Legislature(2005 - 2006)CAPITOL 17
03/02/2005 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HCR3 | |
| HB150 | |
| HB147 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HCR 3 | TELECONFERENCED | |
| += | HB 147 | TELECONFERENCED | |
| *+ | HB 150 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
March 2, 2005
3:27 p.m.
MEMBERS PRESENT
Representative Tom Anderson, Chair
Representative Gabrielle LeDoux
Representative Norman Rokeberg
Representative Harry Crawford
Representative Pete Kott
MEMBERS ABSENT
Representative Bob Lynn
Representative David Guttenberg
COMMITTEE CALENDAR
HOUSE CONCURRENT RESOLUTION NO. 3
Relating to renewable energy resource development.
- MOVED HCR 3 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. 147
"An Act relating to the regulation of insurance, insurance
licensing, surplus lines, insurer deposits, motor vehicle
service contracts, guaranteed automobile protection products,
health discount plans, third-party administrators, self-funded
multiple employer welfare arrangements, and self-funded
governmental plans; and providing for an effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HCR 3
SHORT TITLE: RENEWABLE ENERGY ALASKA PROJECT
SPONSOR(s): REPRESENTATIVE(s) RAMRAS
02/22/05 (H) READ THE FIRST TIME - REFERRALS
02/22/05 (H) L&C, RES
03/02/05 (H) L&C AT 3:15 PM CAPITOL 17
BILL: HB 150
SHORT TITLE: LICENSING RADIOLOGICAL 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
BILL: HB 147
SHORT TITLE: INSURANCE
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/14/05 (H) READ THE FIRST TIME - REFERRALS
02/14/05 (H) L&C, FIN
02/23/05 (H) L&C AT 3:15 PM CAPITOL 17
02/23/05 (H) Heard & Held
02/23/05 (H) MINUTE(L&C)
03/02/05 (H) L&C AT 3:15 PM CAPITOL 17
WITNESS REGISTER
REPRESENTATIVE JAY RAMRAS
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Spoke as the sponsor of HCR 3.
CHRIS ROSE, Executive Director
New Energy for Alaska Project
POSITION STATEMENT: Testified in support of HCR 3.
JON BITTNER, Staff
Representative Anderson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 150 on behalf of the sponsor,
Representative Anderson.
DONNA RUFSHOLM, Chairman
Alaska Society for Radiological Technologists
POSITION STATEMENT: Testified in support of HB 150.
CLYDE PEARCE, Chief Inspector,
Radiological Health Program
Section of Laboratories/State of Alaska/DH&SS
Anchorage, AK
POSITION STATEMENT: Testified in support of HB 150.
ED HALL, physician assistant and legislative liaison,
Alaskan Academy of Physician Assistants
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 150.
BARBARA HUFF-TUCKNESS, director of governmental affairs,
Teamsters Union 159
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 150.
STEVE GAGE, physician assistant,
SE Alaska Healthcare Consortium
Sitka, Alaska
POSITION STATEMENT: Testified in opposition to HB 150.
ANN DAILY, physician assistant
Regional clinic
Illiama, Alaska
POSITION STATEMENT: Testified in opposition to HB 150.
GUMENSINDO ROSALES, registered radiological technologist
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 150.
CHRISTINE SASSE, Director
Department of Finance
City of Valdez
Valdez, Alaska
POSITION STATEMENT: Testified in opposition to HB 147.
GREG CULBERT, Assistant School Superintendent,
Galena School District
Galena, Alaska
POSITION STATEMENT: Testified in opposition to HB 147.
MATT LARKIN, Broker,
Willis of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 147.
RICHARD CAMPBELL, General Services Director
Human Resources
Kenai Peninsula Borough
Kenai, Alaska
POSITION STATEMENT: Testified in opposition to HB 147.
MARY STOLL, trust attorney,
Law Offices of Mary L. Stoll
Seattle, Washington
POSITION STATEMENT: Testified in opposition to HB 147.
COLLEEN SAVOIE, benefits consultant and vice president,
Marsh USA
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 147.
ACTION NARRATIVE
CHAIR TOM ANDERSON called the House Labor and Commerce Standing
Committee meeting to order at 3:27:59 PM. Representatives
Crawford, Rokeberg, Ledoux, and Anderson were present at the
call to order. Representatives Lynn, and Guttenberg are excused
from the meeting. Representative Kott arrived as the meeting
was in progress.
HCR 3-RENEWABLE ENERGY ALASKA PROJECT
CHAIR ANDERSON announced that the first order of business would
be HOUSE CONCURRENT RESOLUTION NO. 3, Relating to renewable
energy resource development.
3:29:08 PM
REPRESENTATIVE JAY RAMRAS, Alaska State Legislature, introduced
the bill, stating that although the state is awash in petroleum
and oil, the state does have other alternative energy sources.
Alaska has an opportunity to be at the forefront of the energy
production and this resolution recognizes these facts and urges
the Governor and his office to work with these individuals and
groups aimed at developing these future energy sources.
REPRESENTATIVE RAMRAS then stated that the local utility company
in Fairbanks issues a magazine that recently had some
interesting facts about green power coming to the area that
Golden Valley Electric Association manages. This article, he
said, has some interesting statistics:
-86 percent agree that electrical utilities need to plan
for the eventual demise of nonrenewable fossil fuels.
-82 percent agree that Alaskans need to invest now for
future development of alternative energy.
-79 percent agree that it means a lot that energy come from
environmentally sound sources.
-72 percent agree that developing green power is necessary
to reduce pollution emissions from fossil fuels.
-64 percent agree that increasing the use of green power
will reduce the need for imported petroleum and increase
national security.
REPRESENTATIVE RAMRAS ended by stating that he was very excited
about this resolution and will have a bill that will begin by
showing initial steps being made by communities in Bethel, who
are experimenting with wind power by using Alaska Industrial
Development Authority to help bring down the costs for the
consumers.
3:31:20 PM
REPRESENTATIVE RAMRAS continued his conclusion by stating that
the big issue for this particular subject is the cost of
alternative energy sources. This is, he said, the big issue
with alternative energy. He pointed out that it costs way more
to produce a kilowatt than it does with more conventional energy
sources.
3:31:51 PM
CHAIR ANDERSON indicated that he supported the resolution and
was looking forward to seeing the bill in final form. He then
asked Representative Crawford if it were similar to one of his
bills.
REPRESENTATIVE CRAWFORD answered that is was very similar to a
several bills and he thought it was excellent then and added
that Ramras had made it an even better bill.
REPRESENTATIVE ROKEBERG, in regards to a conference on climate
change with energy conservation, he found that many states are
finding that some legislators are creating what they believe to
be 'Sons of Kyoto' bills, which, he said, referred to a very
promising but ultimately unsigned environmental treaty between
various countries of the world and the United States.
REPRESENTATIVE ROKEBERG indicated that he felt that this bill
had a strange ring to the Kyoto protocol and that he knew that
similar legislation in other states were when they made policy
statements on portfolio allocation of generations for the power
generation capabilities of the future. This set state policy
about what types of sources are used. He then asked if it was
appropriate for legislature to get involved in energy
legislation.
REPRESENTATIVE RAMRAS answered that he agreed that it was an
appropriate issue. He indicated that Alaska has unique needs
for energy sources. One example of this is wind power in the
Fairbanks area. This type of energy is really not particularly
valuable since that area has good reserves of coal and can
generate electricity that way. He then stated that the goal is
to deliver thermal units of energy across the state cheaply and
that there are many industries that require an abundance of
energy and alternate energy is a viable option. He pointed out
an example in California where Governor Arnold Schwarzenegger is
working on creating the 'Hydrogen Highway'. For Alaska to be an
innovator, he said, even as the state sits upon thousands of
barrels of crude oil and a healthy supply of natural gas, the
state must pursue alternative energy options. This move, he
said, should be applauded and not continually couched into a
political statement [against progressive thinking]. He ended by
stating that this speaks to the desires of many for Alaska to be
a leader in energy development.
3:36:47 PM
REPRESENTATIVE ROKEBERG replied that he agreed with the
sentiments of the previous speaker, and then said that it's
interesting to note that interest in the market for wind power
has grown so substantially in Europe and the entry of General
Electric into creating new types of turbines that have been able
to drive the cost down from 20 cents per kilowatt hour to 5.5
cents per kilowatt hour. He pointed out that despite this
development, green power always costs more than conventional
sources. However, he commented that many people are willing to
pay more for the service because it comes from alternative
source. He then asked if Representative Ramras had ever taken a
poll in the Valley to determine if this were the case there as
well.
REPRESENTATIVE RAMRAS answered that this does seem contradictory
since green power has the characteristic of being cheaper since
it is free and renewable. It can be cheaper than conventional
sources if, in the case of wind power, the turbines are
optimally placed in a wind farm that is large enough to see
significant size of product. He said that this is evidenced
with the communities of Palmer and Bethel, which are good
examples of this industrial sized green power being implemented.
REPRESENTATIVE RAMRAS continued to state that it would behoove
the rest of the state to look to develop alternative energy
sources "where we can, where it's wise and where we are starved
for it, and in whatever form makes the best sense".
REPRESENTATIVE RAMRAS stated, in deference to his own committee
efforts, that when his committee hears the next bill, in which
the committee asks the Alaska Industrial Development and Export
Authority (AIDEA) to help finance the construction of
alternative energy sources for those communities for whom it
does make sense, you would be pleased with the direction and
leadership that we are trying to provide through this
legislative body.
3:39:57 PM
REPRESENTATIVE ROKEBERG asked if anyone else was supporting it,
more specifically AIDA.
REPRESENTATIVE RAMRAS affirmed his own sentiments and commented
that he did not care, since AIDA had moved away from being
interested in what is good for the average Alaskan. He then
added that cheap power development is a critical part of
Alaska's future in its rural communities.
3:40:43 PM
CHRIS ROSE, Executive Director for the New Energy for Alaska
Project, announced his full support for the resolution and
believed that the state has the unique opportunity to be leaders
in this field. He indicated that many states had already
benefited economically with jobs created in the construction
associated with new alternative energy sources, and because of
the high tech businesses that are moving into these states.
This is, he said, due to these governments realization of the
need for diverse energy sources. He ended by stating that
Alaska has many more opportunities than these states to lead in
this field, including geothermal, tidal, wind, hydroelectric,
which are just a few examples.
3:42:07 PM
MR. ROSE explained that hydrogen is something that is going to
sustain Americans in the future and since there is an increasing
demand for energy in the world, especially from third world
countries like India and China, and that the world's reserve of
fossil fuels is finite, and a contributing factor to planet wide
pollution, and lastly concern about the related issue of climate
change.
MR. ROSE announced that right now there are wind farms being
built all over the Midwest and that opportunity is here as well.
He illustrated this point by referring to Fire Island off the
coast of Anchorage, Alaska. The scale of that project will
enable it to be very economically competitive with natural gas
and coal fire plants at 4 cents a kilowatt an hour. The price
of natural gas and coal are going up and the price of wind is
negative- it is free. He indicates that his group, made up of
various utility companies, have all come together to support
this resolution and the eventual use of alternative energy
sources.
3:44:05 PM
REPRESENTATIVE CRAWFORD thanked the previous speaker for the
article today in the local paper and told the committee that
renewable energy does not have to be in conflict with the
standard types of energy and instead should be seen as natural
progression and an eventuality.
MR. ROSE stated that this is true for Alaskans and that the
creation of Hydrogen fuel begins with the already plentiful
natural resources, like geothermal and wind, that can be used
for hydrogen production, through electrolysis. The source for
hydrogen is water and this is very plentiful for Alaskans.
CHAIR ANDERSON asked if there was anyone in the committee that
wanted to move the bill out.
REPRESENTATIVE CRAWFORD moved to report HCR 3 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, it was so ordered.
HB 150-LICENSING RADIOLOGICAL TECHNICIANS
3:45:58 PM
CHAIR ANDERSON announced that the next order of business would
be HOUSE BILL NO. 150, "An Act requiring licensure of
occupations relating to radiological technology, radiation
therapy, and nuclear medicine technology; and providing for an
effective date."
JON BITTNER, Staff to Representative Anderson, introduced the
bill by first reading the following opening statement:
House Bill 150 will establish educational and
certification standards for the health care personnel
in Alaska who perform medical imaging and radiation
procedures.
MR. BITNER then continued by reading the following:
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
Radiological 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.
Thirty-eight 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 radiological 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.
MR. BITNER concluded by stating the following:
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.
REPRESENTATIVE ROKEBERG asked about the letter from the Alaskan
Academy Of Physician Assistants and wondered if they were in
favor of the bill.
MR. BITNER stated that there is some confusion here.
REPRESENTATIVE ROKEBERG stated that he believed there was a
letter that was floating around in the past that said that they
were supporting the bill. He then stated that there was current
letter stating some kind of opposition to the bill.
MR. BITNER then stated that this was sent recently.
3:49:55 PM
DONNA RUFSHOLM, Chairman, Alaska Society for Radiological
Technologists, stated that establishing state procedures for
licensure has been an ongoing effort by this group. She
indicated that it started ten years ago and only in the last 4
years has any progress been made. She then continued that
currently there are no stipulations or standards for the
regulation of radiological technicians. She revealed that anyone
off the street can take a job as a radiological technician at a
hospital or clinic. Radiologists in the state have some concern
about the quality of these radiographs that they are receiving
from villages that do not have properly educated personnel, as
they are more often than not, bad images or images that are not
viable for use in diagnosis. Furthermore, she said, there are
huge concerns from radiologists about these poor efforts at
imaging because of the high levels of radiation that result.
This radiation, she said, impacts not only the villager getting
the imaging but the uneducated technician as well.
MS. RUFSHOLM stated that HB 150 would establish educational and
certification standards for the healthcare personnel to perform
the radiation imaging procedures. She pointed out that studies
show that these kinds of efforts to educate the operator insure
better work quality which leads to quality information being
used for proper diagnosis. She continued by stating that it
would also reduce healthcare costs since repetitive exposures
would not be made due to inadequate knowledge of radiological
science and technique. This bill will ensure that excellence in
radiological imaging and better healthcare for Alaskans.
MS. RUFSHOLM then outlined the history of this effort by stating
that over the years the group had been working extensively with
the Alaska State Hospital and Nursing Home Association (ASHNA),
where we tried to address some of the issues that are being
faced by the rural communities that do not have credentialed
individuals performing radiological procedures.
MS. RUFSHOLM then stated that there were some concerns about
access to radiological facilities and services if there were
some standardization and licensing put into effect.
Nevertheless, there is support from ASHNA for this bill.
3:53:15 PM
MS. RUFSHOLM indicated that her group does work with association
of Physician Assistants, most recently last October, when we
addressed some of their concerns. She indicated that the final
outcome of this meeting was that they wanted to be listed under
the definition of licensed practitioners.
MS. RUFSHOLM pointed out that she did change the language to
include them as licensed practitioners in what was then called
HB 186. She continued to state that she had also worked with
the association of nurses and resolved issues that they felt
concerned about. Recently this week, the Physician Assistants
have brought up new issues and she stated that they will be
testifying to this today.
3:54:26 PM
CHAIR ANDERSON pointed out that Ms. Rusholm is the technical
person at the meeting.
REPRESENTATIVE LEDOUX stated that she was a firm believer in not
fixing something that did not seemingly need to be fixed, and
asked what the problem was exactly with the radiological
technician issue in the state of Alaska.
MS. RUFSHOLM affirmed that there was indeed a huge problem that
is obviated by her presentation and the one that will be given
by Mr. Clyde Pearce, the state radiological inspector.
MS. RUFSHOLM described this presentation as one that will
include physical displays of terribly poor radiographs that will
illustrate examples of radiographs that, because of faulty
techniques, and because many contain both over exposure and
under exposure, the radiographs were not viable for diagnosis or
use in clinic evaluation. She then went on to say that these
examples being shown today were actual 'x-rays' taken by village
technicians that were sent to radiologists elsewhere in the
state.
REPRESENTATIVE LEDOUX expressed her nescience and asked what
excessive doses of radiation meant.
MS. RUFSHOLM carefully explained that radiation exposure is
measured accumulatively and that excessive exposure can be
hazardous.
3:57:33 PM
MS. RUFSHOLM went on to explain that a radiation burn can be
evidenced by the manifestation of erythema in a few days, which
is followed by the deterioration of the skin. This, she said,
culminates in an ulcer. However, she said, the connection
between overexposure and radiation and the resultant
manifestation is not something that happens overnight. This
takes months, sometimes years.
REPRESENTATIVE LEDOUX asked that if 38 states require licensing,
would there be any stats that illustrate that these difficulties
happened more in the states without licensing.
MS. RUFSHOLM answered that no, she did not know about any
documentation that would illustrate this.
CHAIR ANDERSON asked how Ms. Rusholm was able to reconcile the
issue of rural Alaska not having access to educated technicians
and the fact that if it were the case of either not having any
radiology abilities and poor quality radiology services, that
they would rather have the latter.
3:59:27 PM
MS. RUFSHOLM explained that the exemptions do exist for this
bill and there would be not problem for them to obtain technical
education and continue doing what they are doing, provided that
they are able to sit for a national registry examination, after
which they would receive a limited scope license. They can sit
in their homes and do this test online. The costs are nominal.
CLYDE PEARCE, Chief Inspector, Radiological Health for the State
of Alaska, Department of Health, stated that he performed
inspections at over 360 facilities, which includes about 800
sources of radiation. He then indicated that currently he worked
on scientific equipment, and in the past, he worked on airport
screening machines. He began by first referring to
Representative Ledoux and her earlier question about examples of
radiation exposure leading to hospitalization and stating very
affirmatively that there was several examples of documentation
in prestigious medical journals. He cites the American Society
of Radiological Technologists, which conducted a longitudinal
study that continues to the present, looked at various diseases
that were suffered by people working as radiological
technicians. One example he said, was that they found they
suffered three times the national rate of breast cancer in non
operators before licensing began in other areas.
REPRESENTATIVE LEDOUX asked if these statistics were done when
the equipment emitted more radiation than modern equipment.
MR. PEARCE answered that that the actual x-ray was discovered in
1895 and the first biological injury from radiation occurred in
this country the following year. He then continued discussing
the morbidity factors, primarily the loss of fingers and hands
that dentists and other medical professionals suffered. He
pointed out that the first death of radiation exposure took
place in the United States in the late part of the 19th century
by a man who worked for Thomas Edison. He then talked about the
use of radiation for cosmetic hair removal and how it resulted
in arm amputations for women in large numbers. The dangers were
seen right away and safety measures were put into place.
MR. PEARCE continued by saying that the discovery of the CAT
scan in 1971 changed this trend. He announced that the exposure
rate of this type of imagery was 10 to 100 times higher than the
normal x-ray dose. This is justified medically, since many
life-threatening conditions can be found quickly and mitigated
before things get worse. An example, he offered, would be sub
dural hematoma inside the skull, that would increase in pressure
and cause major damage to the brain if left undetected. He then
stated that a real concern is the level of exposure to children
using adult doses of radiation.
4:06:37 PM
MR. PEARCE stated that most of the burns that we have seen has
occurred with stints and fluoroscopy and has been done by
uneducated and non-radiological technicians and doctors. This
indicates, he said, that education and training make the
difference and this lack of training is directly related to the
injuries that are documented.
REPRESENTATIVE LEDOUX asked if this bill allowed doctors to
perform x-rays.
MR. PEARCE answered by stating that this bill is specific to
technicians and excludes licensed healings arts professional
practitioners.
REPRESENTATIVE LEDOUX answered that she believed, based on
previous testimony that the issue was one between trained
radiologists and doctors, albeit, general practitioners who do
not have the training in radiation science.
MR. PEARCE answered plaintively that this bill had nothing to
do with radiologists but it does address safe versus hazardous
exposure.
4:09:07 PM
MR. PEARCE continued by stating that clarification of the bill
over time had led to many who once opposed the bill to come
forward with support. He then said that a lot of things have
been changed including a change in how the bill treated
geographical location. He clarified this by stating that this
was not a rural versus metropolis issue. As an example, he
pointed to the worst problem that he had encountered which was
found in downtown Anchorage. He explained that the problem that
occurred was exposing patients to great amounts of radiation.
MR. PEARCE pointed out to the committee several examples, and
[pointing to several radiographs], said that the flaws that were
found in Anchorage were evidence of too much exposure and yet,
he said, this technician's supervisor explained to her that
there was not enough exposure. In other words, there was not
enough radiation. This was, he said, completely opposite of
reality.
MR. PEARCE then described an experiment that he and a colleague
did at the University of Alaska. They produced a perfect
radiograph that was medically diagnostic. He then explained that
they did a series of exposures that exponentially doubled the
radiation each time. The first doubled the normal optimal
radiograph which made tissue observation impossible and left
bone analysis okay. He indicated that to get a full black
radiograph, the dummy patient had received 60 times the optimal
level of radiation. This is close to what is happening here in
Alaska.
MR. PEARCE warned that the reason these technicians must be
trained and be required to operate at higher caliber than they
currently are required to do. He pointed out that current state
regulations stipulate that technicians must be trained but it
does not say for what duration. The people that have gone to
professional schools are excluded by this bill and are left
untouched, but those so-called technicians that operate
radiological equipment that are no trained will be affected.
MR. PEARCE ended by bluntly stating that this bill really has to
do with people that are exposing other people to unsafe levels
of radiation. He then exhibited several other examples of bad
radiography including a cervical spine shot, which exposed the
occipital and temporal aspects of the skull with huge amounts of
unneeded radiation, in addition to the chest and the thyroid
gland, which is very sensitive to radiation. He also pointed
out an example that showed a patient receiving a cervical spine
shot, not being asked to lower his shoulders to minimize
exposure to the chest.
MR. PEARCE pointed out that depending on what part of the body
you are trying to image, the techniques will vary and it is
important not to visualize radiography like one would
photography, since they are very different approaches to imaging
physical reality.
4:15:41 PM
MR. PEARCE stated that getting an overdose does not mean you are
mortally injured. He pointed out that there are some medical
standards of practice regarding acceptable radiation exposure
limits. However, the state regulations do not specify radiation
exposure limits and decisions regarding radiation exposure are
left to the clinician. However, this responsibility that is
levied towards the health care provider, does not mean that
radiation-imaging go beyond what is a medically sound exposure.
MR. PEARCE then referred back to his previous example and said
that exposing the patient 60 times the optimal level is not
acceptable. He ends by stating that it does require a modicum
of intelligence.
CHAIR ANDERSON gave his appreciation gave a succinct summation
to the speaker by stating that whether it is over or under the
medically appropriate radiation exposure, the problem lies in
having to repeat the procedure due to first time technical
difficulties. He then asked if getting these people licensed
and educated was the quintessential thing to do so that this
would not ever happen.
MR. PEARCE stated that this would not occur if these people were
educated. He concurred with the Chair and then offered the
reasonable assertion that if there was an accident, it would be
a salvageable radiograph. The whole idea here is that this is
not photography and this tool is not comparable to the camera
[in that the former is passive]. The x-ray is an active
administration of radiation. He mentioned also that even
diagnostic radiation levels have been linked to diminished
capacity in intelligence development, and to breast cancer.
CHAIR ANDERSON stated that MR. PEARCE had made the point that
the sponsor was trying to make and asked if he would stand by
for questioning.
ED HALL, legislative liaison for the Alaskan Academy of
Physician Assistants, stated that there has not been a flip-flop
on our position and have always thought that some of the
language on the bill could be changed so that it appealed to the
group. Basically this would have been the inclusion of
physician assistants and nurses practitioners as part of the
excluded group not affected by the new bill.
4:21:11 PM
MR. HALL indicated that as PA's, they recognize that his group
works for our physician within their specific specialties.
However, he said, that one of his concerns was why the bill was
not being hear in the HES committee instead of the Labor and
Commerce committee.
MR. HALL continued by noting that the language was changed and
that upon further reading he pointed out that in section
8.89.120, beginning on page 2, line 29, and ending on page 3,
line 12, section C, the bill never states whether or not out his
profession can do radiology.
4:24:20 PM
MR. HALL indicates that he is mostly speaking on behalf of
people who have the radiological equipment and will be kept from
using it for simple radiology. He agreed thought that the bill
dealing with higher end imaging like cat-scans, and fluoroscopy,
do need to regulated, but putting simple radiology into the same
class would be a detriment to healthcare. He also said that
requiring this amount of training for the number and type of
imaging that is done annually does not balance itself.
MR. HALL then described the actual process that goes on between
a clinic and the radiologist that actually reads the film. He
said that if the radiologist makes a comment about the film,
i.e., that it is too dark or too light, then that is noted. The
radiologist makes a qualified read or they refuse to look at it
if is very poor quality.
MR. HALL then indicated that he understood the passion behind
this bill, however, he announced that what the academy would
support is changing the bill so that there is a requirement for
certification for anyone doing high end imaging including
nuclear medicine, MRI, Cat-scans, and any process that might
result in higher than normal radiation exposure, but not impact
the day-to-day routine use of low grade radiation used with
normal x-rays.
CHAIR ANDERSON announced that at first he was not going to
support this bill but after receiving several examples of the
problem and experiencing a radiological over exposure in his own
family, he changed his mind. He indicated that his son had
fallen and hurt his arm and after listening to a clinic PA
exclaim that the arm was broken, it was re-shot at the hospital
where the radiologist said that it was not broken. He said that
this was a perfect example of double exposure.
MR. HALL asked if the film was read at the hospital and asked if
the radiologist indicated what was wrong with the first film.
CHAIR ANDERSON answered that he was just following orders and
did not get a reason for the problematic film.
MR. PEARCE stated that he heard something in the previous
speakers speech that gave him some concern. He pointed out that
the bill simply is not centered on physician assistants at all.
He then indicated that in AS 8.89.100, the bill is talking about
who is impacted by the bill and who is not, as found in
subsection (b). He stated that what a PA knows or doesn't know
is irrelevant. This bill does not concern this profession.
CHAIR ANDERSON announced that he was going to obtain a legal
opinion on this and get back to the committee.
MR. HALL asked if the two nurses that work underneath him were
going to have to be licensed.
MR. PEARCE answered that yes, any healthcare worker that does
not have a professional degree will have to be licensed.
MR. HALL then asked if he were going to be forced to do all the
shots until these women were certified.
4:32:18 PM
MR. PEARCE answered that the training administered by Mr. Hall
can be evaluated and take the place of certification. He then
said that the bill is a platform and refinement will certainly
take place. He then again said that it does not matter what the
PA does or does not know and that this lack of knowledge is
dealt with by the board and not this bill.
MR. HALL asserted that the medical board would rely heavily on
this bill and pointed out that this is why diligence was being
paid to the passage of the bill now.
REPRESENTATIVE ROKEBERG stated that it may be possible to apply
for temporary permits as a transitional phase, and that this may
have to be determined while the bill is in committee.
CHAIR ANDERSON indicated to Mr. Hall that this bill is a work in
progress.
BARBARA HUFF-TUCKNESS, Director, Governmental Affairs, Teamsters
Union 159, indicated that in representing radiological
technologists, she was surprised that certification in
radiological science was not required. She said that training
and certification of this training is a must ubiquitously around
the state, and that the South Peninsula and Kodiak Island
Hospital already require certification. She then said that if
you don't have a properly trained worker and as the equipment
becomes more technical, the lack of certification will affect
job performance. The workers that are being utilized as
radiological technicians should be encouraged to go to school
and become experts in their field.
MS. HUFF-TUCKNESS then changed course to voice an objection to
the fact that truck drivers to be certified since they haul the
equipment around the state, yet radiology technicians are not
required by state law to be certified. She describes this
oversight as appalling. She asked the committee to please pass
the bill through.
4:36:35 PM
STEVE GAGE, physician assistant, Sitka, Alaska, announced that
he was Chair of the Community Health Care Directors Association
and representative SE Alaska Healthcare Consortium. He
indicated that he had some concern about the bill and how it
affects mid-level practitioners, or Nurse Practitioners and
Physician Assistants. He agreed with Mr. Hall that this is not
communicated effectively or explicitly.
MR. GAGE stated that his chief reason for testifying is the
concern he and others have about access to basic radiological
services in the villages and deep in the bush, for basic
extremity care. He described the community health aid program
as a collection of 500 clinics that are headed by mid-level
providers, such as nurse practitioners and physician assistants.
He continued by stating that these clinics are the backbone of
healthcare in the rural areas and without the clinics, there
would be no modern healthcare. He then stated that the main
thing that these clinics are in need of are radiological
services. Unfortunately, he said that native communities do
have to take a plane ride into a larger town to get the same
services that Representative Anderson used for his son in
Anchorage. Weather and daylight play a factor in transportation
to the hospital since flight to and from there from the village
is the only way to get the patient to the services that they do
not have in the bush. Things of this nature could be taken care
of in the village and the trip would not be necessary.
4:39:23 PM
MR. GAGE then stipulated that even though the mid-level
practitioners are grandfathered in, the medical workers that
work for them are not and that he wondered what kind of training
is going to be required by the state for education and training.
He pointed out there are 20 hours of continuing education and
that these workers were busy people and could not be bothered
with this type of requirement, since it would not be feasible
financially. He then added that it leaves the clinics
shorthanded while they are gone. He then stated that the clinics
have been utilized the protocol already put into place by the
Alaskan Native American Healthcare Diagnostic Training. This is
augmented by the fact that all of the films that are taken are
overseen by an actual radiologist and there is dialog that takes
place immediately. He ended by stating that he was concerned
about the fees and that the training not be overkill.
4:42:49 PM
CHAIR ANDERSON stated that he would try to work on the cost
factors in rural Alaska and trying to keep the fees reasonable.
4:43:25 PM
ANN DAILY, physician assistant, regional clinic, Illiama,
Alaska, pointed out that the 7 remote clinics in her region do
not have ready access to high end radiological diagnostic care
provided by trained, educated technicians, and lack the ability
to have the native workers directly supervised by a certified
technician. She indicated that they also lack the ability to
effectively certify all of these uneducated native workers. She
then pointed out that the physician assistants working in these
clinics are well qualified to do simple radiological procedures
and that the radiographs that are created by the physician
assistants are reviewed by radiologists and there is discussion
between the two professionals. She indicated that there are
measures of protection in the clinics that measure the amount of
radiation exposure that occurs.
MS. DAILY made it a point to mention that she had worked with
radiological technicians that were certified, and that she
actually experienced on occasion, both over and under exposed
films created by credentialed staff.
MS. DAILY ended by stating that House Bill provided no
additional safety assurances and in some instances, will
negatively impact the ability to provide decent healthcare to
some Alaskans. She asked the committee to consider the
financial impact on these remote villages.
4:47:09 PM
REPRESENTATIVE LEDOUX pointed out that Ms. Daily operates the
sub regional class of village healthcare, but those serving
underneath her are not medical professionals and that they
certainly were not physician assistants.
MS. DAILY agreed and answered that this was correct.
GUMENSINDO ROSALES, registered radiological technologist,
indicated that the current medical system in Alaska is broken,
especially based on the testimony of Clyde Pearce. He then
pointed out that testifiers that have come before are coming at
this from a weak and unrelated issue, primarily that being
access and the inability for the native workers to be able to
afford to leave and get training and certifications. He then
pointed out that by investing $70 a year, and $140 dollars for
two years, they can continue their education (CE) and not be
burdened with the travel expenses or the time spent away
receiving the training in a classroom. He ended by stating that
the only financial impact here is the initial training which all
uneducated workers will have to manage, and updating this
training can be as simple as reading a magazine provided by the
American Society for Radiological Technology, which they will be
a part of when they are certified.
4:49:27 PM
MR. ROSALES referring to Article 1, Section 8.89.150, stated
that this bill is primarily pointed at ionizing radiation and
not magnetic energy. He then referred to Article 3, Section
8.89.990, where it defines the work of the limited technician as
one that is primarily concerned with the "the axial-appendicular
skeleton". He said, from his experience, that the axial-
appendicular aspect of the human skeleton includes the head and
neck, and spine and that these areas are not touched by the
inexperienced technicians, since the eyes and the abdomen are
very vulnerable to radiation exposure. He indicated that this
work is reserved for the radiologist or a certified technician.
CHAIR ANDERSON asked if Mr. Rosales would memorialize his
testimony and make a concrete argument that is definitive.
MR. ROSALES stated that in the industry, the nationwide standard
consisted of 24 hours of continuing education exams (CEE), and
changing the bills stipulation of 20 to the national standard of
24, which would make it easier for people who are transferring
from other states to work in Alaska.
CHAIR ANDERSON asked the speaker to contribute this in written
form. He then closed public testimony.
[HB 150 was held over.]
HB 147-INSURANCE
4:52:49 PM
CHAIR ANDERSON announced that the last order of business would
be HOUSE BILL NO. 147, "An Act relating to the regulation of
insurance, insurance licensing, surplus lines, insurer deposits,
motor vehicle service contracts, guaranteed automobile
protection products, health discount plans, third-party
administrators, self-funded multiple employer welfare
arrangements, and self-funded governmental plans; and providing
for an effective date."
4:53:18 PM
CHRISTINE SASSE, Department Director, City of Valdez, announced
that she was addressing Article 2, where the bill discusses
self-funded government plans, and how they are going to have to
comply with the provisions of AS 21.85. She indicated that her
biggest concern was the applicability clause found in Article 2,
page 15, line 8, which seemed too broad in her eyes, though she
assumed that it was not intended to be so broad. She then
indicated that she had looked up AS 39.30.090 and it refers to
plans under the state of Alaska, but it appears that any other
state funded government plan has to comply. If this is the
case, then this entire Article 2 imposes onerous requirements
for self funded governmental plans.
MS. SASSE then pointed out that the filing of the plan
description and the contribution rates and the financial reports
all have to be filed quarterly, and there has to be actuarial
memorandums concerning all these issues. In addition to this,
there is a requirement to generate a board of trustees. She
added that this adds considerable expense to a plan and very
little benefit.
4:55:53 PM
MS. SASSE said that there is a committee that helps determine
how the plan is to be administered. It is very flexible and we
have assistance given by a consultant who helps us determine
what benefits are reasonable under the plan. In referring back
to the board of trustees, she said that having a board that is
indifferent and uninterested in the participants of the
insurance plan seems ridiculous. On top of this is the cost of
the fidelity bond and the requirement to have an actual actuary
look at and confirm the plan is financially sound. She also
complained about the requirement to comply with additional
standards. These additional standards include defining her
group as a mutual insurer, which requires the city to file a
certificate of authority with the state on an annual basis that
requires a financial assurance and legal certification. She
pointed out that most companies have a separate department to do
these tasks and it is obvious, she said, that the city of Valdez
cannot do this and would be forced to hire a consultant to help
on this matter. There is also, she said, the requirement of
mutual insurers to pay taxes to the state, which means that the
city would pay taxes to the state.
4:58:18 PM
MS. SASSE then stated that in addition to all of this, there are
the rules on regulations placed on the director, found on page
17, Section 21.85.230, line 21. She pointed out that the
required coverage of risks in parity with other governmental
plans would increase the cost of insurance to the consumer. She
indicated that her city plan is a good one and that these new
changes will double the cost of the insurance plans and
eliminate cost effective and flexible health insurance for those
that are under self funded governmental plans.
REPRESENTATIVE ROKEBERG asked if her consultant was providing
actuarial analysis of solvency and also asked if she had a stop-
loss policy.
MS. SASSE answered that our consultants has provided us with
considerable amount of information that will help determine what
our premium levels will be. She then indicated that there is a
policy in place and reserves are in place, and have in fact, had
some high claims recently but the financial reserves are still
viable and above the minimum required.
REPRESENTATIVE ROKEBERG asked if she carried stop loss
insurance.
MS. SASSE answered that they do have stop loss insurance.
GREG CULBERT, assistant school superintendent, Galena School
District, stated that his group has a self-funded plan and that
it would have the same problems as mentioned by Ms. Sasse. He
indicated that there was a cost effective plan for the employees
and a trustee council in place that administers the insurance.
He stated that his group and all other self-funded governmental
plans ought to be able to create their own insurance and manage
in their own way. In lieu of their viability, he indicated that
they have stop loss insurance, aggregate stop loss insurance,
and they fund the policy quite well.
MR. CULBERT then asserted that if the true reason behind this
language is to rid the state of self funded insurance groups,
and get everyone into a nationwide policy that is based in the
lower 48 insurance conglomerate, and then stated that the reason
for wanting self-funded insurance is a fiduciary responsibility
to save money and divert it into the school itself, which then
helps the community.
MATT LARKIN, Willis of Alaska, Anchorage, stated that he agreed
with both previous speakers. He then stated that he
specifically had problems with the applicability section, from
which there are many different readings that can gathered, and
that they do not make it clear for who this section is intended.
He then commented that these new requirements are onerous, and
burdensome and expensive. He continued by stating that new bill
is impractical by requiring these communities to obtain a board
of trustees even though most of these plans do not have the need
for a board of trustees, and, he asserted, certainly not one
that does not have a vested interest in the group plan. He
continued by stating that the fact that the group cannot use one
of their own as an entrusted trustee is ridiculous. Lastly, he
said that most of these communities are not big enough to find
someone that is not related or affected by the plan, or more
importantly, bare the fiduciary liability, since they would not
be affected by its coverage.
MR. LARKIN then stated that implementing this bill would be
hugely expensive costly as hiring actuaries and attorneys to
draft the trust document, and the premium cost would be very
costly.
5:06:36 PM
MR. LARKIN stated that all of these municipalities are under
budget constraints and that the addition of these requirements
will increase costs, require them to reduce the benefit or have
the employers pay more for the insurance. He ended by stating
that there is nothing good that come out of this bill and that
these groups already have good plans in place and they do not
need this type of regulation.
RICHARD CAMPBELL, General Services Director, Kenai Peninsula
Borough, asked if this bill would concern us and what the
reasoning behind the drastic changes that are being proposed.
MARY STOLL, trust attorney, Local 71 Trust, stated that the bill
placed an economic burden on self-funded plans and on the out of
state PK's. Why does it carve out specifically self-funded
governmental plans and not all self funded plans that are
operating in the state. She assumed that it was some sort of
ploy to drag self-regulated groups under the direction and
control of the Director of Insurance.
MS. STOLL remarked that these groups do not operate under
policies or contracts of insurance. The coverage is given with
boards of trustees, and is a product of collective bargaining
and the authority to operate in the state as required by AS
21.030.21B was provided by a letter of agreement which is signed
by the Division of Retirement and Benefits. She pointed out
that each year they work out what the contribution rate is going
to be based on advise from qualified consultants working in the
area of insurance.
5:11:13 PM
MS. STOLL then stated that she thought that these employers
would want the contribution to go to the provision of benefits
and not the to the compliance to onerous filing requirements
provided in this bill. She then complains about the
stipulations found in the bill concerning the organization and
the definitions that are used in the bill. She described the
bill as being sort of a quagmire for her and the rest that were
trying to interpret the bill.
5:12:28 PM
MS. STOLL stated that the independent funds already complied
with the fiduciary standards of ARISA. It would be easier to
file a 5500 with ARISA than comply with the statutes found in
this bill. She ended by stating that she did not know what the
bill was trying to achieve other than placing a huge economic
burden on plans that are already struggling to do the right
thing by their clients
5:13:17 PM
COLLEEN SAVOIE, consultant, local public 71 trust, wanted to
speak specifically to the concerns of the local 71 trust, but
she indicated that there were several other governmental groups
that are not sure about its applicability. This bill imposes a
costly administrative burden and the filing requirements that
are proposed in House Bill 147 is tremendous. The cost at
minimum for an actuary would be 40 to 50 thousand dollars a
year.
5:15:15 PM
MS. SAVOIE said the fidelity bond would be no less than 10
percent of the benefits paid the previous year. This is larger
than that requirements of ARISA and larger than fidelity bonds
that most healthcare insurers hold. A bond of this size
according to several insurance carriers we talked to said that
is would increase administrative rates and increase the
deductible on the premiums held by the clients since it may not
be considered an ARISA bond.
MS. SAVOIE then said that the requirement for an actuary is too
much since not too many of them are willing to insure their work
and assume the liability of the plan. She continued by stating
that employer plan contribution rates have to be filed 60 days
after the end of the plan year which means that State plans have
to be filed by the administration sometime towards the end of
session. She mentioned that this might be an inconvenience.
MS. SAVOIE ended by stating that the bill is unnecessary and
that all the plans that she knew about were doing quite well and
had governing organizations and audits by separate oversight.
She ended by stating that people involved in these plans have an
appeals process that includes arbitration and civil suits.
REPRESENTATIVE ROKEBERG asked, referring to the third party
arbitration, if each member received this type of appeals
process.
5:19:51 PM
MS. SAVOIE answered that each plan determines what the appeals
process is going to be. They go to the board and then on to
binding arbitration, which is a low cost alternative to courts.
MS. STOLL stated that any allegation of fiduciary breech or non-
funding, or insufficient funding of the trust, any participant
has a right to bring suit for a breech in trust. She continued
by stating that there is ample opportunity to hear testimony
concerning alleged violation of trust to be heard in the court
system.
REPRESENTATIVE ROKEBERG stated that he sees a problem with the
lack of supervision in the arbitration mode, and that this area
needs to discussed further since it is clear that one has to sue
in order to have someone hear grievances. Under state law, the
patient bill of rights, which puts in place a third party peer
review that that is "scientific" peer review and not some
arbitration.
MS. STOLL answered that it's more than a two-tier process. The
participant would have an opportunity to appeal to the claims
administrator, and from there they go to the board of trustees,
and they in turn, refer this to a medical review corporation who
is given no incentive for one decision or another. She ended by
stating that there are rules that govern self-funded plans in
the United States and Canada.
CHAIR ANDERSON said that this was a work in progress.
[HB 147 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
5:23:42 PM.
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