Legislature(2005 - 2006)CAPITOL 17

03/02/2005 03:15 PM LABOR & COMMERCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HCR 3 RENEWABLE ENERGY ALASKA PROJECT TELECONFERENCED
Moved Out of Committee
+= HB 147 INSURANCE TELECONFERENCED
Heard & Held
Bills Previously Heard/Scheduled
*+ HB 150 LICENSING RADIOLOGIC TECHNICIANS TELECONFERENCED
Heard & Held
                    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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