02/22/2008 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HJR34 | |
| SB196 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 316 | TELECONFERENCED | |
| + | SB 196 | TELECONFERENCED | |
| *+ | HJR 34 | TELECONFERENCED | |
| *+ | HB 355 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE JUDICIARY STANDING COMMITTEE
February 22, 2008
1:05 p.m.
MEMBERS PRESENT
Representative Jay Ramras, Chair
Representative John Coghill
Representative Bob Lynn
Representative Ralph Samuels
Representative Max Gruenberg
Representative Lindsey Holmes
MEMBERS ABSENT
Representative Nancy Dahlstrom, Vice Chair
COMMITTEE CALENDAR
HOUSE JOINT RESOLUTION NO. 34
Urging the United States Congress to reauthorize the Debbie
Smith DNA backlog grant program.
- MOVED HJR 34 OUT OF COMMITTEE
CS FOR SENATE BILL NO. 196(FIN) am
"An Act relating to establishing a controlled substance
prescription database."
- HEARD AND HELD
HOUSE BILL NO. 316
"An Act relating to establishing a controlled substance
prescription database."
- SCHEDULED BUT NOT HEARD
HOUSE BILL NO. 355
"An Act requiring the disclosure of the identity of certain
persons, groups, and nongroup entities that expend money in
support of or in opposition to ballot initiatives and the
aggregate amounts of significant contributions or expenditures
made by those persons, groups, and nongroup entities."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HJR 34
SHORT TITLE: FEDERAL FUNDING FOR DNA TESTING
SPONSOR(S): REPRESENTATIVE(S) ROSES
02/13/08 (H) READ THE FIRST TIME - REFERRALS
02/13/08 (H) JUD
02/22/08 (H) JUD AT 1:00 PM CAPITOL 120
BILL: SB 196
SHORT TITLE: PRESCRIPTION DATABASE
SPONSOR(S): SENATOR(S) GREEN
01/16/08 (S) PREFILE RELEASED 1/4/08
01/16/08 (S) READ THE FIRST TIME - REFERRALS
01/16/08 (S) L&C, FIN
01/29/08 (S) L&C AT 1:30 PM BELTZ 211
01/29/08 (S) Heard & Held
01/29/08 (S) MINUTE(L&C)
02/05/08 (S) L&C AT 1:30 PM BELTZ 211
02/05/08 (S) Moved CSSB 196(L&C) Out of Committee
02/05/08 (S) MINUTE(L&C)
02/06/08 (S) L&C RPT CS 4DP 1NR SAME TITLE
02/06/08 (S) LETTER OF INTENT WITH L&C REPORT
02/06/08 (S) DP: ELLIS, DAVIS, HOFFMAN, STEVENS
02/06/08 (S) NR: BUNDE
02/14/08 (S) FIN AT 9:00 AM SENATE FINANCE 532
02/14/08 (S) Moved CSSB 196(FIN) Out of Committee
02/14/08 (S) MINUTE(FIN)
02/15/08 (S) FIN RPT CS 3DP 2NR SAME TITLE
02/15/08 (S) L&C LETTER OF INTENT WITH FIN REPORT
02/15/08 (S) DP: HOFFMAN, STEDMAN, THOMAS
02/15/08 (S) NR: ELTON, OLSON
02/19/08 (S) TRANSMITTED TO (H)
02/19/08 (S) VERSION: CSSB 196(FIN) AM
02/20/08 (H) READ THE FIRST TIME - REFERRALS
02/20/08 (H) JUD, FIN
02/22/08 (H) JUD AT 1:00 PM CAPITOL 120
WITNESS REGISTER
CRYSTAL KOENEMAN, Staff
to Representative Bob Roses
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HJR 34 on behalf of the sponsor,
Representative Roses.
GINGER BLAISDELL, Staff
to Senator Lyda Green
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 196 on behalf of the sponsor,
Senator Green.
BRIAN HOWES, Investigator III
Division of Corporations, Business, and Professional Licensing
Anchorage Office
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the discussion of
SB 196.
GREG POLSTON, M.D.
Anesthesiology; Pain Management
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 196.
ALEX MALTER, M.D.
Medicaid Medical Director
Division of Health Care Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified on SB 196.
JULIE WOODWORTH
Homer Chamber of Commerce
Homer, Alaska
POSITION STATEMENT: Testified in support of SB 196.
JANET MULLEN, Home Health Nurse
South Peninsula Hospital
Homer, Alaska.
POSITION STATEMENT: Testified in support of SB 196.
LINDA BAREFOOT, Regional Director
State Government Affairs
Purdue Pharmaceutical Company ("Purdue Pharma")
Stamford, Connecticut
POSITION STATEMENT: Testified in support of SB 196
ACTION NARRATIVE
CHAIR JAY RAMRAS called the House Judiciary Standing Committee
meeting to order at 1:05:51 PM. Representatives Coghill,
Samuels, Lynn, Gruenberg, and Ramras were present at the call to
order. Representative Holmes arrived as the meeting was in
progress.
HJR 34 - FEDERAL FUNDING FOR DNA TESTING
1:06:31 PM
CHAIR RAMRAS announced that the first order of business would be
HOUSE JOINT RESOLUTION NO. 34, Urging the United States Congress
to reauthorize the Debbie Smith DNA backlog grant program.
1:06:51 PM
CRYSTAL KOENEMAN, Staff to Representative Bob Roses, Alaska
State Legislature, stated on behalf of the sponsor,
Representative Roses, that HJR 34 urges Congress to reauthorize
the federally funded Debbie Smith DNA backlog grant program
until FY 2014. This program ensures that the deoxyribonucleic
acid (DNA) kits used to convict the guilty and free the innocent
are processed. In 2004, Congress passed the grant program with
a sunset date of FY 2009. In Alaska, a backlog of 400 cases
exists. She explained the packet information that outlines
expenditures in Alaska.
1:08:37 PM
REPRESENTATIVE COGHILL inquired as to where Congress now stands
with regard to the reauthorization process.
MS. KOENEMAN related that Congresswoman Carolyn Maloney from New
York has introduced a bill to reauthorize the program.
1:09:41 PM
REPRESENTATIVE SAMUELS moved to report HJR 34 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HJR 34 was reported from the
House Judiciary Standing Committee.
SB 196 - PRESCRIPTION DATABASE
[Contains brief mention of HB 316, the House companion bill.]
1:10:48 PM
CHAIR RAMRAS announced that the final order of business would be
CS FOR SENATE BILL NO. 196(FIN) am, "An Act relating to
establishing a controlled substance prescription database."
CHAIR RAMRAS noted that he sponsored a companion bill, HB 316,
which is substantially similar to this version, with the
exception of an amendment which he intends to offer. He
explained that he has worked closely with Senator Green and her
staff on establishing a controlled substance prescription
database. He stated that he has attended annual conferences at
the Loussac Library, for the statewide Meth Watch program
consisting of two members from Fairbanks, Alaska, Juneau,
Alaska, the Matanuska-Susitna Borough, Anchorage, Alaska, and
Kenai, Alaska. This year a member from the U.S. Drug
Enforcement Administration (DEA) participated from Washington
D.C.
1:14:45 PM
GINGER BLAISDELL, Staff to Senator Lyda Green, Alaska State
Legislature, stated on behalf of the sponsor, Senator Green,
that she asked pharmacists to identify any concerns regarding SB
196 prior to presenting the bill to 175 pharmacists. She
indicated that the medical community and the Alaska Pharmacists
Association (APA) brought this need to the attention of Senator
Green. Ms. Blaisdell described the legislation as a compilation
of existing statutes from forty other states. Many in the
medical community who prescribe or dispense prescriptions and
the Department of Public Safety (DPS) support the bill. She
offered that feedback from her presentation included requests to
more clearly define terms in the bill. She stated one
suggestion was to change the term "inpatient" to someone who
administers medications since dentists and other professionals
administer drugs to patients who do not spend the night in their
facilities. She characterized the support from the pharmacists
as very positive.
MS. BLAISDELL referred to the PowerPoint presentation of the
Prescription Drug Monitoring Program and Database contained in
SB 196 and HB 316. All states have laws and regulations that
govern the distribution and handling of controlled substances.
Diversion of controlled substances and other pharmaceuticals is
generally recognized as a serious problem throughout the United
States, she stated.
MS. BLAISDELL, in response to Representative Samuels, explained
that the bill does not change any existing requirement.
Controlled substances are generally recognized as a serious
problem throughout the United States. She offered that 53
prescription drug deaths were documented in Alaska in 2000. By
2003, 102 deaths were recorded, which demonstrates the rise in
deaths. Homicides, thefts, muggings, and other problems have
increased due to prescription drug abuse. States have found
that Prescription Drug Monitoring Programs (PDMPs) are one of
the most effective tools for curbing prescription drug abuse.
Diversion is taking a legal prescriptive substance and altering
it to provide a different effect or selling it to someone other
than the person to whom it was intended. The street rate for
oxycodone hyrdrochloride (OxyContin) is about $1 per milligram,
with one pill yielding $80. She opined that in Bethel, Alaska,
a single tablet sells for about $250.
1:22:43 PM
MS. BLAISDELL, in response to Representative Samuels, explained
the levels of drugs. She noted that schedule I drugs generally
include illicit drugs or illegal drugs such as OxyContin and
codeine, schedule II drugs include pain relievers, schedule III
drugs include drugs such as Ritalin and stimulants, and lastly
schedule V drugs would include low-dose narcotics such as cough
syrup containing codeine.
MS. BLAISDELL offered that it takes a pharmacist about two
minutes to download the information from the PDMP database.
From a national standpoint, there is a new news article every
week. She described national ads produced for the $30 million
U.S. drug awareness campaign. She stressed the importance of
education.
MS. BLAISDELL stated that the national perception is that use of
prescription drugs is safer than use of illicit drugs.
Prescription and over-the-counter medications are fast becoming
the new "party" drugs for many teenagers and adults. Twenty-
five to forty percent of MySpace users include postings on how
to get prescription medication on the Internet, she opined.
MS. BLAISDELL revealed that the most commonly abused medications
include pain killers, stimulants, sedatives, tranquilizers, and
over-the-counter drugs, which are not considered controlled
substances. She explained that 12-13 year olds' first drug of
choice is a painkiller. She opined that painkillers are within
one percent of surpassing marijuana use. She described
prescription abuse to include children, who sometimes obtain
prescription drugs from the elderly. Some elderly individuals
keep half and sell half of their prescription use in order to
pay fuel bills and other living expenses. Nearly seventy
percent of prescription drugs are obtained for free from friends
and family. Pain killers are the number one abused drug because
of the feeling of euphoria and their high resale value.
MS. BLAISDELL explained that the Department of Commerce,
Community, & Economic Development (DCCED) currently
investigates, but must use paper. Data entry from
investigations can take months and the only clues investigators
generally receive are from external complaints. Complaints are
not prevalent since other pharmacies don't see prescriptions
filled by other pharmacies, she opined.
1:29:29 PM
MS. BLAISDELL stated that state and local law enforcement
personnel have experienced increases in criminal activity. With
legislation in place the state will be eligible for federal
funding. Under SB 196, the Board of Pharmacy would establish a
controlled substance prescription database administered by the
Board of Pharmacy and provide the board with the necessary staff
to implement the program. The database would contain data for
every prescription for federally controlled substances contained
in schedule I, II, III, IV, or V under state and federal law.
Schedule I drugs are considered most harmful for the user. She
noted that schedule I drugs generally include illicit drugs or
illegal drugs such as OxyContin and codeine, schedule II drugs
include pain relievers, schedule III drugs include drugs such as
Ritalin and stimulants, and lastly schedule V drugs would
include low-dose narcotics such as cough syrup containing
codeine. The prescription monitoring database is for use by
licensed practitioners when considering or dispensing
prescriptions for a current patient in their office, by licensed
or registered dispenser when dispensing drugs, and by law
enforcement officers pursuant to a search warrant.
1:31:26 PM
REPRESENTATIVE HOLMES asked what constitutes an inquiry.
MS. BLAISDELL said obtaining a license renewal would not
constitute an inquiry. Rather, an inquiry means someone
suspects that a person is doing something out of the norm. She
said that she did not have a specific definition for the term,
"inquiry".
MS. BLAISDELL returning to her PowerPoint presentation said that
data can be used by the personnel of the Board of Pharmacy
regarding licensing inquiries and for database management. Data
can be requested through the board by law enforcement entities
with a subpoena or court ordered warrant. Law enforcement
personnel will not have direct access to the database to
randomly review names.
1:33:51 PM
MS. BLAISDELL said that data can be used to improve health care
for patients. The data can be used to identify prescribing and
dispensing practices and can identify individuals who show a
pattern of inappropriate use. The information is confidential.
The Health Insurance Portability and Accountability Act (HIPAA)
provides an exemption for states with Prescription Drug
Monitoring Programs. The bill contains many security
provisions. She pointed out that intentional disclosure of
information or access to the database would be a class A
misdemeanor, while someone who intentionally obtains access or
alters or destroys information in the database would be subject
to a class C felony.
MS. BLAISDELL reviewed the fiscal note and stated that the DCCED
has already received some federal funding, but that
approximately $400,000 in additional federal funds is available
to states that adopt legislation for prescription drug
monitoring programs. The typical startup costs cover computer
hardware and public education. She noted that ongoing costs are
significantly less than the initial startup costs. In Wyoming,
which is similar to our state in population, the ongoing costs
are only $90,000 per year. The Medicaid Services, Department of
Health and Social Services (DHSS) fiscal note reflects an
initial savings of $86,000 in the first year. However, the DHSS
testified in other committees that the amount could be as much
as three times that amount.
MS. BLAISDELL, in response to Chair Ramras, explained that the
cost savings are due to the decrease in the number of
prescriptions that are filled and then illegally resold, a
practice known as "diversion." She surmised that statewide the
cost savings could be $1.4 million including from private
insurance and governmental agencies.
CHAIR RAMRAS pointed out that the fiscal note is unique in that
it saves money and the harm, which is amplified through street
drugs is eliminated.
REPRESENTATIVE GRUENBERG referred to the letter of intent dated
February 5, 2008, and read:
It is the intent of the Legislature that the Alaska
Prescription Drug Monitoring Program be funded with
federal grants and state appropriations. It is not
the intent of the legislature that the professional
users of the database absorb the costs of managing
this public program through their license fees or
other fee structure.
REPRESENTATIVE GRUENBERG inquired as to whether the drug
companies or insurers would obtain cost savings.
1:38:28 PM
MS. BLAISDELL answered the insurers would save approximately
$1.4 million savings.
REPRESENTATIVE GRUENBERG inquired as to whether the insurers
should share part of the cost since they would obtain the
benefits.
MS. BLAISDELL surmised that the state would also benefit by
reductions in insurance premiums.
REPRESENTATIVE GRUENBERG argued that in the industry premiums
have typically not been reduced. He inquired as to whether the
sponsor would support the industry bearing part of the cost.
CHAIR RAMRAS interjected that as sponsor of the companion bill,
he would not support that concept at this time.
MS. BLAISDELL answered that the impetus of this program is that
it is a public program. It would seem appropriate for the state
to bear the costs, she opined. Fortunately, states have often
received full federal funding for multiple years, she noted.
She said she anticipates that federal funding will continue.
She offered the reason for the intent language was to appease
pharmacists, who held concerns that the program would be paid
for by pharmacists through license fees if federal funding was
eliminated.
1:41:03 PM
MS. BLAISDELL returned to her PowerPoint presentation and
reviewed changes that were made to SB 196. She referred to a
document in the member's packet labeled, "Summary of Side-by-
Side Bill Comparison in Senate Labor and Commerce," which
outlines changes that were made in the Senate Labor and Commerce
Standing Committee. This bill originally required pharmacists
to collect information on the person picking up the
prescription, but pharmacists expressed concern that collecting
third party information would place an additional burden on
pharmacists. She noted language was added to improve data
security, and memorandums of agreement with health care
entities, typically tribal and military entities. More
specifically the language added read, "The board shall undertake
to ensure the security and confidentiality of the database and
the information contained within the database." The bill is
asking the board to follow national standards for prescription
data collection. Many safeguards could be placed in the
database, but in order to keep pace with technology, the
legislature may not want to place the safeguards in statute.
Thus, SB 196 contains one broad statement instead.
1:43:39 PM
MS. BLAISDELL relayed that the following statement was added to
SB 196, and she read:
The board shall promptly notify the president of the
senate and the speaker of the house of representatives
if, at any time after the effective date of this Act,
the federal government fails to pay all or part of the
costs of the controlled substance prescription
database.
MS. BLAISDELL opined that the notification provides the
strongest language that can be placed in a bill to support state
funding. She explained other substantive changes with respect
to civil liability. She noted that a prescriber or dispenser
can not be held liable if they do or don't use the information.
She opined the changes made the database more secure and
attempted to address the concerns of pharmacists. She noted
that in Senate Finance Committee an amendment was added to
clarify the penalty provisions.
1:45:47 PM
MS. BLAISDELL explained changes that occurred in the Senate that
include changing "inpatient" to "administered to a patient".
Several amendments help to ensure privacy, including that the
"method of payment" helps ensure that specific account numbers
would not be collected and stored in the database; a provision
was removed that would have allowed the Board of Pharmacy the
ability to collect other information as necessary; and data is
required to be destroyed after it is more than two years old.
An amendment added a requirement to collect the patient's "date
of birth" at the request of health care professionals, she
noted. Prescriptions are sometimes transferred to a patient's
pharmacy of choice so the database only will track prescriptions
that are actually filled in order to avoid a false impression of
overprescribing drugs. An amendment changed "tribal and
military" with "non-state regulated health care" in order to
ensure that other health care entities are captured, but the
language still will allow tribal and military entities to
participate in the program.
MS. BLAISDELL explained amendments that failed in the Senate,
including an amendment that would have decreased the fee charged
for requesting a report leaving it at $10 since most medical
providers can provide information to patients at no cost. An
amendment to remove redundant language with respect to checking
the database was removed at the request of Senator Therriault.
BRIAN HOWES, Investigator III, Division of Corporations,
Business, and Professional Licensing, Anchorage Office,
Department of Commerce, Community, & Economic Development
(DCCED), stated that he is the senior investigator for the
DCCED.
1:52:11 PM
REPRESENTATIVE GRUENBERG referred page 2, lines 20, through page
3, lines 6, of proposed AS 17.30.200. He asked whether the best
organization to administer the program is the Board of Pharmacy.
INVESTIGATOR HOWES answered that historically in other states
the data capability to provide the information is through the
pharmacy boards.
REPRESENTATIVE GRUENBERG referred to page 2, line 26, and
inquired as to whether the DCCED is the best department to serve
the board.
INVESTIGATOR HOWES answered that the DCCED is the best
department to oversee the database since all of the health
professionals are licensed by the division.
REPRESENTATIVE GRUENBERG referred to page 2, line 29, and
inquired as to whether the pharmacist-in-charge of each licensed
or registered pharmacy refers to one in each store, for example
the grocery stores, or one that oversees all of its stores'
pharmacies.
INVESTIGATOR HOWES opined that there would be one at each
branch.
1:53:30 PM
REPRESENTATIVE GRUENBERG said he is assuming that it is each
branch, but if it is not, that SB 196 should reflect that
specifically.
INVESTIGATOR HOWES related that investigators currently send
requests to the corporate store and not to the individual
pharmacy.
MS. BLAISDELL related that she spoke with the Fred Meyer
pharmacists in order to determine the dispensing authority in a
chain store. She stated that typically licensed pharmacists
must be assigned to a specific store. One pharmacist is
assigned to a specific store although he/she may not be present
during the entire store hours, that pharmacist would be
responsible for the activity.
REPRESENTATIVE GRUENBERG referred to page 2, line 31, and
inquired as to whether "dispensed" means that the pharmacist is
the only one who could dispense prescriptions, or if a
pharmacist's technician can also dispense prescription drugs.
MS. BLAISDELL said that a pharmacist's technician cannot
dispense any prescriptions without the pharmacist's
authorization of the pharmacist.
REPRESENTATIVE GRUENBERG referred to page 3, line 7, and
inquired as to whether "practitioner" is defined as he did not
find it on page 6 of SB 196.
MS. BLAISDELL answered that in order for a practitioner to
prescribe, he/she would have gone through the same criteria as a
pharmacist. She offered that in some locations in rural Alaska
a practitioner can also dispense.
REPRESENTATIVE GRUENBERG inquired as to whether practitioner is
defined in state law.
INVESTIGATOR HOWES surmised that a practitioner is anyone who
has the ability to prescribe.
REPRESENTATIVE GRUENBERG asked that Ms. Blaisdell research that
point further because he said that he thinks it's essential to
have the term "practitioner" defined.
1:58:03 PM
GREG POLSTON, M.D., Anesthesiology, Pain Management, stated that
he has served on the Medicaid and Pharmacy and Therapeutics
Committees for the past six years and during that time has
observed some of the problems with prescription abuse. He
stated that he has observed other prescription monitoring
programs. He said that he is concerned that the bill might
potentially limit the ability to provide care to legitimate
patients who need the ability to manage their pain. He said he
wants to ensure that the database is accurate. He currently
reviews the Medicaid database and finds errors when providers or
pharmacies are incorrectly listed.
DR. POLSTON said that the second concern is to ensure that
health care providers receive training or education in how to
use the database. He hopes safeguards will be in place to
monitor its effectiveness.
2:00:54 PM
REPRESENTATIVE GRUENBERG related that he has heard from another
physician, Dr. Jasper, who has expressed similar concerns. He
asked whether Dr. Polston is recommending any amendments.
DR. POLSTON answered that Ms. Blaisdell has worked with
pharmacists and physicians. He offered that use of morphine or
other drugs in an emergency room is often necessary, but is not
the source of drug diversion or misuse. However, chronic
conditions that require prescription pain medication pose more
of a problem for drug diversion. By delaying [the data entry]
it helps to limit the information and those that have immediate
access. One concern by physicians who provide pain management
is that they may become targets of "fishing" operations since
they write a lot of pain medication prescriptions.
2:03:40 PM
REPRESENTATIVE GRUENBERG referred to page 3, lines 4-5, of AS
17.30.200. He stated that the practitioners, " ...shall submit
the information to the board ... ". He inquired as to when the
information should be submitted, which he thinks is as soon as
it is prescribed, not at a later stage.
DR. POLSTON disagreed and clarified that he would like the
information collected immediately. He said that what he is
referring to is the extraction of the data and use it clinically
to benefit patients and protect citizens of Alaska. He
expressed concern about the availability of access to the
database. Therefore, he said he thinks that the database should
have limited access, with the retrieval sent to providers,
quickly, and through a secure means.
CHAIR RAMRAS inquired as to which drugs are covered by the
proposed database.
2:06:12 PM
MS. BLAISDELL stated that the only prescription drugs covered
are the schedule I-V drugs, which typically consist of the drugs
that are considered most harmful for the user, if used
inappropriately. The scheduled narcotics equate to about 10-15
percent of all drugs prescribed or dispensed in the state. She
surmised that this is a relatively small group of drugs that
would be tracked in the database. With regard to data security,
she said that she spoke with a nationwide gatherer of this type
of information for other states. A simple scenario is that
information can be sent modem-to-modem, which means "a phone
call to a phone call" and no opportunity for hackers, or through
the Internet using the same type of encryption program used by
online bankers. Information can also be sent via compact disc
(CD), photo copy, or fax for data entry by the company. The
"output" is in the form of reports and is not entered or edited,
she stated. A prescriber would see an Internet screen, type in
a person's name, birthday, and address, and obtain a history.
Most of the databases have a seven second rule to keep the mouse
or keyboard active or the system automatically times out the
user, she noted.
2:09:10 PM
REPRESENTATIVE GRUENBERG opined that new language is necessary
to accomplish what Dr. Polston suggests. He referred to page 4,
lines 3-31, as a possible place to consider for an amendment,
but stated that it was difficult to know what change to make
without consulting with the bill drafter.
DR. POLSTON stated that he also did not yet have specific
language to offer. He suggested that the highest level of
encryption is necessary, but that the system would need to be
continued and monitored.
REPRESENTATIVE GRUENBERG referred to page 3, lines 7-9, of
proposed AS 17.30.200(b) (1), which requires the name and an
identifier of the prescriber be included in the database. He
acknowledged that prescriber's signatures are often illegible.
DR. POLSTON agreed, adding his hope that the industry will move
more towards electronic records and e-prescribing so that data
will be accurately entered by the prescriber, to reduce the
human error of keypunching the information into the database.
Thus, since the patient will not have access to the written
form, the patient cannot alter the prescription, which can curb
diversion. Controlled substances are not allowed to transmit
prescriptions for opiates electronically transferred to curb
diversion. He surmised that the problem of diversion is much
larger than tampering with physicians written prescriptions. He
opined that many sources for prescription drugs are currently
available on the Internet.
2:13:08 PM
REPRESENTATIVE HOLMES referred to page 4, line 14, of proposed
AS 17.30.200(d)(3), which relates to access of the database by a
licensed practitioner. She gave her understanding that many
doctors have patients waiting and are behind schedule. So,
while the language states the access is limited to the
practitioner, she inquired as to whether it might be someone
else who is checking the database, such as a receptionist,
nurse, office manager, or an aide.
MS. BLAISDELL said she'd inquired as to whether it would be
appropriate for a pharmacist to delegate the authority to
someone else. The pharmacists were adamant that the authority
not be delegated to someone else. She offered one suggestion
from medical professionals, which is that if the authority to
delegate the access to the database is considered, to ensure
that the access is delegated to a licensed health care
professional. Thus, licensing action could be taken against the
licensee for any abuses. She added that the function of using
the database is not mandated and if it was used, that only 10
percent of prescription drugs are entered into the database.
REPRESENTATIVE HOLMES surmised that the only person who would
access the database is the prescriber, such as the doctor or
nurse practitioner.
MS. BLAISDELL explained that a prescriber could be a doctor, a
dentist, a veterinarian, or a nurse practitioner and cannot be
delegated.
DR. POLSTON speculated that this information would be treated
just like any other form of healthcare information. It would
have to come from the physician and it would the responsibility
to ensure that it is secure and not seen by others. He said he
would not want his medical records person to request that
information without his knowledge. He suggested maintaining the
limit to access the information to the provider.
2:18:37 PM
REPRESENTATIVE SAMUELS inquired as to how the process for
obtaining a prescription for restricted drugs will change under
SB 196.
MS. BLAISDELL answered that currently a patient can hand carry
the prescription, it is filled at a pharmacy, and the pharmacist
maintains a record. At some point the DEA may wish to see a
record, either in ledger form, or electronic form for their
review. The prescriber would have the information listed on the
patient's chart, and the only record the pharmacy would retain
is information that a drug was dispensed. In contrast, by
entering this information into a database, the prescriber can
review the complete patient drug history.
REPRESENTATIVE SAMUELS surmised that currently he could visit
three different doctors for injuries and go to three different
pharmacies to have the prescriptions filled.
MS. BLAISDELL stated that what will change under SB 196 is that
the data base would show frequency of prescriptions, doctors and
pharmacies visited by patients, which could indicate and
identify a potential drug diversion problem since a person who
"doctor shops" will do so frequently.
MS. BLAISDELL, in response to Representative Samuels, stated
that only the pharmacist would provide the data. The prescriber
or pharmacist would have access, but not any regulatory agency
such as workers' compensation, the insurance company, or law
enforcement.
REPRESENTATIVE SAMUELS surmised that the health care provider
can choose whether or not to prescribe the drug to the patient.
MS. BLAISDELL concurred. She explained that the database helps
to confirm what the health care professional intuitively
determines.
MS. BLAISDELL, in response to Representative Samuels, explained
that a pharmacist is not required to check each time a schedule
of narcotics is distributed. She referred to page 5, line 12-
18, of proposed AS 17.30.200(h), which states that the
pharmacist may not be held civilly liable. Further, that
subsection would remove any mandate that the pharmacist must
check the database. Instead, she offered that the database is
only an option for the pharmacist to use.
2:24:27 PM
REPRESENTATIVE SAMUELS asked whether a prescriber will take the
time to check if he/she is not required to do so.
MS. BLAISDELL related that Nevada is the only state of the 40
states that use a prescription monitoring program that mandates
that a prescriber access the database. Most states have found
that the program is helpful and prescribers find that the
database helps to resolve questions they may have about their
patients.
2:26:07 PM
ALEX MALTER, M.D., Medicaid Medical Director, Division of Health
Care Services, Department of Health and Social Services (DHSS),
stated that the DHSS has previously testified in support of this
bill. He noted the DHSS has several recommendations for
changes. He offered he is available for questions.
DR. MALTER noted that he also practices internal medicine in
Juneau. He offered his support for the previous testimony and
surmised that most physicians will be very supportive of the
prescription monitoring program, and that it will be most useful
to prescribing physicians. He noted that when doctors consult
with patients not known to them, who come in an unusual injury
or ailment, the doctor will use his/her intuition to assess that
something seems astray. This bill would provide an easy method
to observe the patient's prescription history and to determine
whether the patient has had numerous prescriptions filled or if
this is the first prescription being issued. He said he did not
have a feeling for how many pharmacists would access the
database, but he surmised that they might contact the physician
in instances in which the pharmacist thought the prescription
involved diversion or had been altered.
2:30:50 PM
DR. MALTER, in response to Chair Ramras, agreed that most of the
patients obtain narcotics for good reasons. He stated that only
a small percentage of patients cause concern for prescribers and
dispensers.
DR. MALTER, in response to Representative Gruenberg, noted that
he is not a pharmacologist. He sated that the federal drug
administration (FDA) certifies drugs for one year so he did not
think shelf life is something that can be solved in this
legislation.
2:32:48 PM
JULIE WOODWORTH Homer Chamber of Commerce, stated that the Homer
Chamber of Commerce recognizes that drug abuse adversely affects
the quality of life and increased crime. She stated that the
Chamber of Commerce supports SB 196. She said that she
personally experienced issues in her family which led to her
involvement in the methamphetamine education task force. She
related that through her involvement she has been amazed at the
propensity to abuse prescription drugs. She related one drug
abuser was quick to say he only took pills, which is not drug
abuse. This highlighted the misperception that exists with
prescription diversion. In response to a question by Chair
Ramras, she acknowledged that she attended the "Meth Watch"
conference at the Anchorage Loussac Library last summer. She
commended the state for developing the Alaska Meth Education
Project (AME) and in joining 40 other states in working to curb
methamphetamine use. She stated that the project emphasized
that methamphetamine abuse is a national epidemic, she said.
She also stated that she is grateful for the work that Alaska is
taking to combat methamphetamine use.
2:34:53 PM
JANET MULLEN, Home Health Nurse, South Peninsula Hospital,
stated that the South Peninsula Hospital supports SB 196. On a
personal level, she said that her own son has been involved in
meth and prescription drug use. She opined that it is so easy
for teenagers to obtain prescription drugs. She hopes that SB
196 will pass since she said she believes it will help prevent
the widespread use of drug diversion among teenagers.
2:35:44 PM
LINDA BAREFOOT, Regional Director, State Government Affairs,
Purdue Pharmaceutical Company ("Purdue Pharma") stated that
Purdue Pharma manufactures and distributes controlled and non-
controlled prescription medications. She offered support of
appropriately designed state monitoring programs. She said she
believes that SB 196 is a good example of such a program. She
asked to have Purdue Pharma shown on the record in support of
SB 196. In response to questions by Chair Ramras, Ms. Barefoot
answered that Purdue Pharma manufactures OxyContin (oxycodone
hyrdrochloride), and that Purdue Pharma wants its products to be
prescribed for legitimate pain patients. Purdue Pharma believes
that a state monitored prescription program would be able to
provide a resource tool for the prescriber and can assist them
in assessing appropriate pain patients. Purdue Pharma does not
want their products distributed to the wrong people since it can
jeopardize the legitimate patient access to the benefits of
their products, she offered.
2:37:25 PM
REPRESENTATIVE HOLMES inquired as to whether there are any
procedures or laws that address how to dispose of physical
evidence such as printouts of prescription drug information.
DR. MALTER answered that the federal HIPPA regulation is quite
stringent with regard to medical office data. He surmised that
most clinics would shred information prior to disposing of it.
Although concerns of drug use are highlighted in the bill, most
medical records contain sensitive information that patients
trust their physician to safeguard. Currently, medical history
is private and he did not sense a looming problem to maintain
the narcotic prescription data.
2:40:42 PM
REPRESENTATIVE HOLMES offered that she would assume that most
doctors and pharmacies would maintain confidentiality. She
inquired as to whether any other law applies.
MS. BLAISDELL relayed that she would research that issue further
and if necessary, have a provision prepared to highlight
disposal of medical information. In further response to
Representative Holmes, Ms. Blaisdell explained that law
enforcement can gain access to information is through a court-
ordered warrant or subpoena. Further, the information is
provided in a report format and the officer would not gain
access to the database.
REPRESENTATIVE HOLMES surmised that an officer has a subpoena;
the database could help provide evidence, but would not allow
him/her to "fish" for information.
2:43:10 PM
REPRESENTATIVE HOLMES inquired as to whether a method exists to
correct inaccuracies in one's own record.
MS. BLAISDELL answered that there is not an appeal process, but
the first thing a doctor would examine is the date of birth.
The computer would perform some presorting and similar
information, she advised.
CHAIR RAMRAS stated that he would research that issue further
and provide information to members as the bill progresses.
2:46:08 PM
REPRESENTATIVE HOLMES referred to page 5, line 21, of proposed
AS 17.30.200(h)(i). She inquired as to whether the information
is clear as to which date to use when purging files since it
refers to both "issued or dispensed" dates.
MS. BLAISDELL surmised that some language has been deleted from
this proposed section so it might be appropriate to remove the
words "issued or" since it would refer to prescriptions that
were dispensed rather than prescriptions that are not picked up.
REPRESENTATIVE HOLMES referred to page 4, lines 12-13, of
proposed AS 17.30.200(d)(2), which refers to who can obtain the
information. She asked whether it would be appropriate to add
the word, "database" to "tighten up" that provision.
MS. BLAISDELL pointed out that subsection (d) that leads into
that paragraph refers to "access to the database" so she thought
that it was not necessary to identify database in paragraph (2).
She further added that she held discussions with the bill
drafter about "review" in that paragraph. She advised the
members that review refers to the information that people can
access in the database. She opined that the board's personnel
or contractors can not conduct any review of a physician's
practice. In further response to Representative Holmes, Ms.
Blaisdell answered that subsection (c) refers to the purposes of
the database, but does not provide the authority to access the
information. She further offered that subsection (d) allows
access to the database.
REPRESENTATIVE HOLMES surmised that subsection (d) would not
allow people authorized to access the database to conduct random
searches.
2:52:42 PM
CHAIR RAMRAS inquired as to how he manages to work in private
practice and for the DHSS.
DR. MALTER explained that he had a fulltime practice up until a
year and a half ago. The DHSS was seeking a Medicaid/Medical
director, which most states employ. However, it is a small
enough state that the DHSS did not need a fulltime person. He
stated that his practice accepts Medicaid. He opined that
Medicare is under fire for low reimbursement rates. However,
the state has been diligent to provide good access for its
Medicaid patients. He opined that Alaska provides better care
for its Medicaid patients. He said that Alaskans are lucky that
the legislature has been willing to support Medicaid.
REPRESENTATIVE COGHILL referred to page 5, lines 1-5, of
proposed subsection (e), which outlines disciplinary action for
failure to submit information. He asked how the board would
know the pharmacist is not reporting the information.
INVESTIGATOR HOWES offered that licensees are required to report
and the board would have the ability to conduct an audit review.
REPRESENTATIVE COGHILL inquired as to whether the board would
review sales versus the data entry.
INVESTIGATOR HOWES concurred.
2:57:14 PM
DR. MALTER, in response to Representative Gruenberg, answered
that he could not speak for the department with respect to
Medicare problems. However, he offered his understanding that
Medicare access is a tremendous problem, particularly in
Anchorage, and many are not taking any new Medicare patients.
He offered his understanding that a few years ago the
Congressional delegation was able to obtain a fix, but since
then, the rates have fallen to national rates. He opined it may
pose a problem due to the scarcity of physicians in the state.
The past few years the DHSS and medical associations have
examined these issues. Although he does not have the reports
with him, his impression is that the problems have been
examined. He offered to provide the information to members.
2:59:17 PM
REPRESENTATIVE GRUENBERG referred to page 3 lines 4, of proposed
AS 17.30.200(b), which in part reads, "federal law other than
those administered to a patient at a health care facility", and
asked if people in a health care facility are exempt.
MS. BLAISDELL answered that the prior language read, "inpatient"
but that term was unclear since some patients have day surgeries
and are not admitted to a hospital or clinic. Thus, the
language in subsection (b) means that the patient is in a health
care facility when the drug was dispensed and the health care
facility does not need to report.
REPRESENTATIVE GRUENBERG inquired as to whether that exemption
would skew the database.
MS. BLAISDELL explained that most feel that in "inpatient
facilities" the patient is managed and is under supervision.
Thus, the level of concern is reduced. The people that would be
targeted by subsection (b) are those who must self-manage their
prescriptions. She surmised that once the patient leaves the
facility with the drugs that the concern of prescription drug
abuse is raised.
REPRESENTATIVE GRUENBERG expressed concern that not having
access to the initial prescription information could impact the
subsequent follow up care and the quantity of drugs later
prescribed.
3:01:47 PM
DR. MALTER offered that the inpatient care is a less critical
issue. If the person is in a hospital, he/she might be
prescribed morphine IV for surgical pain. However, some people
are obtaining large amounts of narcotics and using them on a
day-to-day basis. He noted that Medicaid allows 120 milligrams
of methadone a day. He noted that the bill is trying to address
the problem of non-malignant pain and chronic back pain. Many
need their medication and probably most are using them
appropriately. However when large numbers of pills, for
example, 300 pills per month or more are issued, prescribers are
concerned that the outpatient's tablets are being diverted.
3:03:08 PM
REPRESENTATIVE COGHILL referred to page 5, lines 6-8, of
proposed AS 17.30.200(f) which refers to agreements that the
board may enter into with dispensers that are not regulated by
the state. He inquired as to how this would fit into the felony
accountability.
MS. BLAISDELL answered that this subsection was amended on the
Senate floor, and previously referred to "tribal or military"
entities. She said the term relates to "federally regulated
entities." Further, she noted these are not Internet
activities. The entities would have to follow the same
requirements set out in statute under a memorandum of agreement.
REPRESENTATIVE COGHILL disagreed since some immunity issues may
arise that would not require the parties to be held accountable.
He suggested that this issue may need further review.
3:05:47 PM
CHAIR RAMRAS, after determining that no one else wished to
testify, closed public testimony on SB 196.
3:06:25 PM
CHAIR RAMRAS made a motion to adopt Amendment 1, labeled 25-
LS1092\LA.1, Luckhaupt, 2/22/08, which read:
Page 4, lines 10 - 11:
Delete "regarding license inquiries"
Page 4, line 11, following "practitioner":
Insert "pursuant to a search warrant, subpoena,
or order issued by an administrative law judge or a
court"
REPRESENTATIVE SAMUELS objected for the purposes of discussion.
CHAIR RAMRAS noted that Amendment 1 was requested by Dr. James
Jordan, Executive Director of the Alaska State Medical
Association. He stated that the intent of the amendment is to
provide due process protection for licensed prescribers. He
explained that the additional language would require a board or
other administrative agency to obtain search warrant, subpoena,
or order issued by an administrative law judge or a court. The
new language would ensure appropriate protection while still
allowing the database to be used as a tool to assure that best
medicine is practices in Alaska. He noted that a letter from
the Alaska State Medical Association requesting this amendment
is in member's packets.
REPRESENTATIVE SAMUELS removed his objection.
CHAIR RAMRAS, noting that there were no further objections,
relayed that Amendment 1 was adopted.
3:08:32 PM
REPRESENTATIVE GRUENBERG made a motion to adopt Conceptual
Amendment 2, which read [original punctuation provided]:
On page 6, line 10
Add a new definition:
(5) "practitioner" has the meaning given in AS
08.80.480.
REPRESENTATIVE COGHILL objected.
REPRESENTATIVE GRUENBERG explained that the term "practitioner",
on page 3 of SB 196, is not defined for purposes of proposed AS
17.30.200; instead, the term is defined in AS 08.80.480, which
pertains to pharmacists.
REPRESENTATIVE COGHILL removed his objection.
CHAIR RAMRAS announced that Conceptual Amendment 2 was adopted.
3:09:48 PM
REPRESENTATIVE GRUENBERG made a motion to adopt Conceptual
Amendment 3, which read: [original punctuation provided]
page 5 line 9
after "shall" insert "promptly"
page 5 line 11
after "pay" insert "all or part of"
REPRESENTATIVE COGHILL objected.
REPRESENTATIVE GRUENBERG explained that Conceptual Amendment 3
is a technical amendment to proposed AS 17.30.200(g), which
would require the Board of Pharmacy to notify the legislature as
soon as possible if federal funding does not cover the costs of
the database to initiate the budget process.
REPRESENTATIVE COGHILL removed his objection.
CHAIR RAMRAS announced that Conceptual Amendment 3 was adopted.
3:10:59 PM
REPRESENTATIVE HOLMES referred to page 5, line 21, of proposed
subsection AS 17.30.200(i), and inquired as to whether the
terms, "issued or "dispensed" should be clarified.
REPRESENTATIVE GRUENBERG explained that a prescription can be
issued even if the drug is not dispensed. Thus, both instances
would be covered in SB 196, he opined.
MS. BLAISDELL offered that there is not any provision for the
subscriber to enter any data until the prescription is dispensed
to the patient.
3:12:34 PM
REPRESENTATIVE HOLMES made a motion to adopt Conceptual
Amendment 4, to delete the words, "issued or" from page 5, line
21. There being no objection, Conceptual Amendment 4 was
adopted.
3:12:56 PM
REPRESENTATIVE COGHILL again referred to page 5, lines 6-8, of
proposed subsection AS 17.30.200(f) with respect to tribal and
military agreements.
CHAIR RAMRAS asked to work with the sponsor to address the two
issues with respect to tribal and military agreements and to
create a method to correct any inaccuracies in a medical record.
MS. BLAISDELL pointed out another issue the committee could
consider is to specify how the board shall dispose of records.
CHAIR RAMRAS announced that CSSB 196(FIN)am, as amended, would
be held over.
ADJOURNMENT
There being no further business before the committee, the House
Judiciary Standing Committee meeting was adjourned at 3:15 p.m.
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