM CAPITOL 106
03/17/05 (H) Moved CSHB 12(STA) Out of Committee
03/17/05 (H) MINUTE(STA)
03/18/05 (H) STA RPT CS(STA) NT 6DP
03/18/05 (H) DP: GARDNER, LYNN, GATTO, GRUENBERG,
ELKINS, SEATON
04/01/05 (H) JUD AT 1:00 PM CAPITOL 120
04/01/05 (H) Heard & Held
04/01/05 (H) MINUTE(JUD)
04/04/05 (H) JUD AT 1:00 PM CAPITOL 120
04/04/05 (H) -- Meeting Canceled --
04/06/05 (H) JUD AT 1:00 PM CAPITOL 120
04/06/05 (H) Heard & Held
04/06/05 (H) MINUTE(JUD)
04/08/05 (H) JUD AT 8:00 AM CAPITOL 120
04/08/05 (H) Bill Postponed To 4/11
04/11/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: SB 105
SHORT TITLE: OVERTIME WAGES FOR FLIGHT CREW
SPONSOR(S): SENATOR(S) SEEKINS
02/14/05 (S) READ THE FIRST TIME - REFERRALS
02/14/05 (S) L&C, JUD
02/22/05 (S) L&C AT 1:30 PM BELTZ 211
02/22/05 (S) Heard & Held
02/22/05 (S) MINUTE(L&C)
03/01/05 (S) L&C AT 1:30 PM BELTZ 211
03/01/05 (S) Moved CSSB 105(L&C) Out of Committee
03/01/05 (S) MINUTE(L&C)
03/02/05 (S) L&C RPT CS 3DP 1AM SAME TITLE
03/02/05 (S) DP: BUNDE, SEEKINS, STEVENS B
03/02/05 (S) AM: ELLIS
03/09/05 (S) JUD AT 8:30 AM BUTROVICH 205
03/09/05 (S) Moved CSSB 105(L&C) Out of Committee
03/09/05 (S) MINUTE(JUD)
03/09/05 (S) JUD RPT CS(L&C) 2DP 2NR
03/09/05 (S) DP: SEEKINS, HUGGINS
03/09/05 (S) NR: FRENCH, GUESS
03/18/05 (S) TRANSMITTED TO (H)
03/18/05 (S) VERSION: CSSB 105(L&C)
03/21/05 (H) READ THE FIRST TIME - REFERRALS
03/21/05 (H) JUD
04/06/05 (H) JUD AT 1:00 PM CAPITOL 120
04/06/05 (H) Heard & Held
04/06/05 (H) MINUTE(JUD)
04/11/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HJR 9
SHORT TITLE: URGE CONGRESS HONOR EXXON VALDEZ JUDGMENT
SPONSOR(S): REPRESENTATIVE(S) LEDOUX
02/14/05 (H) READ THE FIRST TIME - REFERRALS
02/14/05 (H) RES, JUD
03/30/05 (H) RES AT 1:00 PM SENATE FINANCE 532
03/30/05 (H) Moved Out of Committee
03/30/05 (H) MINUTE(RES)
04/01/05 (H) RES RPT 6DP
04/01/05 (H) DP: OLSON, ELKINS, LEDOUX, CRAWFORD,
RAMRAS, SAMUELS
04/11/05 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 150
SHORT TITLE: LICENSING RADIOLOGIC TECHNICIANS
SPONSOR(S): REPRESENTATIVE(S) ANDERSON
02/14/05 (H) READ THE FIRST TIME - REFERRALS
02/14/05 (H) L&C, JUD, FIN
02/23/05 (H) L&C AT 3:15 PM CAPITOL 17
02/23/05 (H) Scheduled But Not Heard
03/02/05 (H) L&C AT 3:15 PM CAPITOL 17
03/02/05 (H) Heard & Held
03/02/05 (H) MINUTE(L&C)
03/18/05 (H) L&C AT 3:15 PM CAPITOL 17
03/18/05 (H) Moved CSHB 150(L&C) Out of Committee
03/18/05 (H) MINUTE(L&C)
03/22/05 (H) L&C RPT CS(L&C) 2DP 1NR 2AM
03/22/05 (H) DP: LYNN, ANDERSON;
03/22/05 (H) NR: CRAWFORD;
03/22/05 (H) AM: ROKEBERG, KOTT
03/30/05 (H) JUD AT 1:00 PM CAPITOL 120
03/30/05 (H) Heard & Held
03/30/05 (H) MINUTE(JUD)
04/06/05 (H) JUD AT 1:00 PM CAPITOL 120
04/06/05 (H) <Bill Hearing Postponed>
04/11/05 (H) JUD AT 1:00 PM CAPITOL 120
WITNESS REGISTER
HEATHER NOBREGA, Staff
to Representative Norman Rokeberg
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 14 on behalf of the sponsor,
Representative Rokeberg.
TAMMY SANDOVAL, Acting Deputy Commissioner
Office of Children's Services (OCS)
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 14.
STACIE KRALY, 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 14.
BRIAN HOVE, Staff
to Senator Ralph Seekins
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 105 on behalf of Senator
Seekins, sponsor.
GREY MITCHELL, Director
Central Office
Division of Labor Standards & Safety
Department of Labor & Workforce Development (DLWD)
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding SB 105.
SUZANNE HANCOCK, Staff
to Representative Gabrielle LeDoux
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HJR 9 on behalf of the sponsor,
Representative LeDoux.
JERRY McCUNE, Lobbyist
for United Fishermen of Alaska;
President
Cordova District Fishermen United
Juneau, Alaska
POSITION STATEMENT: Testified in support of HJR 9.
MATTHEW D. JAMIN, Attorney at Law
Jamin, Ebell, Schmitt & Mason
Kodiak, Alaska
POSITION STATEMENT: Testified in support of HJR 9 on behalf of
the plaintiffs in the Exxon Valdez oil spill litigation.
JON BITTNER, Staff
to Representative Tom Anderson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of the sponsor, Representative
Anderson, explained the changes incorporated in the proposed CS
for HB 150, Version S, and responded to a question.
DONNA J. RUFSHOLM, R.T., Chair
Licensure Committee
Alaska Society of Radiologic Technologists (AKSRT)
Homer, Alaska
POSITION STATEMENT: Provided comments during discussion of HB
150 and responded to questions.
REPRESENTATIVE PEGGY WILSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Expressed concerns during discussion of HB
150.
PAMELA LaBOLLE
The Mulder Company
Lobbyist for the Alaska Society of Radiologic Technologists
(AKSRT)
Juneau, Alaska
POSITION STATEMENT: Provided comments during discussion of HB
150 and responded to a remark.
CLYDE E. PEARCE, Radiologic Health Specialist II
Radiologic Health
Laboratories
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 150 and
responded to questions and concerns.
ED HALL, P.A., Legislative Liaison
Alaska Academy of Physician Assistants (AKAPA)
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of HB
150.
RONALD L. DEIS
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of HB
150.
BARBARA HUFF TUCKNESS, Director
Governmental And Legislative Affairs
Teamsters Local 959
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 150.
B.J. ANDERSON
Anchorage Neighborhood Health Center (ANHC)
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of HB
150 and asked that the bill be changed before it moves from
committee.
SUSAN MASON-BOUTERSE, Executive Director
Sunshine Community Health Center
Talkeetna, Alaska
POSITION STATEMENT: Her written testimony in opposition to HB
150 was paraphrased by Beth Little-Terry.
LORREN J. WEAVER, M.D., Medical Director
Camai Community Health Center
Naknek, Alaska
POSITION STATEMENT: Testified in opposition to HB 150 on behalf
of the Bristol Bay Borough, which owns the Camai Community
Health Center.
KAREN FAGERSTROM, Director
Village Health Services
Community Health Services Division
Norton Sound Health Corporation (NSHC)
Nome, Alaska
POSITION STATEMENT: Testified in opposition to HB 150,
suggested that changes be made to the bill, and responded to a
comment.
LOUISE REED, Diagnostic Imaging Director
Yukon-Kuskokwim Health Corporation (YKHC)
Bethel, Alaska
POSITION STATEMENT: Provided comments during discussion of HB
150.
CHRIS DEVLIN, Executive Director
Eastern Aleutian Tribes, Inc.
Sand Point, Alaska
POSITION STATEMENT: Testified in opposition to HB 150.
CHERYL KILGORE, Executive Director
Interior Community Health Center (ICHC)
Fairbanks, Alaska
POSITION STATEMENT: During discussion of HB 150, provided
comments for herself and Tammy Wilkerson, Clinic Nurse Manager
for the ICHC.
TIMO SAARINEN
Homer, Alaska
POSITION STATEMENT: Testified in support of HB 150.
ACTION NARRATIVE
CHAIR LESIL McGUIRE called the House Judiciary Standing
Committee meeting to order at 1:14:28 PM. Representatives
McGuire, Coghill, Dahlstrom, and Gruenberg were present at the
call to order. Representatives Anderson, Kott, and Gara arrived
as the meeting was in progress. Senator Seekins was also
present.
HB 14 - DISCLOSURES BY FOSTER PARENTS
CHAIR McGUIRE announced that the first order of business would
be HOUSE BILL NO. 14, "An Act relating to disclosure of
information about a child or a child's family to a legislator or
a member of a legislator's staff; and making conforming
changes." [Before the committee was CSHB 14(HES).]
1:14:45 PM
HEATHER NOBREGA, Staff to Representative Norman Rokeberg, Alaska
State Legislature, sponsor, said on behalf of Representative
Rokeberg that HB 14 came about after constituents relayed to him
that foster parents are not currently permitted to discuss with
legislators confidential information regarding their foster
children. This precludes foster parents from seeking
legislative help in matters pertaining to those children. House
Bill 14 will allow foster parents to contact their legislator
and speak with him/her or his/her staff about their foster
children. She mentioned that it has been brought to the
sponsor's attention that language in HB 14 might conflict with
federal law, and so she asked that the bill be held over so that
that issue can be addressed.
1:16:50 PM
TAMMY SANDOVAL, Acting Deputy Commissioner, Office of Children's
Services (OCS), Department of Health and Social Services (DHSS),
concurred that HB 14 proposes to allow foster parents of
children who are in State custody to disclose privileged and
confidential information to a legislator or a member of his/her
staff for review or use in the legislator's or legislative
staff's official capacity. However, subsequent to the bill
being reported from the House Health, Education and Social
Services Standing Committee, the OCS learned that adding foster
parents to the list of those able to disclose confidential
information to a legislator or legislative staff member would
cause the OCS to be in violation of federal law, specifically
"title IV-E," and thus jeopardize approximately $29.7 million in
federal reimbursements for fiscal year 2006 (FY 06). She
mentioned that members' packets include a copy of the federal
language.
MS. SANDOVAL went on to say:
Absolutely, for the record, I just want to say ...
[that] we want to be responsive to the needs of foster
parents, [and] that we believe that existing [AS
47.10.080(q)] clearly defines and limits what specific
information foster parents are entitled to. They are
entitled to the child's case plan; ... medical, mental
health, and educational information regarding the
child to assist them in providing the proper care for
that child; [and] ... information to help assure the
safety of the child and their own family's safety.
The same statute clearly requires foster parents to
maintain confidentiality of records regarding a child
placed in their home except when the disclosure of the
records is necessary to obtain medical and education
services for the child - for example, providing
information to physicians. We believe that there are
several avenues by which foster parents can ... get
their needs met through our system. Foster parents
are a part of the regular case review system, which
allows them to express concerns they have about the
plan and/or services being provided for children in
their care.
They're allowed and encouraged to attend court
hearings, provide testimony to the judge; they're
welcome to contact their licensing specialist, the
assigned worker ..., [and] their ... social worker's
supervisor. And then there are other levels as well:
the staff manager, the regional children's services
manager, and just this morning I responded to a
concern. So there are several lines of communication
by which we hope that foster parents can get their
needs met through us. Additionally, foster parents
have access to a formal grievance process and the
ombudsman's office if they feel the issues they have
with the department are not being resolved. For that
reason, the department opposes HB 14.
1:20:35 PM
REPRESENTATIVE COGHILL asked what can a foster parent currently
discuss with his/her legislator.
MS. SANDOVAL said:
I think that there's a number of things that ...
foster parents can say. What we're concerned about is
confidential information. ... It seems like
specifically what we want to be able to do is talk to
you about our process rather than specific information
about a child; [we'd] rather talk about our policies
and procedures and the normal process. ... And you
alerting us is one thing, what's being said and what
we can say back is another.
REPRESENTATIVE GARA asked what is the law currently with regard
to what information a foster parent can discuss with a
legislator.
1:22:10 PM
STACIE KRALY, Senior Assistant Attorney General, Human Services
Section, Civil Division (Juneau), Department of Law (DOL), said
that theoretically, all information in a child in need of aid
(CINA) proceeding is confidential, adding that AS 47.10.092(c)
provides criminal penalties for violating the confidentiality
provisions pertaining to CINA cases. She elaborated:
A foster parent who has access to confidential
information should ... not call their legislator and
divulge that confidential information, and doing so
would potentially subject them to criminal penalties.
The question ... [becomes one of] reciprocity, if you
will. If a foster parent calls a legislator and says,
"I've got a problem with the Office of Children's
Services and 'X'" - whatever the issue may be - as
long as it's not a confidential communication, then
the legislature can call the Office of Children's
Services and say, "We've got this issue," and we can
talk about the process. It's just getting into the
underlying confidential information - the case plan,
information about the parents, information about the
children, what sort of services they're receiving -
that information is confidential and, theoretically,
if divulged by anybody, even by the Office of
Children's Services, [they would be] subject to ...
potential criminal penalties. ...
REPRESENTATIVE GARA opined that if a foster parent sees a child
being abused by the natural parent, he/she ought to be able to
discuss this with the OCS even if "that evidence" was also an
aspect of the CINA proceeding. "It seems to me that the law
couldn't be interpreted to mean you can't talk to somebody about
what you saw once it becomes part of the confidential
proceeding; you just can't talk about the things that you only
know because they've gone on in a confidential proceeding,
right?" he asked.
MS. KRALY concurred, adding that nothing within "this construct
of what we're talking about" would preclude anybody, let alone a
foster parent, from making a report of harm to the OCS or to a
legislator in his/her legislative capacity.
CHAIR McGUIRE remarked that the issue is probably not as clear-
cut as that, particularly in CINA situations involving ongoing
abuse.
1:26:26 PM
MS. KRALY agreed. She opined, however, that the distinction
being made within the context of the statute is whether the
information has been independently received or whether it was
received solely due to the fact of being a foster parent and
thus having access to the confidential information. If the
latter were the case and the foster parent were to call a
legislator and divulge that information, he/she would basically
be waiving a [biological] parent's privacy rights and well as
the child's privacy rights. The issue becomes one of ensuring
that the information a foster parent has is kept in the highest
of confidence, and if a foster parent has a concern and calls a
legislator for assistance, of course the OCS wants to know about
the concern and be given a chance to address it, but the
question then becomes one of just how much information the OCS
can exchange with a legislator in response to a concern brought
forth by a foster parent. The main concern is that if the
changes proposed by HB 14 take place, and the confidential
aspects of a CINA case are divulged without first obtaining a
waiver from the [biological] parent, the OCS risks losing
federal funding.
CHAIR McGUIRE noted that CSHB 14(HES) no longer contains
reference to the confidential information about the child's
family. She mentioned that although she would trust Ms. Kraly
and Ms. Sandoval to provide legislators with the information
they need to assist constituents, there is no guarantee that the
same could be said of future departmental employees; sometime
things fall through the cracks, and [the current limitation] on
the kinds of information a foster parent can share with a
legislator could be construed as interfering with a foster
parent's ability to go to his/her legislator and seek assistance
in the same way a biological parent could.
1:29:49 PM
REPRESENTATIVE DAHLSTROM relayed that in the few cases that she
has been involved with, the [biological] parents were willing to
sign a confidentiality waiver and that is all that was needed in
order for her to assist her constituents. She said that she was
reassured that departmental employees were not just giving out
confidential information but were instead making sure that she
did actually have a waiver. She added that she is comfortable
with the concept that information in CINA cases be kept
confidential.
CHAIR McGUIRE noted that the House Health, Education and Social
Services Standing Committee showed bipartisan support for the
bill.
REPRESENTATIVE DAHLSTROM surmised that whether one supports the
bill or not depends on how the issue is phrased. If the issue
is looked upon as simply striving towards what is in the best
interest of the child, then the proposed change might be viewed
in a favorable light, but if the issue is looked upon with the
knowledge that not all citizens use information in the correct
way or for the betterment of the child - and sometimes even have
ulterior motives - then the concept of using caution when
releasing confidential information could seem to be the better
choice.
REPRESENTATIVE GARA said he has mixed feelings about [the issues
raised by the bill], referred to a case that came to light the
previous summer, and surmised that the bill came about in
response to that case. He said that absent some showing that
the OCS is acting abusively or incompetently, he is not willing
to alter the current confidentiality provisions.
1:34:33 PM
REPRESENTATIVE COGHILL made mention of a bill that he has
sponsored. He opined that parents have a "natural supremacy,"
but because sometimes parents do things that they ought not do,
foster parents have been called upon to take over the parents'
duties. A frustration arises when legislators are called upon
to act as watchdogs over some of the department's actions, he
remarked, adding that he is satisfied with just having the
ability to discuss issues of process. Issues involving
confidential information will just have to be decided by the
courts. He mentioned that he struggles with the issues raised
by the bill because he gets a lot of calls by people who are
looking for help in navigating the system.
CHAIR McGUIRE indicated that one of the issues that has recently
arisen is that of providers being able to share information with
each other, and noted that yet another bill will be addressing
that issue. She mentioned that one of her constituents has
mentioned to her that if state agencies know that certain
children in state custody have behavioral problems, that
information should be disclosed to school officials in order to
ensure the safety of all the children in the school system.
REPRESENTATIVE DAHLSTROM relayed that she is familiar with the
aforementioned case, and noted that media portrayals of those
involved in that case were not accurate, but the OCS was unable
address the accusations that were made against it because of the
current confidentiality provisions in state law. She went on to
say she has never had any conversations with OCS employees
wherein they indicated that they were unwilling to take steps to
improve the current system.
1:41:29 PM
REPRESENTATIVE GRUENBERG referred to AS 47.10.092(c), and noted
that it says, "A person who violates a provision of this section
is guilty of a misdemeanor, and upon conviction is punishable by
a fine of not more than $500 or by imprisonment for not more
than one year, or by both.". He relayed that he would be
offering an amendment that would alter AS 47.10.092(c) such that
it would say a violation of it would also be a violation of AS
24.60.060(a), which says:
A legislator or legislative employee may not knowingly
make an unauthorized disclosure of information that is
made confidential by law and that the person acquired
in the course of official duties. A person who
violates this section is subject to a proceeding under
AS 24.60.170 and may be subject to prosecution under
AS 211.56.860 or another law.
REPRESENTATIVE GRUENBERG asked whether there is currently any
requirement for a legislator or legislative staff member to sign
a statement of confidentiality.
MS. KRALY offered her understanding that AS 47 requires
temporary assistance information to be kept confidential and
provides a form that must be signed by legislators before they
receive that confidential information, and said this type of
form is also being used by the OCS to ensure that information
released to legislators under AS 47.10 is kept confidential,
though in such instances the form is not statutorily required.
REPRESENTATIVE GRUENBERG opined that it should be.
MS. NOBREGA clarified that the bill was not introduced in
response to the aforementioned case; instead, it was introduced
in response to a situation involving a foster parent who was
being dissuaded by OCS staff from contacting his/her
legislator's office regarding difficulties he/she was having in
obtaining reimbursement from the OCS.
CHAIR McGUIRE relayed that CSHB 14(HES) would be held over.
HB 12 - TVS AND MONITORS IN MOTOR VEHICLES
1:47:11 PM
CHAIR McGUIRE announced that the next order of business would be
HOUSE BILL NO. 12, "An Act relating to televisions and monitors
in motor vehicles." [Before the committee was the proposed
committee substitute (CS) - with a handwritten alteration
included - for HB 12, Version 24-LS0058\X, Luckhaupt, 4/5/05,
which had been adopted and amended on 4/6/05.]
REPRESENTATIVE GRUENBERG moved to adopt the proposed committee
substitute (CS) for HB 12, Version 24-LS0058\R, Luckhaupt,
4/11/05, as the work draft. There being no objection, Version R
was before the committee.
1:48:25 PM
REPRESENTATIVE GRUENBERG relayed that Version R now also exempts
portable cellular telephones; equipment that displays only audio
equipment information, functions, and controls; and equipment
that displays only vehicle information or controls related to
speed, fuel level, battery charge, and other vehicle safety or
equipment information. He relayed that the language
specifically exempting RVs has not yet been added to the bill,
though industry representatives liked the model language
provided in members' packets, and mentioned that he received
assurance from industry representatives that any TV that is
positioned in the front of an RV disconnects once the engine is
started.
1:51:07 PM
REPRESENTATIVE ANDERSON moved to report the proposed (CS) for HB
12, Version 24-LS0058\R, Luckhaupt, 4/11/05, out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, CSHB 12(JUD) was reported from
the House Judiciary Standing Committee.
SB 105 - OVERTIME WAGES FOR FLIGHT CREW
1:51:48 PM
CHAIR McGUIRE announced that the next of business would be CS
FOR SENATE BILL NO. 105(L&C), "An Act relating to the
retrospective application and applicability of the overtime
compensation exemption for flight crew members; and providing
for an effective date."
The committee took an at-ease from 1:52 p.m. to 1:55 p.m.
1:55:01 PM
BRIAN HOVE, Staff to Senator Ralph Seekins, Alaska State
Legislature, sponsor, stated on behalf of Senator Seekins that
he was available to answer questions regarding SB 105.
1:55:37 PM
REPRESENTATIVE GARA referred to testimony during the bill's last
hearing regarding memoranda from the 1980s, and questioned
whether they made it clear that Hageland Aviation Services, Inc.
("Hageland Aviation Services"), was not required to pay
overtime.
GREY MITCHELL, Director, Central Office, Division of Labor
Standards & Safety, Department of Labor & Workforce Development
(DLWD), replied that the 1980 and 1984 memos were attorney
general's opinions, which were used as the basis of the DLWD
interpretation. He noted that the 1986 memo is an opinion
letter that was written to the Alaska Air Carriers Association
(AACA) from the deputy director of the Division of Labor
Standards and Safety. Mr. Mitchell continued: "This opinion
letter is written in such a way that it appears to be making a
policy type of decision that conflicts with the attorney
general's [opinions]. I think that kind of sums up the conflict
between these opinions."
REPRESENTATIVE GARA asked whether the 1986 memo proclaims that
if there is substantial hauling of mail, then the overtime
provisions do not apply.
MR. MITCHELL said that was correct.
REPRESENTATIVE GARA asked if Hageland Aviation Services engaged
in substantial mail hauling.
MR. MITCHELL said he understood that Hageland Aviation Services
did haul mail, but did not know to what degree.
1:58:51 PM
REPRESENTATIVE GARA asked how the aforementioned 1986 memo
seemingly conflicted with the Department of Law memos.
MR. MITCHELL said: "The 1986 memo essentially takes the
position of establishing the federal guideline for overtime
eligibility of employees of air carriers. That's a pretty big
step for an opinion letter, without any regulation or attorney
general's opinion to fall back on."
REPRESENTATIVE KOTT moved to report CSSB 105(L&C) out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSSB 105(L&C) was
reported from the House Judiciary Standing Committee.
HJR 9 - URGE CONGRESS HONOR EXXON VALDEZ JUDGMENT
2:00:27 PM
CHAIR McGUIRE announced that the next order of business would be
HOUSE JOINT RESOLUTION NO. 9, Urging the United States Congress
to honor the process and judgment of the federal courts in the
case of the Exxon Valdez disaster and to refrain from enacting
legislation that would affect the outcome of the courts'
resolution of the case.
2:00:36 PM
SUZANNE HANCOCK, Staff to Representative Gabrielle LeDoux,
Alaska State Legislature, sponsor, presented HJR 9 on behalf of
Representative LeDoux. She explained:
This resolution from the Alaska State Legislature
would urge the United States Congress to respect the
judicial process and refrain from enacting any
legislation that would alter the punitive damages
awarded to more than 32,000 plaintiffs as a result of
the 1989 Exxon Valdez oil spill, as finally determined
by the federal courts. Nearly 15 years after the
disaster and more than 10 years after the original
jury verdict, the plaintiffs are still waiting
resolution of the lawsuit. While the United States
Congress considered the Oil Pollution Act of 1990,
ExxonMobil Corporation sought an amendment that would
have substantially reduced the punitive damages that
would have been paid for the Exxon Valdez oil spill.
This resolution urges Congress only to let the courts
determine this matter.
REPRESENTATIVE GRUENBERG offered his understanding that
constitutionally, after a final judgment, there could be no
retroactive changes. He questioned whether the committee ought
to get a legal opinion in case another section should be added
to HJR 9 to address this issue.
2:03:01 PM
REPRESENTATIVE GARA replied:
[ExxonMobil Corporation] is on appeal to try and get
rid of the punitive damage verdict, get it set up for
retrial or rehearing by the court. Once the final
judgment disappears, then they feel that they'll be
free to get Congress to write the law in a way that
will prevent the fishermen from getting the same
judgment as they got the last time. ... I don't know
if what they're doing is legal or constitutional, but
that's how they address your point. They're trying to
vacate the final judgment.
2:03:56 PM
REPRESENTATIVE GARA commented that he thought the resolution
should also ask the governor to make a demand upon ExxonMobil
Corporation. He asked that this idea be relayed to
Representative LeDoux.
2:05:01 PM
JERRY McCUNE, Lobbyist for United Fishermen of Alaska;
President, Cordova District Fishermen United, testified in
support of HJR 9. He commented that the governor has already
called for all parties to settle this case. He said, "All we're
asking is for the ... courts [to] rule on this - win, lose, or
draw."
REPRESENTATIVE GARA confirmed that the governor has called on
all parties to settle the case. He explained that he thought
the governor should call on ExxonMobil Corporation to pay.
2:06:53 PM
MATTHEW D. JAMIN, Attorney at Law, Jamin, Ebell, Schmitt &
Mason, stated that he is one of the lawyers representing the
plaintiffs in the Exxon Valdez oil spill litigation. He said:
On behalf of plaintiffs' counsel, we do support the
resolution and we think it is a very sensible
resolution at this time. The suggestions thus far
have been that there might be something deliberate
that would affect the case, and certainly that's a
possibility. But we are equally concerned that there
might be something - given the attempts made in the
federal legislature to change class action
legislation, to change tort legislation, what's called
tort reform - ... that is not deliberate. And we
think that the legislators' proposed resolution brings
to everyone's attention the need to be wary as
legislation is passed on the federal side so that it
does not affect this case.
CHAIR McGUIRE, after ascertaining that no one else wished to
testify, closed public testimony on HJR 9.
2:08:13 PM
REPRESENTATIVE COGHILL moved to report HJR 9 out of committee
with individual recommendations and the accompanying zero fiscal
note. There being no objection, HJR 9 was reported from the
House Judiciary Standing Committee.
HB 150 - LICENSING RADIOLOGIC TECHNICIANS
2:08:32 PM
CHAIR McGUIRE announced that the next order of business would be
HOUSE BILL NO. 150, "An Act requiring licensure of occupations
relating to radiologic technology, radiation therapy, and
nuclear medicine technology; and providing for an effective
date." [Before the committee was CSHB 150(L&C).]
2:08:51 PM
REPRESENTATIVE GARA moved to adopt the proposed committee
substitute (CS) for HB 150, Version 24-LS0470\S, Mischel,
4/11/05, as the work draft. There being no objection, Version S
was before the committee.
2:09:26 PM
REPRESENTATIVE ANDERSON, speaking as the sponsor, relayed that
the concept embodied in HB 150 has been evolving since the
1990s. He paraphrased from the following written opening
remarks [original punctuation provided]:
House Bill 150 will establish educational and
certification standards for the health care personnel
in Alaska who perform medical imaging and radiation
procedures. Any radiology procedure is only as
effective as the person performing it.
An underexposed chest x-ray cannot reveal pneumonia or
a malignant lesion, just as an inadequate mammography
technique cannot detect breast cancer. No matter what
the procedure, the Radiologic Technologist's knowledge
of anatomy, careful application of radiation and
skillful operation of sophisticated medical equipment
are the keys to its success. To be clinically useful,
diagnostic imaging exams must be accurate.
38 states have adopted recommendations for state
licensure of radiology personnel. Alaska is not one
of those states. Establishing state standards will
ensure that Alaskans will have access to safe and high
quality radiologic care. Licensure will establish
radiation protection measures as well as education and
credentialing standards that will ensure the
competency of persons operating medical equipment
emitting radiation.
To ensure that the citizens of the State of Alaska
receive maximum protection from the harmful effects of
excessive and improper exposure to radiation,
licensure must be passed to establish standards.
2:12:28 PM
REPRESENTATIVE ANDERSON opined that HB 150 is critical for the
safety of Alaskans. Passage of HB 150 would make Alaska the
39th state to adopt legislation regarding the licensure of
radiology personnel. He noted that although there might be
arguments that personnel in rural Alaska have been performing
radiologic procedures [without any problems to date], he can
provide examples of over-radiated, under-radiated, and
misdiagnosed cases that resulted from improperly trained
personnel, generally in rural settings. The University of
Alaska has worked to make it easier to enroll in its Radiologic
Technology program, he remarked, and asked the committee to
support the bill, particularly given the changes in Version S.
2:16:07 PM
JON BITTNER, Staff to Representative Tom Anderson, Alaska State
Legislature, sponsor, relayed that members' packets include a
memorandum that outlines the changes in Version S, which now
references "department" throughout rather than "division". He
indicated that other changes include adding a new Section 1,
which amends AS 08.01.010 to include the regulation of
radiographers; removing dental hygienists from proposed AS
08.89.100(b)(2); adding schools of dentistry and dental hygiene
to proposed AS 08.89.100(b)(4); adding the word "current" - with
regard to certification - to proposed AS 08.89.140(2); adding
the words, "or have demonstrated experience sufficient in the
opinion of the department to waive the program", to proposed AS
08.89.150(a)(3); changing the words in proposed AS 08.89.170(c)
from, "three out of five years preceding application", to, "two
years preceding July 1, 2007".
2:21:00 PM
MR. BITTNER indicated that still other changes include adding
the word, "nonrenewable" - with regard to temporary permits - to
proposed AS 08.89.170(d); changing the text in proposed AS
08.89.180(d) to say, "Sponsors approved by the American Registry
of Radiologic Technologists are considered approved continuing
education providers"; changing the time frame in proposed AS
08.89.210 from, "24 months", to, "one year", and adding the
sentence, "The department may require an examination for
reinstatement"; and adding, to proposed AS 08.89.220 - which
pertains to fees - new paragraphs (8) and (9), which read:
(8) adding an area of practice to an existing
license;
(9) program approval under AS 08.89.130.
2:24:12 PM
MR. BITTNER indicated that further changes include changing
proposed AS 08.89.340(c) to read:
(c) The department may summarily suspend a license
before final hearing or during the appeals process if
the department finds that the licensee poses a clear
and immediate danger to the public welfare and safety.
A person is entitled to a hearing conducted by the
office of administrative hearings under AS 44.64.010
with seven days after the suspension order is issued.
A person may appeal an adverse decision after hearing
to the superior court.
MR. BITTNER also indicated [that proposed AS 08.89.340 no longer
contains a subsection (e), which required waiting a year after
license revocation before reapplying]; that proposed AS
08.89.990 no longer contains a definition for "division", and
now defines "radiographer" rather than "radiologic
technologist"; [that Version S no longer exempts proposed AS
08.89.340(c) from AS 44.64.030(a)(6); that the section
pertaining to regulations no longer references the division;
that Version S no longer contains revisor's instructions]; and
that conforming changes have been made to section numbers.
2:25:46 PM
REPRESENTATIVE DAHLSTROM referred to the new language in
proposed AS 08.89.210 - "The department may require an
examination for reinstatement" - and asked how it will be
determined whether a person should take the examination.
MR. BITTNER said his assumption is that the Division of
Occupational Licensing will ultimately make the determination
regarding whether an examination is warranted, and suggested
that a representative from the division could better address
that question.
2:27:30 PM
DONNA J. RUFSHOLM, R.T., Chair, Licensure Committee, Alaska
Society of Radiologic Technologists (AKSRT), relayed that the
AKSRT asked Representative Anderson to sponsor HB 150. She
explained that in 1981, Congress passed the Consumer-Patient
Radiation Health and Safety Act of 1981, which established
minimum standards for state licensure of personnel who
administer ionizing radiation. The goal of establishing those
standards was to minimize unnecessary exposure to radiation.
Since then, 41 states have adopted licensure laws, though Alaska
has yet to do so. Currently, pending legislation in Congress
would require all states to either meet or exceed federal
standards or else risk losing Medicaid and Medicare
reimbursement for imaging procedures. Thus, HB 150 is
important, she remarked, because it would establish state
standards and thereby remove the risk of losing federal
reimbursement; in lieu of having its own state standards, Alaska
would have to comply with whatever standards the federal
government imposed.
MS. RUFSHOLM then posed the question, "Why establish minimum
standards for personnel who perform medical imaging procedures?"
and responded by saying that basically, it all boils down to
quality; safety to the patient, the operator; and the cost. She
went on to say:
We all know that radiation is a carcinogen; operators
of medical x-ray equipment deliver the largest portion
of manmade radiation to the general public. Radiation
is safe if properly applied, but it can be harmful or
even deadly if it's ... [maladministered]. I think
that's [a] really important factor ..., that radiation
... has been recognized as one of the leading
carcinogens. ... Delays [of] diagnosis or misdiagnoses
caused by poor imaging exams can drive up health care
costs, [and] inaccurate ... imaging can delay
diagnoses.
Accurate diagnosis depends on a good and useful
medical image; the quality of [a] medical imaging exam
is only as good as the person performing it. Right
now ..., in Alaska, anyone can take x-rays; [even]
anyone who's sitting on the committee ... right now
could go into an office, if someone would hire them,
and take x-rays without any training. We require
hairdressers to be licensed, but ... we don't require
people delivering radiation to patients to have any
sort of licensing or educational requirements. ...
There is a report that's just out ... [by] the Medical
Payment Advisory Commission (MedPAC) - which is an
agency that advises Congress on health care policy -
regarding what they called the overuse, under use, and
misuse of imaging services. And on March 17 of 2005,
the [federal] House Ways and Means Committee's
subcommittee on health conducted a hearing to address
the MedPAC recommendations that Congress set standards
for those ... who perform or interpret diagnostic
imaging examinations. ...
[A synopsis indicates that] Medicare has an interest
in ensuring that imaging studies are done by skilled,
technical staff using appropriate equipment, and that
the "CMS" - which is Medicare - strongly should
consider setting standards for at least the following
areas: imaging equipment, qualifications of the
technicians performing the studies, the technical
quality of the images produced, and procedures for
ensuring patient safety. So this is Medicare, and
they're really going to be setting some guidelines and
standards for those individuals who perform radiology
procedures.
MS. RUFSHOLM added:
With HB 150, we have recognized the fact that the
rural areas of the state have different needs than
what the urban areas do, and I think that in writing
[HB 150] and working with the different groups around
the state, we've tried to address those needs. We
surely do not want those services to be discontinued -
that's not the intent of the bill - we know that those
services need to be there, especially in the very,
very remote areas; it's really imperative that they be
able to provide radiology services for patient care,
and our concern is that we don't want to see those
services discontinued but we would like to see the
people [who] deliver those services have some sort of
training.
And we've worked with the University of Alaska, in
Anchorage, to provide an online course for those
individuals; there are other online courses also
available on the Internet for individuals to receive a
minimum of training so that they can protect
themselves as well as the patient from unnecessary
radiation. We've kept the cost down, [and] we've made
accommodations in the bill ... so that people who are
currently taking x-rays can ... probably be tested out
- they would be looked at for competency, and would
actually forgo the program ... if they can prove
competency.
MS. RUFSHOLM concluded:
We've allowed ... a very long period of time - a four-
year period - for individuals to be able to
participate in the course if [that requirement] ...
was something that they would have meet ..., and we've
also made accommodations [such] that individuals who
are new coming into the field would be able to take x-
rays as they're taking the first module at the
[University of Alaska Anchorage (UAA)] so that they
could go to work immediately as long as they had a
mentor - someone working at the facility with them.
So we're doing our best to try to meet all those needs
and still recognizing the fact that people do need to
be educated for their own safety and the safety of the
public, which is what the whole intent of this bill
is.
2:34:55 PM
REPRESENTATIVE GARA said he's heard concerns that even if the
UAA offers a program, it will only have a certain number of
openings available, as well as concerns regarding what courses
are going to satisfy the bill's training requirements. He also
relayed that he's been told that many of the people currently
being exempted from the bill's requirements don't have any
experience in taking x-rays, and so is wondering why such people
should be exempted.
MS. RUFSHOLM first offered her belief that the UAA will make
enough courses available so that people can meet the bill's
requirements, and so meeting those requirements won't be a
problem, particularly given that if the bill passes this year,
it will be 2007 before it's enacted; also, people will have
another two years to fulfill their education requirements. And
once people fulfill their education requirements, the state will
send in their names to the American Registry of Radiologic
Technologists (ARRT), which, as a courtesy to states with
limited-scope licensure, offers an examination that individuals
can take, and passage of that examination would then qualify a
person as a "limited-scope" radiographer; additionally, online
courses [currently] available on the Internet also allow an
individual to sit for that examination.
2:39:20 PM
REPRESENTATIVE GARA relayed that he's been told by some people
that they believe the UAA might only be able to accommodate
about 20 students per year, and that it could take as many as
three semesters to complete the educational requirements
proposed by the bill.
MS. RUFSHOLM suggested that UAA staff might be better able to
address that issue. She acknowledged, however, that she, too,
has been told that the UAA might only be able to accommodate 20
people during the upcoming fall semester, but only because it is
a new program. She explained that the program will consist of
three modules, the first to be completed in a minimum of four
weeks, with the second and third modules perhaps being completed
at the same time should UAA staffing levels allow. Thus the
educational requirements could be completed in as few as eight
weeks or as many as twelve weeks. She mentioned, though, that
she is not familiar with how much time the online courses take
to complete.
2:41:23 PM
MS. RUFSHOLM, in response to the question of why certain groups
of people have been exempted from the bill, said it is because
those groups have their own boards and practice standards,
including standards related to radiology procedures. She also
mentioned that concerns offered by those practicing in rural
areas and in small clinics in urban settings regarding a
possible interruption of services for training purposes have
prompted the change in Version S that allows a person to begin
the first module of the UAA's program while he/she is working.
So as long as a person has a mentor, an employer who is willing
to oversee the person while he/she is taking x-rays, then he/she
can take module one of the program and be working at the same
time. That person would, of course, also have to continue on
with module two [and three] of the program.
REPRESENTATIVE ANDERSON mentioned that his son was x-rayed at a
clinic after a bicycle accident and was told by the person
taking the x-ray that his arm was probably broken, but further
x-rays at a hospital revealed that his arm wasn't broken. He
indicated that this experience has furthered his belief that
certification of those taking x-rays would eliminate such
misdiagnoses.
REPRESENTATIVE GARA said he supports the concept of the bill,
but some of its aspects still raise questions. For example,
should those groups of people currently being exempted from the
bill really be exempted? Is the training such people currently
get really sufficient?
2:48:41 PM
REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, said she
is concerned that the bill could create a hardship for small
businesses, particularly in rural areas. She mentioned that [as
a registered nurse], she used to work in a very small clinic in
Tok, and that both nurses and the laboratory technician working
at that clinic were trained, on the job, to use the x-ray
machine and were then monitored to ensure that safety procedures
were followed. In such settings, there is a need to have more
than one person trained in the use of the x-ray equipment, since
it wouldn't possible to have a trained technician brought in
should the person who regularly takes the x-rays be unavailable.
Another of her concerns centers on the fact that because the
machines in rural areas of the state are older models, the
educational modules may not addresses the specifics of all the
different types of machines - particularly the older, more
complex types - that are currently being used in various areas
of the state. Additionally, she opined, the cost of the
proposed educational requirements are quite prohibitive,
particularly given that many small clinics operate with limited
funds.
2:53:42 PM
REPRESENTATIVE WILSON mentioned that in Tok, the chief emergency
medical technician (EMT) also knew how to take x-rays, and this
saved clinic employees from having to come to work in the middle
of the night in emergency situations. She pointed out that many
small communities and places in rural Alaska aren't on the road
system, and opined that the bill is much needed when it comes to
the issue of radiation therapy, but questioned whether the
restrictions the bill imposes are really necessary with regard
to normal, everyday x-rays. Referring to Representative
Anderson's example regarding his son, she noted that in most
situations, the person who takes the x-ray is not the person who
reads it; the x-ray must still be sent off to be read by a
trained radiologist. So just because a person hasn't been
taught to read an x-ray and so perhaps misdiagnoses a condition
doesn't mean that the x-ray itself wasn't a good x-ray. She
said she questions whether the state really has a problem with
regard to those taking x-rays, particularly given that she has
not been shown any evidence of or been given a listing of
mishaps.
CHAIR McGUIRE said she would provide Representative Wilson with
the testimony from those that believe problems are occurring.
Noting that Representative Wilson believes that those performing
radiation therapy should be licensed, Chair McGuire asked her
whether believes that there are other types of radiation use
that ought to only be performed by licensed individuals.
REPRESENTATIVE WILSON opined that anytime one is performing a
procedure that is "all inclusive" - such as a mammogram,
magnetic resonance imaging (MRI), or computerized axial
tomography scan (CAT scan) - that person should be licensed
because the procedure is so specialized, adding that usually
such people receive special training in the use of that
equipment anyway. She surmised that such persons and procedures
are already covered and so she is not as concerned about them.
2:59:53 PM
REPRESENTATIVE GARA said he is wondering whether the bill should
perhaps focus on procedures other than x-rays. He asked whether
CAT scans and MRIs expose one to more radiation than regular x-
ray machines.
REPRESENTATIVE WILSON suggested that others could perhaps better
respond to that question.
REPRESENTATIVE GARA asked whether registered nurses, as part of
their course work, receive training in the taking of x-rays.
REPRESENTATIVE WILSON said no. She added that she is not saying
that one couldn't "give too many rads" with an x-ray machine,
though newer models make doing so difficult because they are
more sophisticated and thus much safer. She said she has a
concern regarding exempting licensed practitioners, since most
of them often don't have the expertise needed to operate x-ray
machines. Relying on the fact that licensed practitioners are
held accountable by their boards is simply offering a false
sense of security, she concluded.
3:03:32 PM
CHAIR McGUIRE characterized the distinction between the
operation of x-ray equipment and the diagnosis of x-rays as an
important one.
REPRESENTATIVE WILSON noted that even in Wrangell, all x-rays
are sent to a certified radiologist for formal diagnosis, and
the doctors only offer their belief regarding what the x-rays
truly shows. She then noted that page 2, line 16, says in part,
"(A) the direct supervision of a licensed practitioner", and
pointed out that in remote areas, a person could be under the
direct supervision of someone in another town. Referring to
page 4, line 22, she noted that the language says in part, "or
have demonstrated experience sufficient in the opinion of the
department to waive the program", and asked whether department
personnel are actually going to go to a remote site to determine
whether a person is capable of operating the equipment in
question. Referring to page 9, regarding disciplinary actions
and administrative hearings, she noted that [lines 28-29] say in
part, "within seven days after the suspension order is issued",
and pointed out that some areas of the state only get mail every
other week, and so as much as a month could pass before a
response is received by the department regarding a person's wish
to have an administrative hearing take place; therefore, the
seven-day time frame is very unfair to those residing in some
parts of the state, she opined.
3:07:47 PM
PAMELA LaBOLLE, The Mulder Company, Lobbyist for the Alaska
Society of Radiologic Technologists (AKSRT), noted that
consumers are not testifying on this bill, and opined that this
is because the public has been led to believe that anyone who
delivers healthcare to them is trained, certified, and maintains
safety for the patient utmost in his/her mind. She added,
"Won't they be surprised when they find out that the people who
are dealing with radiation, delivering doses of radiation to
these patients, have no training," particularly given that even
food service workers, beauticians, cosmetologists, barbers,
hairdressers, and truck drivers are required by the state to
have training and become licensed.
REPRESENTATIVE GARA noted that he has heard both arguments, that
x-ray equipment can be dangerous, and that x-ray equipment - as
used in a dentist's office - delivers almost no radiation.
MS. LaBOLLE remarked that that dentists, dental assistants, and
nurse practitioners have their own boards and proficiency tests.
3:11:08 PM
CLYDE E. PEARCE, Radiologic Health Specialist II, Radiologic
Health, Laboratories, Division of Public Health, Department of
Health and Social Services (DHSS), relayed that the DHSS
supports the bill and hopes that the concerns raised by "small
and rural providers" can be addressed. With regard to the
question of why people in the health care field who've been
identified as not being trained [to take x-rays] are being
exempted from the bill while other operators are not, he
acknowledged that such is of concern; for example, physician's
assistants (P.A.s) must do everything through, or report to,
their collaborative physician, and so if a P.A. is actually
taking x-rays, then his/her collaborative physician would have
good reason to be concerned, though the bill does not
specifically address that issue. He offered his understanding
that the purpose of the bill is to address situations in which
no one is trained. From the time a patient enters a facility
and the decision to take an x-ray is made and that x-ray is then
taken and read, there ought to be at least one person in that
chain of healthcare services who is trained, he opined.
CHAIR McGUIRE asked Mr. Pearce to comment regarding what levels
of radiation exposure can be expected to occur in various
situations.
MR. PEARCE relayed that one of his duties is to [measure the
radiation levels]of the various types of equipment being used
around the state, and said he does see differences. He went on
to say:
The problem is that it's not just the output
capability of the machine that we need to be concerned
about, it's how the machine is used. And I like to
use the example of a driver of an automobile: when
you look at the automobile with seatbelts, and safety
bags, and tinted windshields, and power brakes and
steering, and all of [these kinds] ... of safety
features, why is [it] that 40,000 people die every
year? It's because of how it's used. And when I do
inspections, I actually rarely find a problem with the
machine even though I find many problems with how it's
used.
I was in Fairbanks recently, and 42 percent of the
repeated films [and errors] were due to positioning.
Now that's not something you normally even cover in a
radiation safety course, but the person doing the x-
rays had no knowledge of topographic anatomy, and so
they didn't know exactly where internal structures
were and they were guessing with the positioning. ...
So there is a real concern there about excessive
exposures, due to how the equipment's used, but in
terms of procedures in general, we have the routine
films - (indisc.) abdomen, chest, skull x-ray; there's
a certain amount of radiation there, and we can think
of that as a unit of one - whatever it might be.
When you look at a [computed tomography (CT) scanner],
the exposure level can increase substantially;
however, there are some real diagnostic advantages to
a CT scanner, and also earlier treatment can be
critical in saving a patient. When you look at bone
densitometers, exposures are very low. [With regard
to] nuclear medicine, surprisingly, ... the patient
receives less exposure than a corresponding ...
medical x-ray exam. But all that aside, as far as a
comparison, it depends on how they're used.
So in the statistics that have [been] published
recently, ... one of those shows [that] about a 1
percent rate of all cancers in the U.S. are due to
diagnostic x-rays. Another one was showing a
diminished intellectual capacity as a result of the
very young being exposed to ... diagnostic levels of
radiation. Now these are ... up in the upper level of
CAT scan. However, in my experience, in certain areas
of Alaska, I have seen those levels exceeded by
ordinary radiography simply because of how the
equipment was used. And I agree with [Representative
Wilson] that the older machines do present a special
challenge; [however,] newer machines don't guarantee a
lower dose - in fact, there are concerns about the
doses getting higher. But the older machines, in my
opinion, require even better foundation in the
principles of how to use them safely. ...
3:16:33 PM
MR. PEARCE, in response to a question, explained that anytime
one uses radiation, there is risk, but the physician is trying
to strike a balance between benefit and risk. Although newer
machines, when used properly, result in lower exposure, because
they are digital and produce an x-ray that compensates
automatically for overexposure, they also have the potential to
result in higher exposure to the patient without the operator
being aware that such is occurring. In response to a further
question, he said it is not true that new x-ray machines don't
produce any more radiation than the x-ray machines used at
airports for security purposes; rather, medical x-ray equipment
deliberately exposes patients to radiation, and does so with a
much larger beam "and a lot of scatter from the patient."
Additionally, because of that "scatter", those who operate x-ray
machines have an incidence of breast cancer three times higher
[than those who do not].
MR. PEARCE, in response to a comment, said, "I do have a
concern, as a radiation inspector, [regarding] ... the fact that
[new equipment] ... may conceal the exposures and actually allow
even higher exposures to occur."
3:19:54 PM
ED HALL, P.A., Legislative Liaison, Alaska Academy of Physician
Assistants (AKAPA), indicated that many of the AKAPA's concerns
have already been addressed through Version S. He said that
although there have been accusations that there are people using
radiological equipment without any training, none of his medical
colleagues have heard of any such instances. He went on to say:
We don't just [pull] people off the street and point
them to the x-ray machine and say, "Go start shooting
x-rays." ... There's a guide book out that addresses
anatomy, we make sure that people have an
understanding of anatomy, [and] most of the clinics
that I know of [that] ... are using "techs" ... to
shoot their films are [using somebody who is] ...
either a community health aide [or] ... somebody who
has had some exposure to anatomy - big, gross anatomy.
And then there's the text that shows positioning, and,
yes, ... it is much easier nowadays to use [modern
equipment] and have the technique of a certain
exposure that one would need to use. So I would like
everybody to recognize that this is just not ...
blindly giving authority to anybody to shoot x-rays;
they do have some training.
As far as training goes, I know that particularly in
the P.A. programs that I'm aware of and several of the
medical school programs that I'm aware of, there is
not a specific course on how to shoot x-rays, but
there are courses on reading radiography, and so
indirectly sometimes you may get some knowledge about
shooting x-rays. But, yes, I think if this bill is
directed at safety, ... then you probably shouldn't
exempt any provider because ..., even though we do
have a licensing board that oversees us, it is not
within most of our training to know how to shoot x-
rays; this is all knowledge that is acquired once we
get into certain situations.
In my clinic I've got two nurses and myself who shoot
x-rays, and ... one of my nurses has been through the
training at the [Alaska] Native Medical Center [ANMC],
and she, basically, trained the other nurse and myself
as far as the appropriate techniques and positioning
and all the important things that we do to try to keep
things safe. I am happy to see the changes that
Representative Anderson and his staff have
incorporated; however, ... ultimately, I think that
this bill would be best if they could separate out
basic radiography from the other procedures such as
MRI and CT testing and things where you have to inject
- I think all of those things defiantly need to have
some certification.
MR. HALL concluded:
And lastly, in [regard] to that certification, there
has been talk about, if we have a licensing board that
we respond to or that we are accountable to, [since]
nurses ... and nurse practitioners ... all answer to
the nursing board, ... the question has to be raised
[whether they can] then be exempt because they're
under a different licensing board, and, then, can a
CNA [certified nursing assistant] - who also is a
licensee of the nursing board - ... be exempt too. So
I think the more we talk about this bill, I think
there's a lot of unanswered questions, but I think
it's heading in the right direction, personally. And
I think, professionally, around the state, ... it's
heading in the right direction, but I still think that
[there are] limitations [that's] going to make this
very costly for medicine in Alaska. And just because
42 other states do it ... is not a good ... [reason]
for us to do it if we are interested in access to
care. Thank you for your time. ...
3:25:40 PM
RONALD L. DEIS relayed that his background is one of teaching
radiologic technology at universities, and that he came to
Alaska to manage a radiology department [at an Anchorage
hospital]. Shortly after his arrival, he began receiving
requests to train those who were taking x-rays at various local
offices. Many of those requesting the training said that they
hadn't any knowledge of how to take x-rays before getting hired
at those local offices and had often ended up repeating an x-ray
five, six, or even seven times without being able to get it
right. He said that eventually he approached the University of
Alaska with the concept of teaching an introduction to
radiography course, and has since been teaching that course for
the last 18 years; additionally, he has been teaching a
[similar] course at the ANMC, for the last 9 years, to P.A.s,
nurse practitioners, and community health aides.
MR. DEIS said that in spite of these efforts, he still runs
across those who've been hired to work in an office or clinic
and have been told that their duties include taking x-rays
regardless of the fact that they hadn't any training. Again,
such people often end up repeating x-rays multiple times in an
attempt to get an adequate x-ray. He said that as a person who
is very familiar with the radiology procedures currently
practiced in the state, he thinks that the state needs to know
who is administering ionizing radiation and institute minimum
educational and clinical standards.
3:28:52 PM
BARBARA HUFF TUCKNESS, Director, Governmental and Legislative
Affairs, Teamsters Local 959, relayed that her organization
supports both HB 150 and its members who work in the industry,
for example, those who work at South Peninsula Hospital, which
does require certification of its radiological technologists,
and Providence Kodiak Island Medical Center, adding that she was
quite surprised to find out a couple of years ago that such
certification was not already a state requirement. She pointed
out that not only are the state's certified nursing assistants
and phlebotomists required to be certified - regardless of
whether they are in rural or urban settings - but so are the
state's truck drivers.
MS. HUFF TUCKNESS surmised that a lot of people believe that the
[bill pertains to] just x-rays and mammograms, and noted that
since she has become aware of the fact that the state does not
require certification of those using radiologic equipment, she
has begun asking those who are performing those services for her
whether they are certified. She added:
I do not believe that the public, in general, realizes
the degree and the type of work that these individuals
are performing. And ... while we supported the
original version of the bill, I think that there have
been some somewhat reasonable compromises - there are
probably some areas that I would say we've probably
gone a little bit too far the other direction - but
having something on the books and moving in the right
direction I think, both from an employee perspective
working in the industry as well as a public health
safety issue, I would encouraged the committee to move
the bill forward.
3:33:52 PM
B.J. ANDERSON, Anchorage Neighborhood Health Center (ANHC),
first relayed that she is the ANHC's x-ray manager, and then
referred to the provision in the bill addressing temporary
permits, and said that they [at the ANHC] have been led to
believe that a person who wants to begin training [and] get a
limited license only needs be enrolled in a program. However,
she pointed out, proposed AS 08.89.170(a)(1) and (2) say that a
person must have first completed the program and taken an
examination. Therefore, she opined, the wording in the bill
should be changed to reflect that once a person is enrolled in a
training program and has a mentor, then the person can begin
working under a temporary permit.
MS. ANDERSON then pointed out that using mammography as an
example of the type of x-ray that [this bill would address] is
inappropriate because mammography technicians in Alaska are
already certified by the ARRT, are already working under the
umbrella of the Food and Drug Administration's (FDA's)
Mammography Quality Standards Act of 1992 (MQSA) program, and
are required to have American College of Radiology (ACR)
certification. She went on to say:
Any clinician or clinic has a huge liability providing
healthcare services, and ... they have taken that
seriously by using a mentoring approach to teach staff
how to safely perform radiologic procedures. And so I
think ... this is one of the reasons why this is a
very difficult bill in that we're requiring
certification but we're forgetting that in the rural
areas they are drawing people from the community and
teaching them, on the job training, how to perform x-
ray radiologic examinations.
And ... I would say for the most part, most clinicians
and clinics are very conscientious about that.
Perhaps ... I can't speak for everyone, but I think
that if this bill goes through, it definitely needs to
make allowances for that mentoring-type of approach to
continue, as well as the professional training that we
could get through [the] UAA. I don't believe that
this bill is ready to progress until some of these
changes have been implemented.
REPRESENTATIVE GARA asked how many hours of on-the-job training
are given to a person before he/she can operate an x-ray
machine.
MS. ANDERSON said that is hard to estimate, given that when a
person is hired, he/she may have had previous training and the
training specific to that facility's radiologic equipment may
not occur all at once. However, if she were to be training
someone from the ground up, she relayed, she would be looking to
enroll that person in the type of program that the UAA is
proposing to provide.
3:40:19 PM
SUSAN MASON-BOUTERSE, Executive Director, Sunshine Community
Health Center, provided written testimony, which was paraphrased
by Beth Little-Terry; Ms. Mason-Bourterse's written testimony
read [original punctuation provided; contains some formatting
changes]:
My name is Susan Mason-Bouterse, and I am testifying
in opposition to HB 150. I am the Executive Director
of Sunshine Community Health Center, located in
Talkeetna. We are a federally qualified health
center, serving the upper Susitna Valley. We serve a
population of about 6,000 people, including a
significant number of visitors to our state with the
tourism activities in this area. We are located 75
miles from the nearest hospital in Palmer. After
hours care is a significant part of our practice.
Our provider staff includes one family practice
physician, 3 physician assistants, and 2 nurse
practitioners. We offer digital radiology at our
center and have a contract with AK Imaging Associates
to provide our radiology reads, which we are able to
do through tele-radiology. We are able to obtain stat
reads; our normal turn-around time is 48 hours.
In the past year, we performed a total of 52 X-Rays,
the majority of which were of extremities. We also
perform a number of chest X-Rays. Our X-Rays are
performed by either our providers or our medical
assistants. We do NOT require our MA's to be licensed
radiology technicians. We DO provide thorough, hands
on training for our MA's, including the areas of
patient and practitioner safety, positioning,
equipment operation and maintenance. And none of our
MA's perform X-Rays without the provider being assured
they are competent and fully qualified.
I do not oppose this bill in its proposed purpose,
which is to ensure quality of care for patients.
However, I do not believe that simply requiring
licensure will ensure that purpose is achieved. And
the very likely impact of this bill is reduced access
to care for people in rural parts of Alaska and for
people who are already challenged in accessing health
care, those without insurance. In a rural health
center such as ours, we often are the first point of
contact for individuals seeking health care. Being
able to offer radiology services provides the
following:
Opportunity to catch severe and life-threatening
diagnoses early
Ensuring that uninsured patients will be follow
through with specialty care, such as orthopedic
referrals (we provide the referring X-Ray and are able
to offer it at discounted fee)
Reduced costly emergency transports and admissions to
ER
MS. MASON-BOUTERSE'S written testimony continued:
I would like to give you a couple of real life
examples of how our ability to offer radiology
provides immense benefits to our patients: (these are
scenarios - you will need to ad lib a bit)
Chest X-Ray revealed lung carcinoma in an elderly
gentleman in our community. He was not willing to see
a specialist or pursue any type of referral for
treatment. The diagnosis of the cancer is allowing
our staff to explore options with him and is allowing
him and his family to prepare for the difficult and
challenging times ahead.
A woman called our after hours services. She had
fallen and needed X-Rays. Unfortunately, our X-Ray
was down at that time and she did not follow up and go
to the hospital for X-Ray. She also didn't come back
when we called her the following week to have her come
in for X-Rays once our equipment was functional. She
called 3 weeks later, complaining of pain and was X-
rayed at that time. Unfortunately, her treatment
course by that time was much more complex and painful
due to her delay in seeking care - the bones were
fractured and had begun to heal unaligned - had to be
re-broken and re-set, with resultant poorer outcome
than should have been.
This bill, though intended to improve quality of care
and ensure safety, actually could severely curtail
access to care. It could very likely have the effect
of making radiology the sole domain for a privileged
few, mostly urban sites. With the ever-increasing
costs of health care, I would prefer to see
legislation that reduces barriers to care rather than
increasing them. If ensuring quality is truly the
goal of this proposed legislation, then requiring
continuing education and periodic proficiency testing
of non-licensed personnel seems a much more effective
way to ensure quality and safety without reducing
access to care.
Thank you for your consideration of this testimony.
3:45:27 PM
LORREN J. WEAVER, M.D., Medical Director, Camai Community Health
Center, said he is testifying in opposition to HB 150 on behalf
of the Bristol Bay Borough, which is the owner of the Camai
Community Health Center. He said:
I believe having licensed radiological technologists
at our clinic will not significantly increase safety,
raise the standard of care, or improve security of
diagnosis in our setting. I understand that bad
things happen and that people can be damaged by people
that do things wrong. We have always trained our
people; I think it always has been incumbent upon the
primary care providers to oversee the quality of the
films that are read - radiologists read them - as well
as [offer] oversight. Even though [Mr. Pearce] says
that there are people that are getting radiated, I'm
sure that may be happening, but I think passing a bill
does not change that necessarily.
For example, a chest x-ray is touted to have the
radiation equivalent to one day's sunlight. ... In a
limited scope clinic, I don't believe that the amount
of radiation, even though there may have to be a few
repeats, is carcinogenic; I don't think that there's
any evidence presented that extremity films and skull
films and spine [films] produce enough radiation for
carcinogenic [results]. ... I don't think anyone
argues against the fact that CT, MRI, mammography,
arteriography, and ... multiple ... other radiation
therapy [modes] all should be heavily governed and do
have risk, [but] I believe that [with regard to]
simple scope procedures done in rural areas, the
benefits far outweigh the risks and the costs [the
procedures] may actually obstruct.
We're [home to] the largest wild salmon fishery in the
world ..., and we see a lot of trauma. ... And in
fact, our population may grow from ... 1,200 to well
over 10,000 in the summertime. ... Most Alaskans know
that [the] fishing industry is dangerous and has a lot
of injuries. [I've] heard a certain amount of
anecdotal stories where people's lives have been saved
by radiology, and I can voice that this is true - I
can give you any number of cases where that happened.
For example, someone with a pneumothorax, which means
a ruptured lung, if that diagnosis is not made here
and a chest tube [inserted] ..., the person will die
before (indisc.) we're approximately 289 air miles
from anchorage, which is a tertiary care [facility].
DR. WEAVER continued:
So stabilization and radiology go hand in hand for
trauma cases, and I think it's important that we
maintain that. I think that having radiologic
technologists will not improve that situations and, in
fact, we have tried to recruit registered
technologists out here and we usually get the guffaw:
"You mean go to rural Alaska? I don't think so." So
... we need to face the reality here and do the best
we can. Obviously patients need to be safe, [but] I
don't think giving the [American Radiologic
Technologists] the responsibility for how we do x-rays
in rural Alaska is helpful. No one's arguing against
[certification for] more complex procedures.
I think that the other thing that would happen is, ...
if we're not able to use in-house people to do the
radiology, it will cost us approximately twice the
amount of money it would cost to operate; this would
probably mean that we would have to cut back our
services. We are ... currently at ... 24/7/365 day
operations, ... [and] we have no other hospital
facility nearby; ... we're barely able to keep our
doors open with the amount of technology that we have.
We are a community health center which is funded
through the same federal grants that the [Sunshine
Community Health Center] in Talkeetna is. We have to
think about the cost to patients. If patients have to
go to Anchorage ... [facilities] for simple x-ray
procedures, this will cost in the hundreds of
thousands of dollars for them; that doesn't mean that
they can't be safe with what we do here, but passing
the bill will not improve that percentage.
3:51:47 PM
KAREN FAGERSTROM, Director, Village Health Services, Community
Health Services Division, Norton Sound Health Corporation
(NSHC), relayed that she is trained as an advanced family nurse
practitioner, and that she is in opposition of HB 150 as
currently written. She went on to say:
We are currently in the process of introducing
radiology equipment in our area. We have one machine
that is currently in use and we have three more that
we'll be bringing on line in the next several years.
Anytime new technology is introduced, obviously
training has to take place so that the equipment can
be operated safely for the patient and the operator.
Currently we have a P.A. who's been doing x-rays over
a number of years, and he's the one that's been
operating the machine. We now have a [person
associated with Community Health Aide Practitioners
(CHAP)] who is learning to ... take x-rays; we sent
her to the class offered by [Mr. Deis] along with
another "midlevel" ..., and now they're back in
Unalakleet working [under] the tutelage of the other
P.A. and learning how to take x-rays.
In the villages, number one, as far as the Bush goes,
we're basically going to be doing simple films. The
idea of mammography, that only takes place in Nome,
and there is a licensed, registered technician who
simply does mammography. As far as radiation
treatment, MRI, CT, none of that even exists for Nome,
let alone is it ever going to exist in a village.
Potentially we're looking at [having] a CT,
eventually, here in Nome, and that person, who would
come in ... [and] operate that [would] have licensure
and everything needed.
I'm speaking ... to the portion of this bill
[pertaining] ... to the people who would take limited
radiology. What we did, in order to get this person
on line, was started looking [at] writing policies and
procedures, and ... [limit] their scope of practice
... as it ... would be in the bill; ... they would
only take radiology of the chest, abdomen, and axial-
appendicular skeleton, and that's basically what [we]
would have them do out in this area - we're not
looking to have them do any more than that [aside
from] also learning how to operate the new digital
equipment.
I went online trying to find information about the
classes taught at [the] UAA, and I cannot locate any
information to be able to download exactly what's
included in that class except [to find out that] ...
the first credit hours [consist of] anatomy and
physiology, [and that] the second portion of the ...
classes that can be taken - section two and three -
can be taken concurrently. ... I've requested
information, [but] I've not received any, and I have
great hesitation about being approved for that class,
[given that we] can't even find out exactly what's
being taught in it.
MS. FAGERSTROM continued:
One of the things, also, that would make it a great
hardship, is [that] in this bill, in [proposed AS
08.89.160], it says, for the limited person, that they
have to have a certain amount of clinical instruction
..., [which is defined as] hands-on experience in a
health care setting, under the direct supervision of a
practitioner or fully licensed radiological
technologist. I have a problem with that because ...
there would obviously be a certain number of hours
that we would need to be able to train that person in
Nome, but also we have a limited number of x-ray
procedures [that] are going to take place.
... How long is that person going ... to have to [be]
out of their villages, here in Nome getting x-rays?
... Is there a place that we can send it to the ANMC?
What, creatively, can we do to get that person in
[and] get the training that they need to safely do the
procedures but not be out of their village for X
number of weeks to months while obtaining that,
because [the] CHAPs are the direct care providers. So
I agree with the idea that there has to be training,
but how can we make it more Bush friendly to get that
training without making it [an] extreme hardship on
the people who are here in the Bush.
Also, with the [continuing medical education (CME)
requirements], how does that relate ... specifically
for the CHAPs when they're doing a limited amount of
CME? Is that CME going to [be] written for them as
applicable to their practice? That's one of the
questions I have that's not really addressed here. ...
So ... while I agree with the area of needing the
training, there's a number of specific issues ...
[that have] not been adequately addressed for the Bush
and [would] potentially make [it] a real hardship for
us [to] try to meet this bill as it stands.
CHAIR McGUIRE asked Ms. Fagerstrom to provide the committee with
any specific suggestions she has for improving the bill with
regard to its educational and mentoring provisions, suggestions
other than to simply exempt all those in rural settings.
MS. FAGERSTROM relayed that she would pass on Chair McGuire's
request to the CHAP directors at their next meeting.
CHAIR McGUIRE said she will suggest to the sponsor that he work
with [CHAP and NSHC] on an individualized basis.
4:00:35 PM
LOUISE REED, Diagnostic Imaging Director, Yukon-Kuskokwim Health
Corporation (YKHC), relayed that the aspects [of HB 150] that
the YKHC is most interested in are the training provisions. She
said she understands the concerns expressed by those in Bush
communities regarding being able to acquire the training
required to do the jobs they've been assigned. She mentioned
that the YKHC has four outlying clinics that provide x-ray
services, and that the YKHC set up its own [training] program a
few years back when it started to set up x-ray equipment in
places like Emmonak, Saint Marys, Aniak, and Toksook. The goal
of that training program was to ensure that those taking x-rays
would have the training to do a good job and not over-radiate
the patients; the students in that program came in from their
village clinics to the hospital in Bethel, and the trainers
subsequently kept in daily contact with them as they were taking
x-rays.
MS. REED referred to a book titled, Radiography Essentials for
Limited Practice, and characterized it as an invaluable tool,
which anyone can order and then take the exams that come with
the book in order to obtain CME credit, adding that this is the
same book that is being used in the UAA class. Additionally,
the UAA has just started a limited radiography program using the
YKHC's hospital and students from the YKHC's outlying clinics as
a beta test station for the rest of the state. The program,
which started in January, is delivered through "distance
education" and so students are able to meet once a week and then
proceed at their own pace.
MS. REED relayed that the YKHC has great hopes that this program
will set the standard for the rest of the state, adding that the
YKHC is very interested in seeing the bill pass; considers it to
be doable; believes that training, particularly with regard to
safety and radiobiology, is much needed; and is concerned both
about its patients and the levels of radiation they are exposed
to, and about staff's ability to take x-rays that lead to
accurate diagnoses. She concluded by saying that the YKHC's
concern is that its employees have the training they need to do
the job that's expected of them, and feels that it is in a good
position to help get a statewide program instituted.
4:06:28 PM
CHRIS DEVLIN, Executive Director, Eastern Aleutian Tribes, Inc.,
testified in opposition to HB 150, opining that the bill will
negatively impact access to [health] care in rural Alaska and
increase the cost of that care without guaranteeing safety. He
noted that his organization has nine clinics, four of which have
x-ray [equipment], out in the Aleutian Islands, and that x-rays
are an essential diagnostic tool in the treatment of injuries
resulting from accidents in the area's fishing industry.
MR. DEVLIN said his organization ensures that its employees get
some training in the use of x-ray equipment, and so to have to
go through another state regulatory process and licensing will
only increase costs and perhaps result in no x-rays being given
because the current in-house training will no longer be
considered sufficient. Without providing for either a rural
exception or a "remote safety-net exception," the bill, which he
characterized as premature, probably won't work for rural
Alaska, he remarked, reiterating his belief that the bill will
have a negative impact in terms of access to health care.
4:08:01 PM
CHERYL KILGORE, Executive Director, Interior Community Health
Center (ICHC), relayed that she and Tammy Wilkerson, Clinic
Nurse Manager for the ICHC, believe in the importance of quality
of care and the safety of all those who are involved with
radiology. She said that one of the ICHC's concerns is that the
bill could potentially create barriers to healthcare access, and
therefore the ICHC's hope is that the originators of the bill
will take into account certain aspects of the bill, one of those
being that currently the testing provision is lacking in detail.
She elaborated:
If it's equivalent to a radiology/radiologic tech
program, then it isn't appropriate for somebody that
has a limited scope. I don't think it is. However,
... it's clear in the testimony so far today that
there is some concern about the capacity of our
existing system, whether it's [the] UAA or other
online courses, to provide access to the number of
students that might potentially need to have access to
... the online courses or get the minimal education
that's required. That should be addressed.
It may be that the course itself can be changed,
although if it's dependent upon [the] UAA getting a
certain amount of funding in order to meet the
requirements of the students, I can tell you what our
experience thus far - although we're moving in the
right direction - has been with nursing, and that is
[that] there are huge amounts of demand and very
limited slots, the competition is fierce, and the
funding will never be there - [funding] that is
required in order to get all the students that want to
get through, done.
So I'd like there [to be] some consideration there, in
this bill, to look at that further, because even if
you have the best case scenario, where you had 20
students going to [the] UAA every 12 weeks - which I
think everyone would agree would be very aggressive -
we probably couldn't meet the demand. And, again,
since we don't want to create insurmountable barriers
to care, that area needs to be looked at.
MS. KILGORE continued:
The work experience requirement, i.e., three years,
may be too rigorous as well, and when we look at,
really, what our workforce issues in this state are in
terms of recruiting healthcare professionals -
including radiology techs - we ... don't want to make
something worse than it currently is, which is,
frankly, in my opinion, already a fairly grim
situation. We need to provide, and I'd like the bill
to consider the bill providing, funding - and ... this
is really a legislative issue - funding for training
for these limited radiology imagers, which I think is
a good conceptual model and might very well be the fix
to remote, rural areas that have difficulty.
And frankly, even in Fairbanks, which we'd consider an
urban area, we have difficulty attracting the
radiologists and the radiology techs. In fact, that's
why we have this collaboration going on, locally,
where we have a school for radiology techs, and even
then the demand exceeds the capacity of the system to
get them through. We're pleased that the bill
recognizes the need for limited radiology imagers, and
we'd like to see, perhaps, in the bill itself, some
"tiering" of activities to accommodate these issues of
education and experience.
For example, if you're a level one, that's the basic;
... you're scope is very limited. And then as you
move up [to] level two, level three, you might have
... a broader scope, and be working towards ...
potentially getting up to where you might even go to
radiology tech school. That might be a way to deal
with some of these issues that are definitely going to
affect those of us that provide care in remote and
rural areas. And we thank you very much for your
consideration of that approach.
The other thing I'd like to just say ... [is, from the
perspective of] being involved in healthcare in both a
rural and urban area for quite a long time, even in
the best of situations with the best of technology and
the most skilled people, radiology imaging is not an
exact science. And we all know that. And that's
where having qualified people is part of it, but also
having a quality assurance program. And even with
that in place, you can have films that don't detect
things. So really we are partners in the delivery of
healthcare.
And we had a situation where we had a film of a hip
taken in the emergency room with the radiologist, and
the interpretation of the film - even with a good film
- was accurate, but it was limited in that you
couldn't visualize the hip fracture on the film. And
that's where, working as a team, you really provide
the very best, state-of-the-art care. And I'd really
like to see more focus ... on CME and relationships
between different healthcare providers and boards,
because it would really improve care in the long term
for Alaskans in this state.
MS. KILGORE concluded:
The other piece that I just would like to put out
there for your consideration is looking at potentially
focusing ... on providing funding for continuing
medical education, in this regard, to those
professions that don't have this as part of their
[usual] background training. And also, if you look at
this as a system of care, and you're looking at
providing these limited radiology imagers as part of
the system, then you would want to feed that film,
from wherever it's being taken, through the system -
ideally digitally, but you could still manually send
films, because we know there's a wide variety of
equipment out in the state of Alaska - into a
radiologist, and get a radiologist to interpret it in
its finality. So thank you so much; we appreciate
your consideration of our comments, and are very glad
that you're looking at providing quality of service
and safety.
4:16:24 PM
TIMO SAARINEN relayed that he is a registered x-ray technologist
and CAT scan technologist and is registered in nuclear medicine,
and noted that he started his radiological career in the
military, via a limited license, and so understands about
maintaining standards and fulfilling limited licensure
requirements. He said he supports HB 150 because it sets
minimal standards for safe, quality, diagnostic practices,
adding that he believes all Alaskans deserve the same standard
of healthcare. Additionally he noted that in the DHSS's
recently released eleventh edition of its report on carcinogens,
it listed x-rays as a known carcinogen. Patient safety is the
main concern, and so a minimal standard ought to be provided
for. He relayed that if it were left up to him, only fully
registered x-ray technologists would be taking x-rays, though
such could be a major problem in rural areas; therefore, he
concluded, HB 150 is very good bill that sets minimal standard
requirements.
CHAIR McGUIRE, after ascertaining that no one else wished to
testify, closed public testimony on HB 150 [Version S], and
relayed that the bill would be held over.
ADJOURNMENT
4:18:25 PM
There being no further business before the committee, the House
Judiciary Standing Committee meeting was adjourned at 4:18 p.m.
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