04/27/2007 03:00 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB209 | |
| HB200 | |
| HB71 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 200 | TELECONFERENCED | |
| += | HB 71 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 209 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
April 27, 2007
3:10 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Mark Neuman, Vice Chair
Representative Gabrielle LeDoux
Representative Jay Ramras
Representative Robert L. "Bob" Buch
Representative Berta Gardner
MEMBERS ABSENT
Representative Carl Gatto
COMMITTEE CALENDAR
HOUSE BILL NO. 209
"An Act relating to the chair of and the membership of and
qualifications of members of the Regulatory Commission of
Alaska; adding positions to the partially exempt service;
creating an administrative law division and natural gas and oil
pipeline division within the commission; amending the timeline
requirements for a final order of the commission; relating to
the commission's regulatory cost charges; and adding to the
duties of the Alaska Judicial Council as they relate to the
presentation of nominees for consideration for appointment to
the commission."
- MOVED CSHB 209(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 200
"An Act relating to the presumption of coverage for a workers'
compensation claim for disability as a result of certain
diseases for certain occupations."
- HEARD AND HELD
HOUSE BILL NO. 71
"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
PREVIOUS COMMITTEE ACTION
BILL: HB 209
SHORT TITLE: REGULATORY COMMISSION OF ALASKA
SPONSOR(S): LABOR & COMMERCE
03/19/07 (H) READ THE FIRST TIME - REFERRALS
03/19/07 (H) L&C, JUD, FIN
04/13/07 (H) L&C AT 3:00 PM CAPITOL 17
04/13/07 (H) Heard & Held
04/13/07 (H) MINUTE(L&C)
04/27/07 (H) L&C AT 3:00 PM CAPITOL 17
BILL: HB 200
SHORT TITLE: WORKERS' COMP: DISEASE PRESUMPTION
SPONSOR(S): REPRESENTATIVE(S) DAHLSTROM
03/14/07 (H) READ THE FIRST TIME - REFERRALS
03/14/07 (H) L&C, JUD
04/27/07 (H) L&C AT 3:00 PM CAPITOL 17
BILL: HB 71
SHORT TITLE: LICENSING RADIOLOGIC TECHNICIANS
SPONSOR(S): REPRESENTATIVE(S) KAWASAKI
01/16/07 (H) PREFILE RELEASED 1/5/07
01/16/07 (H) READ THE FIRST TIME - REFERRALS
01/16/07 (H) L&C, FIN
03/21/07 (H) L&C AT 3:00 PM CAPITOL 17
03/21/07 (H) Heard & Held
03/21/07 (H) MINUTE(L&C)
04/27/07 (H) L&C AT 3:00 PM CAPITOL 17
WITNESS REGISTER
JOHN BITNEY, Legislative Liaison
Governor's Legislative Office
Office of the Governor
Juneau, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 209.
RICHARD GAZAWAY, Hearing Examiner
Common Carrier
Regulatory Commission of Alaska (RCA)
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Responded to questions during discussion of
HB 209.
MARK JOHNSON, Commissioner
Regulatory Commission of Alaska (RCA)
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Responded to questions during discussion of
HB 209.
JANIS WILSON, Commissioner
Regulatory Commission of Alaska (RCA)
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Responded to a question during discussion
of HB 209.
KRISTI CATLIN, Vice President
State Law & Government Affairs
AT&T Alascom
Anchorage, Alaska
POSITION STATEMENT: Expressed concerns with some of the
provisions of HB 209.
JAMES ROWE, Executive Director
Alaska Telephone Association (ATA)
Anchorage, Alaska
POSITION STATEMENT: Expressed concerns and responded to
questions during discussion of HB 209.
VIRGINIA RUSCH
AARP
Anchorage, Alaska
POSITION STATEMENT: Expressed concerns with some of the
provisions of HB 209.
REPRESENTATIVE NANCY DAHLSTROM
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 200.
KELLY HUBER, Staff
to Representative Nancy Dahlstrom
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Responded to questions during discussion of
HB 200 on behalf of the sponsor, Representative Dahlstrom.
LINDA HALL, Director
Division of Insurance
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of HB
200.
MARK DRYGAS, President
Alaska Professional Fire Fighters Association (AKPFFA)
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 200 and
responded to questions.
MATTHEW McSORLEY, Secretary/Treasurer
Alaska Professional Fire Fighters Association (AKPFFA)
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 200, and asked that the bill be moved from committee.
ERIC TUOTT
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 200, and responded to questions.
JEFF BRIGGS
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 200, and asked that the bill be passed out of committee.
PAUL F. LISANKIE, Director
Division of Workers' Compensation
Department of Labor & Workforce Development (DLWD)
Juneau, Alaska
POSITION STATEMENT: Responded to questions during discussion of
HB 200.
KEVIN SMITH, Executive Director
Alaska Municipal League Joint Insurance Association,
Inc.(AMLJIA)
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 200.
REPRESENTATIVE SCOTT KAWASAKI
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 71.
CLYDE E. PEARCE, Radiologic Health Specialist II
Radiologic Health
Laboratories
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 71.
DONNA J. RUFSHOLM, R.T., Chair
Legislative Committee
Alaska Society of Radiologic Technologists (AKSRT)
Homer, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 71.
RHONDA MERRIHEW, R.T., Co-Chair
Legislative Committee
Alaska Society of Radiologic Technologists (AKSRT)
Anchorage, Alaska
POSITION STATEMENT: Provided comments and responded to
questions during discussion of HB 71.
PAUL HANSEN, Deputy Administrator
Maniilaq Health Center
Maniilaq Association
Kotzebue, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 71, and suggested an amendment.
S. LYNN HORNBEIN, M.D.
Palmer, Alaska
POSITION STATEMENT: Provided comments and asked questions
during discussion of HB 71.
SONIA HANDFORTH-KOME, President
Alaska Primary Care Association (APCA);
Executive Director
Iliuliuk Family & Health Services, Inc.
Unalaska, Alaska
POSITION STATEMENT: During discussion of HB 71, provided
comments and indicated that her organizations do not support the
bill as currently written.
ACTION NARRATIVE
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 3:10:04 PM. Representatives Buch,
LeDoux, Neuman, Gardner, and Olson were present at the call to
order. Representative Ramras arrived as the meeting was in
progress.
HB 209 - REGULATORY COMMISSION OF ALASKA
CHAIR OLSON announced that the first order of business would be
HOUSE BILL NO. 209, "An Act relating to the chair of and the
membership of and qualifications of members of the Regulatory
Commission of Alaska; adding positions to the partially exempt
service; creating an administrative law division and natural gas
and oil pipeline division within the commission; amending the
timeline requirements for a final order of the commission;
relating to the commission's regulatory cost charges; and adding
to the duties of the Alaska Judicial Council as they relate to
the presentation of nominees for consideration for appointment
to the commission." [Before the committee was the proposed
committee substitute (CS) for HB 209, Version 25-LS0717\M, Kane,
4/12/07, which had been adopted as the work draft on 4/13/07.]
3:10:53 PM
JOHN BITNEY, Legislative Liaison, Governor's Legislative Office,
Office of the Governor, indicated that HB 209 proposes several
revisions to the statutes pertaining to the Regulatory
Commission of Alaska (RCA), revisions the administration hopes
will improve the RCA and its decision-making processes; in part,
HB 209 addresses the RCA's timelines for dockets, and provides
that the governor shall appoint the RCA's chair. He then spoke
briefly about other pieces of legislation.
CHAIR OLSON offered his understanding that prior to 2002, the
governor had the ability to appoint the chair of what used to be
the Alaska Public Utilities Commission (APUC) and is now the
RCA.
REPRESENTATIVE GARDNER said she has concerns with the governor
appointing the chair of the RCA, and requested clarification
regarding the change proposed via Section 2.
REPRESENTATIVE LeDOUX surmised that under Section 2, hearings
and proceedings before the RCA would become more formal and
complex.
3:21:27 PM
RICHARD GAZAWAY, Hearing Examiner, Common Carrier, Regulatory
Commission of Alaska (RCA), Department of Commerce, Community, &
Economic Development (DCCED), concurred.
REPRESENTATIVE GARDNER asked whether such hearings and
proceedings would then take longer and be more expensive.
MR. GAZAWAY acknowledged that that might be the case.
3:22:21 PM
MARK JOHNSON, Commissioner, Regulatory Commission of Alaska
(RCA), Department of Commerce, Community, & Economic Development
(DCCED), concurred, but remarked that the RCA's hearing examiner
staff is fully capable of handling more complex hearings and
proceedings.
3:22:56 PM
JANIS WILSON, Commissioner, Regulatory Commission of Alaska
(RCA), Department of Commerce, Community, & Economic Development
(DCCED), acknowledged, though, that the RCA's regulatory bar
might need to make some adjustments.
REPRESENTATIVE GARDNER questioned whether adopting Section 2 is
the best approach given that one of the legislature's goals is
to have the RCA's decision-making process take less time and be
less costly. She then referred to page 2, lines 25-29 -
proposed AS 42.05.151(e)(1) - and questioned what precluding
petitions to intervene by those without a current,
nonspeculative property interest in the subject of the
proceeding will mean for groups such as the AARP and the Alaska
Public Interest Research Group (AkPIRG), groups - or even
individual members of the public - that would have a concern
with how rates are set.
MR. GAZAWAY replied that that the RCA currently adheres to a
somewhat lenient standard regarding intervention, taking into
consideration factors such as property interests, financial
interests, or "other" interests, and whether participation by
such parties will aid in the development of the record. He
acknowledged that the proposed change creates a more stringent
requirement for intervention. In response to a question, he
also acknowledged that intervention, regardless of the interest,
can lengthen the time of a proceeding.
REPRESENTATIVE GARDNER referred to paragraph (1)(A) of Section
9, and offered her understanding that the term, "good cause" -
as used in paragraph (1) - is well defined, whereas the term,
"unusually complex and novel" - which is proposed as an
additional qualifier in subparagraph (A) - is not. She opined
that this change offers no benefit but will instead cloud the
issue of whether a timeline should be extended.
CHAIR OLSON suggested that the House Judiciary Standing
Committee could better address that issue.
REPRESENTATIVE GARDNER referred to subparagraph (C) of
Section 9, and offered her understanding that currently the RCA
does extend timelines due to its workload.
MR. JOHNSON concurred, and explained that the RCA would like the
flexibility to extend timelines when its workload necessitates
it.
CHAIR OLSON suggested that the House Judiciary Standing
Committee could better address that issue as well.
MR. BITNEY acknowledged the concerns regarding Sections 2 and 3,
and offered that Section 9 contains suggested language "that
came to us on the docket."
3:31:27 PM
KRISTI CATLIN, Vice President, State Law & Government Affairs,
AT&T Alascom, referred to Section 1, and said that her company
is in favor of maintaining the existing system wherein RCA
commissioners pick their own chair, but would like to see the
chair's term of office lengthened. She shared her understanding
that the existing system was put in place in order to
depoliticize the process, and said her company believes that
this system is working since one must gain the support of
his/her peers before being elected to serve as chair. She then
said that her company shares some of the previously mentioned
concerns regarding Section 2; its proposed changes could cause
further delays and heighten the system's level of technicality.
Rules of evidence normally apply only in civil court and don't
generally apply in administrative hearings, and while RCA staff
may have the skills to handle the proposed change, everyone
involved would have to be refreshed on what the technical rules
of evidence are because they haven't had to operate under them.
Therefore, her company's preference would be that the change
proposed via Section 2 not be adopted.
MS. CATLIN turned attention to Section 3, specifically proposed
AS 42.05.151(d), and said the existing civil rules are not
easily applied and therefore it might be better to allow the RCA
to determine which rules it wishes to adopt, though if this has
not occurred by the next legislative session, the legislature
could address the issue at that point. Referring to proposed AS
42.05.151(e), she said her company is not opposed to the change
regarding petitions to intervene because it feels that there
should be rules regarding intervention, but mentioned that she
herself does have a concern regarding precluding members of the
public from filing petitions to intervene. Referring to the
terms, "good cause" and " unusually complex and novel" as used
in Section 9, she said she agrees that the proposed additional
qualifier might cause difficulties with appeals. In conclusion,
she said her company believes that the RCA has done a tremendous
job of improving its processes and getting decisions out, and
therefore has her company's support.
MS. CATLIN, in response to a question, said that her company has
no problems with the timelines outlined in the bill.
3:36:42 PM
JAMES ROWE, Executive Director, Alaska Telephone Association
(ATA), said that the ATA would like to see the RCA reauthorized,
and agrees that the RCA has done a good job, a job wherein not
all members of the industry are going to be happy with any given
decision. Referring to Section 1, he said that the ATA has no
adverse reaction to having the governor appoint the chair of the
RCA, though it is also satisfied with the current system because
it has resulted in a functioning RCA. Referring to Section 2,
he posited that the current system has worked well without
tighter guidelines regarding evidence brought before the RCA,
and said that the ATA is happy with how things are going in that
regard. Referring to Section 3, he said that the ATA shares the
concerns regarding paragraph (e)(1), adding that it would be
unfortunate if a party was precluded from offering beneficial
information just because the party had only a speculative
property interest.
MR. ROWE, with regard to timelines, stated that the ATA is happy
to see them. With regard to Section 9, he expressed agreement
with the comments made by Janis Wilson at a prior hearing that
the term, "good cause" has already been defined via case law.
He opined that the change proposed via paragraph (1)(A) appears
to be attempting to use the term ""unusually complex and novel"
to define the term, "good cause", and suggested that doing so
will lead to further delays. Referring to Section 10,
specifically proposed AS 42.05.175(n), he opined that if the
commission is not allowed to extend a timeline due to workload
constraints, then this provision implies that a bad decision is
preferable to a considered decision. Remarking that in the last
few years there have been few dockets that have been extended
due to the RCA's workload, he said he would prefer an extended
timeline and a considered and good decision versus a poor
decision.
MR. ROWE, in response to a question regarding Section 1, said
that he doesn't know that one methodology of picking a chair
will serve the public any better than the other. He shared his
hope that the commissioners of the RCA are focusing on the
issues before them rather than who shall get to be chair. Upon
a request to chose which methodology he prefers, Mr. Rowe said
he would prefer for the commissioners of the RCA to elect their
own chair, but suggested that the proposed three-year term ought
to be deleted, adding that he would like the commissioners to
have the opportunity to vote for the best chair.
3:48:35 PM
VIRGINIA RUSCH, AARP, relayed that the AARP has been very
interested in the impact of utility rates on consumers, and that
she has worked with the RCA and its predecessor since 1981 and
has worked as an assistant attorney general for 23 years - 14 of
which she was assigned to represent the APUC and the RCA. She
remarked that she has seen a lot of how the RCA operates, and
mentioned that at one point she was assigned to the
Transportation Section of the Department of Law (DOL) where she
"did some large scale contract litigation in the court system"
and so has observed how the technical rules of evidence and the
rules of discovery in court operate in contrast with the RCA's
proceedings. She said that although the AARP has sent the
committee a letter that summarized the AARP's position, she
would like to respond to some of the questions raised thus far.
MS. RUSCH, referring to Section 2 and the question of whether
having to apply technical rules of evidence would lengthen
hearings and proceedings and make them more costly, opined that
it would, recalling that it often took her many hours of
preparation just to learn the technical utility, accounting, or
finance-type issues involved in a case, and so if she'd had to
also keep in mind technical rules of evidence, it would have
required many more hours of preparation. Such increases in
preparation time will result in increased utility expenses for
all.
MS. RUSCH referred to Section 3, specifically the provisions
regarding discovery, and opined that this will take the RCA in
the wrong direction if the legislature's goal is to cut some of
the costs of proceedings. She suggested as an alternative that
the bill be altered such that it contains standards directing
the RCA to ensure that the parties have appropriate discovery at
the least cost. Referring to the language of Section 3
regarding petitions to intervene, she characterized it as
disturbing to the AARP because it would prevent the AARP from
seeking to intervene or argue or present issues on behalf of
consumers. There is just no need, she opined, for any statutory
provision addressing intervention because the RCA, for many
years, has had standards set out in regulations.
MS. RUSCH mentioned a recent case wherein the court considered
the RCA's decision regarding intervention; in that case, one
refuse utility that competed with another refuse utility sought
to intervene in the rate case of that other utility. The RCA
refused intervention on the basis that the cost of discovery for
the other utility "would drive out the competition," and the
RCA's decision on that proceeding was upheld by the court. She
offered her understanding that ever since the federal Public
Utility Regulatory Policies Act of 1978 (PURPA) began requiring
some compensation for consumers' interveners, there has been a
policy to try to encourage consumer intervention. However, it's
a little more problematic, she remarked, when two utilities are
fighting each other and attempt to participate in each other's
rate cases; intervention in such situations just results in
longer, more expensive proceedings, but the bill's provisions
regarding intervention aren't going to solve this sort of
problem. She urged members to remove those provisions.
MS. RUSCH, in conclusion, stated that the RCA should have
flexibility with regard to timelines because, under the bill, if
the RCA makes a mistake, it will be the consumers who might be
hurt. For example, if a utility files a rate case asking for a
10 percent increase in rates, under the current statute if the
commission doesn't act by certain dates, that rate increase goes
into effect and consumers are required to pay it, but, under the
bill, if the RCA has a proceeding in which it examines all the
utility's rate justifications and concludes that the rate
increase should only be 5 percent but the commission is unable
to meet a deadline, the commission wouldn't have the flexibility
to extend that deadline and so the consumers would end up paying
[a rate increase double what the RCA thinks they should be
paying].
CHAIR OLSON asked how many times in the last three years has the
AARP intervened in an RCA decision.
MS. RUSCH replied that the AARP has intervened twice, has asked
to participate as an amicus curia in a court appeal on one case,
and has appeared at consumer hearings or has sent comment
letters four or five other times.
CHAIR OLSON, after ascertaining that no one else wished to
testify, closed public testimony on HB 209.
3:57:32 PM
REPRESENTATIVE NEUMAN moved to report the proposed committee
substitute (CS) for HB 209, Version 25-LS0717\M, Kane, 4/12/07,
out of committee with individual recommendations and the
accompanying fiscal notes.
The committee took an at-ease from 3:58 p.m. to 4:02 p.m.
CHAIR OLSON, noting that there were no objections to the motion,
announced that CSHB 209(L&C) was reported from the House Labor
and Commerce Standing Committee.
HB 200 - WORKERS' COMP: DISEASE PRESUMPTION
4:02:37 PM
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 200, "An Act relating to the presumption of
coverage for a workers' compensation claim for disability as a
result of certain diseases for certain occupations."
4:03:28 PM
REPRESENTATIVE NANCY DAHLSTROM, Alaska State Legislature,
sponsor, explained that HB 200 establishes a presumption that
certain professions carry a risk of certain diseases,
specifically the professions of firefighter - whether
professional or volunteer - peace officer, and emergency medical
and rescue personnel - referred to as "first responders."
Firefighters and first responders take great risks every day to
protect the public, she remarked, and mentioned that she and her
staff are still working on the fiscal issues related to the
bill.
REPRESENTATIVE GARDNER, referring to similar legislation heard
last year, noted that HB 200 now lists prostate cancer as one of
the presumptive illnesses.
REPRESENTATIVE DAHLSTROM remarked that HB 200 has also been
tightened up with regard to physical exams, tobacco use, and
applicable timeframes.
4:06:52 PM
KELLY HUBER, Staff to Representative Nancy Dahlstrom, Alaska
State Legislature, sponsor, in response to a question, explained
that under HB 200, the amount of time someone must work for "the
department" before qualifying for the presumption is now seven
years, and there is a new proposed AS 23.30.121(c)(1)(F), which
says: "(F) any uncommon infectious disease the contraction of
which the United States Secretary of Labor determines to be
related to the hazards to which an employee in fire protection
activities may be subject". In response to a further question,
she noted that statute does define the term "fire fighter"; AS
09.65.295(c) reads:
(c) In this section, "fire fighter" means a
person employed by a municipal fire department or who
is a member of a volunteer fire department registered
with the state fire marshal, or a person registered
for purposes of workers' compensation with the state
fire marshal as a member of a volunteer fire
department.
MS. HUBER, in response to another question, explained that under
the bill, in order to qualify, a firefighter must have worked as
a firefighter for at least seven years before developing or
manifesting the disease, and have passed a qualifying medical
exam, either upon becoming a firefighter or during employment as
a firefighter. Once these criteria have been met, under the
bill there is then a presumption that the disease was the result
of working as a firefighter. However, Section 1 of the bill
states that the presumption of coverage may be rebutted by a
preponderance of the evidence, which may include the use of
tobacco products, physical fitness, weight, lifestyle,
hereditary factors, and exposure from other activities.
REPRESENTATIVE NEUMAN surmised that such points would be heavily
debated in court, and expressed concern that the bill might
exacerbate the state's current problems with workers'
compensation.
REPRESENTATIVE GARDNER asked how many of Alaska's firefighters
would be affected by the bill.
MS. HUBER offered that the firefighters who will be testifying
later will present Alaska-specific statistics, and remarked that
the other states which have adopted similar legislation have
experienced only minor, if any, cost increases.
REPRESENTATIVE RAMRAS acknowledged that very few other vocations
require people to stand in harm's way, and shared his belief
that the bill is proposing appropriate coverage. He mentioned a
fire that occurred recently in Fairbanks, and stated his support
of HB 200.
REPRESENTATIVE LeDOUX asked what the interplay is currently
between health insurance and workers' compensation insurance.
For example, if firefighters who acquire one of the enumerated
diseases are not covered under workers' compensation, are they
covered under their health insurance policies?
MS. HUBER suggested that someone else might be better able to
answer that question, but surmised that the state's health
insurance policies would cover a firefighter with one of
enumerated diseases but only if it were not a preexisting
condition.
4:16:54 PM
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community, & Economic Development (DCCED), said she
has heard discussion regarding how an increase in the potential
cost for medical care for firefighters would affect the workers'
compensation system, but because few firefighters are currently
part of the "voluntary workers' compensation system," there is
very little data available. The National Council on
Compensation Insurance (NCCI), she relayed, has indicated to the
division that the increase to the overall workers' compensation
system costs is expected to be negligible, but [HB 200] may have
a significant impact on workers' compensation costs for certain
class codes, specifically those generally covered "in the self-
insured arena or in the program that most of the municipal
entities participate in."
MS. HALL remarked that the retroactive nature of some of the
bill's provisions may potentially lead to a significant unfunded
liability for things that have occurred in the past. Most of
what occurs in the workers' compensation rating arena for
insurance is prospective, and so it is particularly difficult to
make estimates of system costs for something that could be
retroactive, she said, but added that she would be willing to
discuss this issue further with the sponsor. In response to a
question, she said she does not know how the bill's provision
regarding a qualifying medical examination would be applied.
4:20:51 PM
MARK DRYGAS, President, Alaska Professional Fire Fighters
Association (AKPFFA), after mentioning that he works for the
City of Fairbanks fire department, relayed that the AKPFFA
stands in strong support of HB 200. He commented that the
diseases listed in the bill have an increasing effect on
firefighters, and that there is very little controversy over
whether such diseases are occurring in firefighters as a result
of their profession. In conclusion, he asked for the
committee's support of HB 200.
MR. DRYGAS, in response to a question, offered his understanding
that most firefighters get an exam upon becoming a firefighter
and then get additional physical exams yearly, adding that it
can be difficult to determine whether the occurrence of a
disease in a particular firefighter is the result of repeated
exposure or one instance of exposure.
REPRESENTATIVE NEUMAN said he'd received a letter from the
Municipality of Anchorage (MOA), and offered that it says in
part:
For specific employees, regardless of the cause, these
bills would have the municipality prove that they are
not work related. This is an impossibly high standard
in most cases, and one that requires personally
invasive investigation into an employee's life.
MR. DRYGAS acknowledged that the bill does require the employer
to dispute a claim that the occurrence of a disease was the
result of the job. He offered his understanding that the
cancers listed in the bill are very specific types of cancers
that are well documented as being more prevalent amongst
firefighters.
REPRESENTATIVE NEUMAN relayed that the aforementioned letter
goes on to say that no evidence has been provided to show that a
problem exists with the workers' compensation system with regard
to providing coverage for first responders.
MR. DRYGAS opined that if true, it merely illustrates that there
would not be a large number people being affected by the bill -
perhaps just one person every couple of years.
4:27:03 PM
MATTHEW McSORLEY, Secretary/Treasurer, Alaska Professional Fire
Fighters Association (AKPFFA), characterizing HB 200 as an
important bill, shared a story involving a Fairbanks firefighter
who died of a cancer that resulted from his exposure to
chemicals he encountered while performing his job, particularly
when putting out fires at industrial complexes. Mr. McSorley
explained that most homes these days contain many items that are
made of plastics and various other chemicals, all of which
produce large quantities of carcinogens when burned; modern-day
firefighters must use air packs when fighting fires because
inhaling such carcinogens even once can render a person
unconscious or dead.
MR. McSORLEY opined that there is an urgent need for HB 200 to
pass, and pointed out that every time he fights a fire, he is
contaminated by various chemicals because his skin - the largest
organ in the body - absorbs the resultant smoke. This is why
fire fighters get cancer two to three times more often than the
general population. He then predicted the arguments that
opponents of the bill would be making against it. In
conclusion, he asked the committee to move the bill from
committee and show support for Alaska's fire fighters and public
safety officers, who, he added, need the extra protection that
the bill provides.
REPRESENTATIVE LeDOUX noted that language on page 2 - proposed
AS 23.30.121(b)(2) - restricts the presumption to 60 calendar
months following the last date of employment, and expressed
concern about this limitation.
MR. McSORLEY said the AKPFFA was also concerned about that
limitation but had attempted to make the bill as fiscally
certain as possible - without the limitation the bill would
never pass and yet the extra coverage provided by the bill is
needed and deserved because fire fighters engage in dangerous
work.
4:34:15 PM
ERIC TUOTT relayed that he is a fire fighter in Anchorage, and
offered that the claims history from other states [that have
adopted a similar law] illustrates that there won't be a huge
increase in workers' compensation cases related to the bill. In
Nevada, out of 4,000 firefighters, there were 3 cancer claims
paid in the first four years after similar legislation was
enacted, and none of those cancers were lung cancer, which is
covered under different Nevada legislation. In Rhode Island
there were 6 claims paid in the first eight years after similar
legislation was enacted. In Massachusetts, during the first
four years after similar legislation was enacted, there were 34
cancer claims, 15 disability claims, 19 death benefit claims
paid - and this is out of 25,000 fire fighters. In Florida,
where there are about 24,000 active career fire fighters, there
were claims paid on .034 percent of the active work force. In
Washington, after which Alaska modeled its proposed legislation,
there were 13 cancer claims between 2002 and 2006, but only 6 of
those claims were accepted and paid.
MR. TUOTT offered that Alaska has an estimated 700 career
firefighters that would be covered by HB 200, and the
predictions are that there will be less than one cancer claim
made every two years. In response to an earlier question, he
explained that if a fire fighter were screened at some point
during his/her career prior to retirement and that screening
indicated that he/she was free of cancer, and then another
screening conducted within five years - 60 calendar months -
after retirement indicated that he/she did have one of the
enumerated forms of cancer, under the bill it would be presumed
that the cancer formed as a result of the fire fighter's
occupation.
REPRESENTATIVE GARDNER questioned whether all currently employed
firefighters have already been screened, or whether the
"qualifying medical exam" referred to in the bill would be a new
procedure. She also asked Mr. Tuott whether the presumption
provided in the bill would apply to him if he were to develop
one of the enumerated cancers within the next four weeks.
MR. TUOTT said the presumption wouldn't apply to him at this
point because he hasn't been with the department for seven
years, as is required in the bill. He relayed that fire
fighters in Anchorage get an initial physical exam upon being
hired and an annual physical exam thereafter, and that during
those exams fire fighters are screened for cancer. He
emphasized that the bill does not mandate that local governments
provide medical exams. In response to a question, he offered
his understanding that fire fighters in Anchorage have been
receiving annual physical exams for at least the last five
years, though he is not sure how long that policy has been in
place. One problem with the five-year threshold, he remarked,
is that many of the enumerated cancers become terminal quickly,
and hence many fire fighters that have contracted cancer have
died quite soon after retiring and weren't alive long enough to
consider that the cancer was linked to their occupation.
4:39:56 PM
JEFF BRIGGS relayed that he is a fire fighter in Anchorage, and
feels that HB 200 is long overdue. He noted that 40 other
states and 5 provinces in Canada currently have some form of
"presumptive legislation" for fire fighters, that a handful
cover every type of cancer that has been linked to fire
fighting, and that even in Washington, D.C., there is pending
legislation that would provide a presumption for federal fire
fighters. Fire fighters as a whole, he remarked, tend to be a
very empathetic, hard working, and courageous group of people,
and they touch the lives of so many people, whether it be
teaching a gymnasium full of children the rudiments of fire
safety, participating in community events, comforting a family
that has lost a loved one, or performing rescues.
MR. BRIGGS recounted how one of his fire fighting mentors died
of cancer less than a year after retiring, adding that that
person is not the only one of his coworkers that has either died
from or been diagnosed with some form of cancer or other disease
related to fire fighting. Characterizing HB 200 as a very good
piece of legislation, he asked the committee to pass it.
4:43:53 PM
PAUL F. LISANKIE, Director, Division of Workers' Compensation,
Department of Labor & Workforce Development (DLWD), in response
to the question of how this proposed workers' compensation
presumption would interact with a fire fighter's health
insurance when he/she is employed by the state or a
municipality, offered his understanding that such a person is
covered by three potential payors of medical costs, and HB 200
would shift the balance such that workers' compensation becomes
the more likely payor in cases of work-related
injuries/illnesses. In response to another question, he
indicated that members of volunteer fire departments that are
registered with the state fire marshal's office are treated as
employees if injured while responding to a fire or other
emergency.
REPRESENTATIVE LeDOUX pointed out, though, that workers'
compensation benefits are based on one's wages, and yet
volunteer fire fighters are not receiving any wages.
MR. LISANKIE offered his understanding that under the workers'
compensation Act, if a volunteer fire fighter serves in an area
that has paid fire fighters, his/her benefits will be based on
the wages of a paid fire fighter in that area, and if a
volunteer fire fighter serves in an area that doesn't have paid
fire fighters, the "governmental area" is required to set, in
lieu of wages, a compensation rate that is not less than the
minimum wage multiplied by 40 hours. In response to another
question, he said he is not certain whether volunteer fire
fighters are extended any sort of health care as part of their
volunteering, and so the bill may have the biggest impact on
volunteer fire fighters.
REPRESENTATIVE NEUMAN asked whether a fire fighter would be
better off financially being compensated through his/her health
insurance or through workers' compensation.
MR. LISANKIE offered that under current law, with the exception
of the various forms of cancer enumerated in the bill, the
workers' compensation system has been pretty good at
acknowledging causality between respiratory diseases or certain
cardiovascular events and a person's work as a fire fighter.
However, because medical science is not nearly as certain about
what causes cancer, the claimant of workers' compensation must
prove causality and this can be difficult. Under HB 200, the
burden of proof will shift to the employer; the employer will
have to prove that a person didn't contract one of the
enumerated cancers or diseases due to his/her work, and proving
this will be difficult because it is unlikely that medical
experts will be able provide a definitive answer that one
absolutely cannot contract cancer because of exposure to certain
chemicals. In response to another question, he reiterated that
volunteer fire fighters probably aren't extended any sort of
health insurance benefits.
REPRESENTATIVE NEUMAN questioned what cost increases might
result from the passage of HB 200 to a small community with only
a volunteer fire dept.
MR. LISANKIE replied that having to provide qualifying medical
exams might result in the only additional costs to communities.
He noted that the bill directs the DLWD to define via regulation
what constitutes a qualifying medical exam. In response to
other questions, he reiterated that it is hard to prove what
causes cancer, and that currently the employee, whether
currently employed or retired, must prove that the cancer is
work-related in order to obtain either workers' compensation
benefits or occupational disability benefits.
[Chair Olson turned the gavel over to Vice-Chair Neuman.]
5:02:03 PM
KEVIN SMITH, Executive Director, Alaska Municipal League Joint
Insurance Association, Inc.(AMLJIA), first explained that the
members of the AMLJIA pool together to cover the first $.5
million of each of the workers' compensation claims and then the
AMLJIA buys excess insurance over that amount.
[Vice-Chair Neuman returned the gavel to Chair Olson.]
MR. SMITH then said that HB 200 would place fire fighters with
seven or more years of experience into a preferred category
wherein they would not be subject to the same proof requirements
for occupational injuries/illnesses as other workers in either
the private or public sector; instead, cardiovascular events,
respiratory problems, and cancers would be presumed to be work-
related. The bill would require tax-payor funded municipalities
to prove a negative - that the fire fighter's cancer, for
example, was not caused by the job. He opined that HB 200 is
bad public policy for a number of reasons, not the least of
which is that it's not really supported by science. House Bill
200 will affect approximately 9,250 first responders, he opined,
and since municipalities employ the vast majority of Alaska's
first responders, the AMLJIA strongly opposes the bill.
MR. SMITH said the bill's potential increase in costs are
difficult to gage; for example, the cost for treating cancer
will vary depending upon the type of cancer, how early it is
detected, and the available treatment options. He offered his
understanding that for the "cancer presumption" alone, the NCCI
has estimated a 15-30 percent cost increase for the affected
class code, and pointed out that HB 200 contains more than just
a cancer presumption. Referring to "Legislative Research
Report, Report Number 07.125", Mr. Smith noted that there are
only 10 states in the country that cover some form of each of
the four "category diseases" as is proposed in HB 200 - heart
disease, lung disease, cancer, and infectious diseases. And
although the NCCI recommends a base rate for Alaska of $4.99 per
$100 payroll, Nevada - one of the aforementioned 10 states - has
a rate of $15.03, and California - another one of the
aforementioned 10 states - has a rate of $10.94.
MR. SMITH said that about half of Alaska's registered fire
fighters are volunteers; most small communities cannot afford to
pay for professional fire fighters and so they have volunteer
fire fighters, but they still need to buy workers' compensation
insurance for them. [The rates for that insurance] will
necessarily have to increase to cover the costs of the
presumption proposed in HB 200, he opined, and, given the rates
in Nevada and California, will probably increase by hundreds of
percentage points. When taxpayers in the smaller communities
can't even afford to pay professional fire fighters, it's
unreasonable to expect them to pay considerably more for
workers' compensation.
5:07:06 PM
MR. SMITH offered his understanding that many of the
"jurisdictions" that provide "this coverage" don't provide a
presumption for volunteers. And although proponents of the bill
have used California as an example - stating that the effect of
similar legislation on the actuarial assumptions for the
California Public Employees' Retirement System (CalPERS) was
negligible/minimal - what hasn't been said thus far is that
California provides a rebate for unfunded mandates; data from
2000 to the present shows that local agency requests for
reimbursement on California's fire fighter cancer presumption
totals approximately $40 million - not a negligible amount, he
opined. Furthermore, in order to take advantage of the
presumption offered by the bill, medical screenings are
necessary, and those screenings, although the costs vary, are
expensive. For example, Juneau's fire and rescue agency reports
that it pays approximately $1,300 per medical screening - for a
medical screening and an electrocardiogram (EKG). Using that
figure and multiplying it by 9,250 - the assumed number of
affected employees - results in a cost of over $12 million for
screenings alone.
MR. SMITH reiterated that the bill is not supported by science.
Cancer is a terrible disease that's probably touched everyone's
lives, he remarked, adding that according to statistics gathered
by the American Cancer Society (ACS), about half the men in
"this room" will be diagnosed with some sort of cancer in their
lifetime. Furthermore, yesterday's Anchorage paper cited a
cancer statistic which indicated that prostate cancer is the
second most diagnosed cancer in men after skin cancer, and that
it is the second leading cause of cancer death; one third of all
the women in "this room" will also be diagnosed with cancer.
The causes of cancer are largely unexplained, he remarked,
opining that the science behind the bill is far from conclusive
[because] the International Association of Fire Fighters (IAFF)
is basing its data on a type of study that is based on several
other studies.
MR. SMITH said that by comparison, in a different kind of study
considered by epidemiologists to have a sound approach, "none of
the cancers" rise to the level of medical certainty;
statistically speaking, there are associations, but in none of
the listed diseases has the standardized mortality ratio
exceeded 200, which is the standard epidemiologists use to
determine [causality]. For example, in situations involving
kidney and bladder cancers, the study indicates that fire
fighting is unlikely to contribute significantly, that more
study is needed, and that more innovative, comfortable
protective equipment needs to be developed. Nearly three out of
ten men in the general population will develop one of the
cancers listed in HB 200, but according to statistics in the
aforementioned study, for every four cancer claims by fire
fighters, three of those cancer cases would have occurred
regardless of occupation.
MR. SMITH, as an alternative, suggested developing a broad-based
state funding source to finance "this extraordinary benefit and
unfunded mandate on local government employers and taxpayers."
Passage of HB 200 would "crack the door for other special
interest groups that would like a similar presumption," he
opined. Case in point, last year, during discussion of a
similar bill, there was discussion regarding an amendment that
would have added nurses to the list of those qualifying for the
presumption. He characterized the bill as discriminatory,
pointing out that similar laws have been challenged in Nevada on
constitutional grounds, and a similar bill was overturned in New
Hampshire because it violated the constitution - specifically it
violated an unfunded mandate clause.
MR. SMITH pointed out that many people have occupational
exposure at their jobs, and that the workers' compensation
system already provides such people with protection. Turning
the system upside down for one class of employees is bad public
policy, he remarked, characterizing HB 200 as special interest
legislation that provides a tremendous benefit to a single group
of employees at local taxpayer expense. Welders, construction
workers, demolition crews, sanitation employees are all exposed
to the same carcinogenic or contagious agents as fire fighters,
but the difference is that the former groups of people are
exposed to those agents on a daily basis. The ailments listed
in HB 200 are already covered by workers' compensation if a
connection between the ailment and work can be shown.
Furthermore, according to the aforementioned study, non fire
fighters can and do get the diseases enumerated in the bill, and
yet most fire fighters never do. In closing, he urged the
committee to not pass HB 200.
5:13:12 PM
REPRESENTATIVE RAMRAS relayed that the statistics he is familiar
with lead him to come to a different conclusion, and pointed out
that workers' compensation insurance rates are higher for hotel
workers than for fire fighters.
REPRESENTATIVE NEUMAN noted that he has heard several times that
as long as a connection between a disease and work can be shown,
workers' compensation will pay benefits. He asked, therefore,
whether fire fighters keep a record of the chemicals they are
exposed to at each fire.
MR. TUOTT said no, and characterized that as a nearly impossible
task, adding that many chemicals, when burned together with
other chemicals, can pose additional dangers. However, fire
departments are required to record which personnel respond to
which fires, and this data may prove helpful in the future if
several fire fighters that attended the same fire come down with
the same sort of cancer several years later.
REPRESENTATIVE NEUMAN expressed concern that paying the costs of
the proposed presumption will result in less money being
available for safety equipment.
MR. TUOTT replied that he does not anticipate HB 200 resulting
in many claims being filed.
CHAIR OLSON relayed that HB 200 would be held over, and offered
his understanding that a committee substitute (CS) will be
forthcoming.
HB 71 - LICENSING RADIOLOGIC TECHNICIANS
5:19:25 PM
CHAIR OLSON announced that the final order of business would be
HOUSE BILL NO. 71, "An Act requiring licensure of occupations
relating to radiologic technology, radiation therapy, and
nuclear medicine technology; and providing for an effective
date." [In members' packets was a proposed committee substitute
(CS) for HB 71, Version 25-LS0321\E, Bullard, 4/10/07.]
5:19:34 PM
REPRESENTATIVE SCOTT KAWASAKI, Alaska State Legislature,
sponsor, relayed that in addition to the proposed committee
substitute (CS) for HB 71 - Version 25-LS0321\E, Bullard,
4/10/07 - there would be a few amendments forthcoming, and then
responded to questions and concerns raised at the bill's prior
hearing. With regard to a concern about cost, he said he
doesn't believe that HB 71 will be particularly cost prohibitive
to those providing radiologic services in Bush communities
because the bill contains criteria allowing a person to obtain
licensure as a limited radiologic imager. With regard to the
question of how many trained radiologic technologists provide
services in the Bush, he explained that there are currently 479
registered radiologic technologists in the state, though that
number fluctuates from year to year, and that there are an
estimated 600-700 untrained individuals in the state most of
whom, if not all, would qualify under the limited licensure
provisions of [Version E].
REPRESENTATIVE KAWASAKI said that hospitals in Kotzebue,
Dillingham, and Nome employ "full" radiologic technologists, and
that proposed AS 08.89.150(b)(1) now requires a limited
radiologic imager to perform limited radiologic diagnostic
imaging only under the "general supervision" of a fully licensed
radiographer or a licensed practitioner. With regard to a
question regarding continuing education, he explained that
continuing education credits are available; that most folks use
an online program found on the web site, "glaciermedicaled.com";
and that the American Society of Radiologic Technologists (ASRT)
also provides an online program for continuing education
credits. With regard to a concern about the updating of
radiologic equipment, he relayed that the Alaska State Public
Health Laboratories (ASPHL), within the Department of Health and
Social Services (DHSS), already addresses that issue, though
with limited staff.
REPRESENTATIVE KAWASAKI said that both large and small hospitals
dealing with the federal Public Health Service (PHS) or Indian
Health Service (IHS), and general hospitals in larger cities,
are accredited, and the [Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)], which deals with larger scale
hospitals, maintains accreditation and has strict compliance
levels, particularly with regard to radiological equipment.
With regard to the question of who supports the bill, he said
that the Alaska Society of Radiologic Technologists (AKSRT), the
ASRT, the Department of Commerce, Community, & Economic
Development (DCCED), the Alaska State Hospital and Nursing Home
Association (ASHNHA), and various other groups all support the
bill.
REPRESENTATIVE KAWASAKI mentioned that other groups such as the
Alaska Native Tribal Health Consortium (ANTHC), the Southeast
Alaska Regional Health Consortium (SEARHC), and the Alaska
Primary Care Association, Inc. (APCA) have expressed concern
with some of the provisions of the bill, particularly as they
might affect rural communities, and so he will be addressing
some of those concerns via amendments. He also mentioned that
some groups that have opposed similar legislation in the past
now either support HB 71 or are neutral towards it. He
indicated that his goal is to get HB 71 passed in a form that
will satisfy the concerns of all interested parties and thereby
address the existing public safety problem. With regard to the
question of why dental assistants are not included in HB 71, he
relayed that such persons are already specifically addressed via
separate statute and regulations.
REPRESENTATIVE KAWASAKI, in response to questions, replied that
currently there is no state licensure of those conducting
radiologic imaging in Alaska, and that he introduced HB 71 by
request because of public health concerns regarding unlicensed
and untrained personnel administering radiologic exams.
REPRESENTATIVE NEUMAN said he just presumes that healthcare
facilities which offer radiologic services have already taken
steps to ensure that the employees conducting radiologic exams
have received the proper training.
REPRESENTATIVE KAWASAKI indicated that such is not the case, and
offered as just one example an incident involving the hospital
in Juneau wherein patients were subjected to improperly-
performed radiologic procedures. In response to another
question, he relayed that although he can't speak about other
hospitals, the Fairbanks Memorial Hospital & Denali Center
requires those performing radiologic procedures to receive
certified training from the American Registry of Radiologic
Technologists (ARRT).
REPRESENTATIVE GARDNER referred to written information from
Clyde Pearce - chief of Alaska's Radiological Health Program -
provided in members' packets regarding state inspections of
radiological equipment and procedures, and noted that this
information illustrates that Alaska is behind the times with
regard to radiological safety practices.
REPRESENTATIVE KAWASAKI, in response to questions, relayed that
he was first approached to sponsor HB 71 by a licensed and
registered radiologic technologist, and that the goal of the
bill is to prevent [further] harm from coming to the people
receiving and performing radiological services.
5:35:56 PM
CLYDE E. PEARCE, Radiologic Health Specialist II, Radiologic
Health, Laboratories, Division of Public Health, Department of
Health and Social Services (DHSS), relayed that he is the
state's radiation inspector and travels throughout the state
performing both state inspections and federal inspections under
contract, adding that the federal rules are different than the
state's current rules; for example, the federal rules require a
level of training for those performing radiologic exams that
meets or exceeds that being required by the bill. He gave a
brief history of the use of ionizing radiation, remarked that
the use of such radiation has been found to be of great benefit
- perhaps even contributing to increased life expectancy in the
last century - but warned that it has also been clearly found
that radiation can cause injury if used in excess.
MR. PEARCE said he feels some passion about HB 71 because even
though there have been a lot of changes over the years that keep
reducing, theoretically at least, the risks associated with the
use of radiation, the changes that have occurred in the last
dozen years have actually increased those risks. He elaborated:
We have two things going on at once: one is that
radiation exposures in general are increasing because
we have many more ways of using the radiation, and if
you use more radiation you can improve the quality of
the image, and so we want a good quality image but we
don't want any more radiation than is absolutely
necessary to get that; and at the same time research
that has been done more recently has shown two things,
one is that biological effects now are shown to occur
at diagnostic levels of exposure, which means it's not
just people who got some horrendous amount or some
radiation therapy treatment to the breast that get
breast cancer, that even at diagnostic levels they're
showing some effects, and the other thing is a study
by Dr. Pierre Hall from Stockholm, Sweden, ... of
about 3,500 adult men who were exposed as infants, and
they had a measurable reduction in mental capability -
they were less smart as a result of radiation exposure
at diagnostic levels.
And so, with the fact that we see biological effects
occurring at lower levels of exposure, and overall
trends of increasing exposure, there's a concern. And
in my inspections throughout Alaska - I am the author
of that [written information which] Representative
Gardner was referring to [and it contains] just some
... representative examples - ... I see a lot of that.
For the most part I see the problem as one that's
amenable through education [because with] the machine
itself, I rarely see an actual problem; I do many
different tests, and the machines normally pass most
of those tests. What I see most often [are] ...
problems with how the machines are used.
And I relate that to an automobile, where you're
required to have a certain amount of knowledge and you
have a skill test and you even have an eye test, and
you go out and you drive the automobile, so you would
think with our transportation regulations that would
be a pretty safe thing - the automobile itself has a
lot of safety features built in - and yet we still
have over 40,000 people a year who've died. And so
what's the problem? It's how the automobile is used -
people exceeding the speed limit or going through red
lights because, if you look at science, if you go fast
enough, a red light does look green, theoretically,
and apparently we have some people in Anchorage ...
REPRESENTATIVE RAMRAS interjected to question the difference
between someone who is trained to used radiologic equipment and
someone who is licensed to use radiologic equipment, adding that
he presumes a certain degree of competency [in those that are
performing radiological exams].
MR. PEARCE characterized that presumption as incorrect: not all
who perform radiological exams are trained - many individuals
operating the equipment have had no formal education or training
in the use of that equipment. He relayed that one of the
examples of misuse he'd listed in his written information was
one he'd come across while investigating a complaint about that
provider's office - the person performing the radiological exams
clearly did not know what she was doing and had been given the
wrong advice by her supervisor who, theoretically, trained her
in the use of the equipment.
REPRESENTATIVE RAMRAS said he will be supporting the bill
because qualified training is needed for those that operate
radiological equipment.
5:43:37 PM
DONNA J. RUFSHOLM, R.T., Chair, Legislative Committee, Alaska
Society of Radiologic Technologists (AKSRT), relayed that the
AKSRT has been working on this legislation for a number of years
because it feels strongly that patient health/safety is primary.
She said that she has worked at both large and small facilities
over the last 23 years, and has seen a number of radiological
images come in from sites that don't hire registered
radiological technologists or people that have been trained at
all, and those images have no diagnostic value whatsoever - they
are either too dark or too light or the positioning of the
patient is wrong, and so a proper diagnosis cannot be obtained
from those images. The AKSRT feels that there is a concern,
particularly after becoming familiar with the information
provided by Mr. Pearce.
MS. RUFSHOLM indicated that that information illustrates that
there are people providing radiological services in this state
who are not properly trained, people who've been "practicing" on
each other, people who've not taken steps to protect themselves.
House Bill 71 will provide protection both for patients and for
those who operate radiological equipment, and will help ensure
that x-rays are taken properly; the way to reach these goals is
to license those who provide radiological services. Requiring
licensure will ensure that those individuals have received the
proper education and credentials to perform radiological
procedures.
MS. RUFSHOLM said that the AKSRT has suggested that the bill
include provisions to ensure that rural areas can continue to
provide radiological services; however, it is important that the
images produced in rural communities are of a quality that can
be used to help determine whether a patient actually needs to be
transferred to a larger medical facility. She explained that
the AKSRT has taken steps to ensure that providers of
radiological services can receive the proper training at a
minimum of expense, and has identified online courses that are
available. Such courses, she remarked, are available at a cost
of $229 - less than the cost of one radiological exam - and
currently there are 40 people voluntarily taking the training
program that's available through the University of Alaska. In
conclusion, she relayed that the AKSRT would like to see HB 71
adopted.
5:47:58 PM
RHONDA MERRIHEW, R.T., Co-Chair, Legislative Committee, Alaska
Society of Radiologic Technologists (AKSRT), shared an example
wherein an individual providing radiological services in a rural
area of the state took a whole-body x-ray - without shielding -
of a baby that only needed a chest x-ray; that baby received far
more radiation than was needed. She also shared an example
wherein an individual providing radiological services in an
urban area of the state told a physician, "I didn't know what I
was doing, so I just aimed for the middle." Ms. Merrihew
remarked: "These are things that we would like to see not
happen, and ... [the AKSRT wants to ensure] that ... people are
not being irradiated unnecessarily."
REPRESENTATIVE GARDNER expressed concern that radiological
services are being provided [by untrained personnel], adding
that she is ready to move the bill from committee.
REPRESENTATIVE LeDOUX asked whether patients are notified when
the person performing radiological services hasn't done it
right.
MS. MERRIHEW said those patients have no idea that they were
being overexposed.
REPRESENTATIVE LeDOUX, referring to the example involving the
baby, noted that that baby may have health problems years from
now as a result if his/her overexposure. She asked whether
there is any way for a person to find out whether he/she has
"been the victim of this sort of thing."
MS. MERRIHEW said not that she is aware of. [Due to technical
difficulties with the microphones, the remainder of Ms.
Merrihew's response was not audible.]
REPRESENTATIVE NEUMAN asked Ms. Merrihew whether she has seen
the letter of opposition to HB 71 provided by the Alaska State
Medical Association (ASMA).
MS. MERRIHEW said she has not.
The committee took an at-ease from 5:54 p.m. to 5:55 p.m.
MS. MERRIHEW shared her belief that all residents of Alaska
deserve to have safe medical care.
The committee took another brief at-ease.
5:56:47 PM
PAUL HANSEN, Deputy Administrator, Maniilaq Health Center,
Maniilaq Association, relayed that the Maniilaq Association is a
tribal organization in Kotzebue; that the Maniilaq Health
Center, which is JCAHO accredited, provides medical services to
eligible individuals that reside in local tribal communities and
in the Northwest Artic Borough; that the medical, clinical, and
nursing services provided by the Maniilaq Association are
delivered both by the federally owned health center and a
network of village health clinics; and that his organization is
a co-signer of the "Alaska Tribal Health Compact." He said that
his organization generally supports the intent of HB 71, but is
concerned that as currently drafted, the bill will negatively
impact access to and the level of healthcare that his
organization provides to its patients, and that it conflicts
with the exemption from state regulations currently provided by
the aforementioned compact.
MR. HANSEN said that his organization feels that HB 71 should be
modified to extend to tribal healthcare providers the same
licensure exemption that the bill currently provides to medical
personnel in the armed forces and the U.S. Public Health Service
(PHS). He relayed that his organization has proposed some
language that would extend the exemption to providers in
federally owned facilities; specifically, language would be
inserted into proposed AS 08.89.100(b) - the exemption provision
- such that the licensure requirements would not apply to "a
person who is in the direct employment of a tribe or tribal
organization for the purpose of carrying out healthcare
programs, functions, services, and activities in facilities
utilizing connection with a contractor or compact with the
Indian Health Service pursuant to Title 1 or 5 of the Indian
Self-Determination and Education Assistance Act".
MR. HANSEN, in conclusion, said that the Maniilaq [Health
Center] opposes the bill without the aforementioned suggested
amendment, adding that the Alaska Native Health Board (ANHB) has
taken a similar position.
CHAIR OLSON asked Mr. Hansen to fax written comments to his
office.
REPRESENTATIVE LeDOUX indicated that she is planning to
introduce an amendment that would read, "(7) in the medical
service of or employed by a tribal health organization providing
a healthcare service or program of the Indian Health Service
while in the discharge of the person's official duties", and
asked Mr. Hansen whether this amendment would alleviate his
concerns.
MR. HANSEN indicated that it would. One reason for including
such an exemption, he added, is that the tribal healthcare
organization, via the aforementioned compact, is now providing
services on behalf of the federal IHS, and as such is entitled
to a federal preemption from state regulations. He pointed out,
however, that Representative LeDoux's suggested amendment may
not necessarily make that point clear. He went on to say that
he agrees that ensuring patient safety is very important, and
that requiring at least a minimum amount of training prior to
providing radiologic services is also important, though the key
to providing quality service is to maintain proper oversight and
ongoing peer review.
6:06:08 PM
S. LYNN HORNBEIN, M.D., relayed that she runs an urgent care
clinic in Palmer, and that the clinic has just purchased an x-
ray machine. She said she questions how she will be able to
afford to keep a full time "radiation tech" on staff, surmising
that the average hourly wage for such a person is probably about
$30. She also surmised that if she has no one on staff that's
allowed to operate the radiological equipment, patients will
have to drive to another facility in order to receive radiologic
services. She opined that HB 71 will cause treatment to be more
expensive and will cause delays in diagnoses. She asked how
limited licensure could be obtained by those who already have
some experience "shooting films ... in practice," and whether
someone seeking limited licensure could receive training while
continuing to work full time. In response to a question, she
said she supports the idea that individuals performing x-rays
should be educated, but she has concerns that the language in
the bill may prove limiting to smaller clinics regardless of
whether they are in rural areas of the state.
CHAIR OLSON suggested that Dr. Hornbein submit her questions to
the sponsor's office.
6:09:48 PM
SONIA HANDFORTH-KOME, President, Alaska Primary Care Association
(APCA); Executive Director, Iliuliuk Family & Health Services,
Inc., said that the APCA is not in support of the bill as it is
currently written and has concerns that the bill will have
significant budgetary impacts on her organizations without
guaranteeing safety. She went on to say:
We have very stringent safety programs in place in
Unalaska, [and] I would be more comfortable with a
bill that required that we prove ... our training
program when we prove our safety measures and ...
quality measures, than with a bill that simply
requires education. I have one certified and two
uncertified x-ray techs on staff and there is no
discernable quality difference between them. In fact,
my two uncertified ones have more experience than our,
arguably, safer and better [tech] because they're very
stringent about how they follow our safety guidelines;
we have to pretty much urge our certified one to
follow the safety guidelines.
MS. HANDFORTH-KOME, in conclusion, reiterated that "we do not
currently support" HB 71.
CHAIR OLSON, after ascertaining that no one else wished to
testify, closed public testimony on HB 71 and relayed that the
bill would be held over. [Although the proposed committee
substitute (CS) for HB 71, Version 25-LS0321\E, Bullard,
4/10/07, was available in members' packets, no motion was made
during this meeting to adopt it as the work draft.]
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
6:12 p.m.
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