02/06/2008 03:00 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB320 | |
| HB316 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 316 | TELECONFERENCED | |
| = | HB 320 | ||
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
February 6, 2008
3:04 p.m.
MEMBERS PRESENT
Representative Kurt Olson, Chair
Representative Mark Neuman, Vice Chair
Representative Gabrielle LeDoux
Representative Jay Ramras
Representative Robert L. "Bob" Buch
Representative Berta Gardner
MEMBERS ABSENT
Representative Carl Gatto
COMMITTEE CALENDAR
HOUSE BILL NO. 320
"An Act relating to certification of search and rescue personnel
and organizations; requiring certain search and rescue personnel
to be considered state employees for purposes of workers'
compensation coverage; and allowing municipalities to elect to
provide workers' compensation insurance coverage for search and
rescue personnel."
- MOVED CSHB 320(L&C) OUT OF COMMITTEE
HOUSE BILL NO. 316
"An Act relating to establishing a controlled substance
prescription database."
- MOVED CSHB 316(L&C) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 320
SHORT TITLE: SEARCH & RESCUE: CERTIFICATION/WORK.COMP
SPONSOR(s): REPRESENTATIVE(s) MEYER
01/15/08 (H) READ THE FIRST TIME - REFERRALS
01/15/08 (H) L&C, FIN
01/28/08 (H) L&C AT 3:00 PM CAPITOL 17
01/28/08 (H) Heard & Held
01/28/08 (H) MINUTE(L&C)
02/06/08 (H) L&C AT 3:00 PM CAPITOL 17
BILL: HB 316
SHORT TITLE: PRESCRIPTION DATABASE
SPONSOR(s): REPRESENTATIVE(s) RAMRAS
01/15/08 (H) READ THE FIRST TIME - REFERRALS
01/15/08 (H) L&C, JUD
02/06/08 (H) L&C AT 3:00 PM CAPITOL 17
WITNESS REGISTER
MIKE PAWLOWSKI, Staff
to Representative Kevin Meyer
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented and answered questions on CS for
HB 320, Version E.
BRAD THOMPSON, Director
Division of Risk Management
Department of Administration (DOA)
Juneau, Alaska
POSITION STATEMENT: Testified on HB 316.
EMILY BEATLEY, Staff
to Representative Jay Ramras
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 316 on behalf of the prime
sponsor.
GINGER BLAISDELL, Staff
to Senator Lyda Green
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
HB 316.
BRIAN HOWES, Investigator III
Division of Corporations, Business, and Professional Licensing
Anchorage Office
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions on HB 316.
BARRY CHRISTIANSON, Pharmacist; Co-Chair
Alaska Pharmacists Association
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions on HB 316.
KEITH MALLARD, Captain; Commander
Alaska Bureau of Alcohol & Drug Enforcement
Division of Alaska State Troopers (AST)
Department of Public Safety (DPS)
Anchorage, Alaska
POSITION STATEMENT: Answered questions on HB 316.
WILLIAM STREUR, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions on HB 316.
ACTION NARRATIVE
CHAIR KURT OLSON called the House Labor and Commerce Standing
Committee meeting to order at 3:04:38 PM. Representatives
Ramras, Buch, Neuman, and Olson were present at the call to
order. Representatives LeDoux and Gardner arrived as the
meeting was in progress.
HB 320-SEARCH & RESCUE: CERTIFICATION/WORK.COMP
3:05:03 PM
CHAIR OLSON announced that the first order of business would be
HOUSE BILL NO. 320, "An Act relating to certification of search
and rescue personnel and organizations; requiring certain search
and rescue personnel to be considered state employees for
purposes of workers' compensation coverage; and allowing
municipalities to elect to provide workers' compensation
insurance coverage for search and rescue personnel."
REPRESENTATIVE NEUMAN moved to adopt the proposed committee
substitute (CS) for HB 320, Version 25-LS1176\E, Bailey, 2/5/08,
as the work draft. There being no objection, Version E was
before the committee.
3:05:27 PM
MIKE PAWLOWSKI, Staff to Representative Kevin Meyer, Alaska
State Legislature, summarized the changes section-by-section to
Version E. He said Section 1 would add a new section to AS
18.60 to allow the commissioner of the Department of Public
Safety (DPS) or his/her designee to organize and conduct search
and rescue training missions. He directed attention to page 2,
lines 3-5, Section 2, which would amend proposed AS 18.60.120 to
clarify that only the commissioner of DPS or his/her designee
could authorize a person to participate in a search and rescue
mission. Sections 3-5 are conforming sections, although Section
5 carries over from the original version of HB 320.
MR. PAWLOWSKI characterized Section 6 as the "meat" of the bill,
because it authorizes workers' compensation coverage for search
and rescue volunteers who participate in a search and rescue
mission under AS 18.60.120 or in a training exercise under
proposed AS 18.60.115. He offered that the key is the volunteer
must be authorized to participate in a search and rescue effort.
This provision was added because DPS expressed concern that co-
mingling volunteers with professionally trained searchers could
make it difficult to determine who is covered by workers'
compensation in the event of an injury.
MR. PAWLOWSKI explained that the primary departure from the
original bill is in response to issues raised by committee
members during the January 28, 2008, committee meeting. After
holding discussions with DPS on the registration and
certification of volunteers, certification provisions were
removed from the bill and the process for conducting search and
rescues now mirror the process the DPS currently uses including
initiating a search, starting the mission, and ending the
mission. The workers' compensation coverage in Version E would
extend only to participants authorized by DPS, he stressed.
3:08:26 PM
REPRESENTATIVE NEUMAN related his understanding that there is
often commotion combined with a high level of emotion because
citizen volunteers want to help during a search and rescue
effort. He inquired as to whether there would be a sign-up
sheet or a list of names available so DPS can track who is part
of the formal search and rescue mission.
MR. PAWLOWSKI answered that under HB 320, DPS would maintain the
responsibility to compile the list of volunteers. He referred
to proposed Section 4 of the bill, which requires that DPS adopt
regulations necessary to carry out its duties to make it clear
who is eligible to assist with the formal search and rescue
mission.
REPRESENTATIVE NEUMAN stressed that it is important for the
committee to hold these discussions in order to establish the
legislative intent for the record. He offered his support for
HB 320.
3:10:44 PM
REPRESENTATIVE GARDNER noted her appreciation for the intent of
HB 320 and her support to provide workers' compensation for
search and rescue volunteers. However, she expressed concern
for any unintended consequences. She posed an example in which
a child is discovered missing near a body of water and the
community galvanizes to locate the child. She inquired as to
whether a volunteer who is injured during such a search is
considered an authorized searcher and if he/she would be covered
under HB 320.
MR. PAWLOWSKI answered that it would depend on whether the
Division of Alaska State Troopers (AST) [in conjunction with the
commissioner of DPS] has authorized the community to search or
has assigned a community leader to oversee the search. He
opined that if a group of townspeople informally gathered and
searched and someone was injured, the injured person would not
be covered under HB 320. However, if the townspeople went
through the AST to activate a search and rescue mission and the
volunteers were authorized as part of the search and rescue
mission, then the volunteers would be covered under the mission.
REPRESENTATIVE GARDNER inquired as to whether the bill should
also have a House Judiciary Standing Committee referral to
review the state's liability for search and rescue personnel.
MR. PAWLOWSKI answered that a referral is something that could
be discussed with Representative Harris. He noted that HB 320
currently has a House Finance Committee referral since the bill
discusses financial responsibility and risk management issues.
He further noted that the state is a self-insured entity.
3:13:08 PM
BRAD THOMPSON, Director, Division of Risk Management, Department
of Administration, said that the division administers the self-
insured program that includes workers' compensation obligations.
This legislation would expand the state's exposure somewhat, he
opined. However, the division's past practice has been to
extend coverage to search and rescue volunteers who have signed
up as volunteers for a mission, he offered. The division has an
agreement form posted on its web site for departments to use.
In the event that a volunteer is injured while in state service,
the division would extend coverage similar to workers'
compensation, he said. He offered that the division would cover
out-of-pocket expenses not covered by the injured person's
medical provider. He related that volunteers would simply fill
out a contractual form. He posed a scenario in which a
volunteer might slip and fall at the state museum and due to an
injury would need medical coverage. He stated that under HB
320, the Department of Public Safety would be required to
designate when the search and rescue mission starts. He said
that the DPS would prepare a list of volunteers and file a
report with the list of participants to formally capture the
information.
3:15:56 PM
REPRESENTATIVE GARDNER offered her understanding that the change
under HB 320 from current statute is that search and rescue
workers would be eligible for workers' compensation benefits.
Currently, if search and rescue volunteers are injured they pay
their own medical expenses out-of-pocket, she surmised.
MR. THOMPSON answered that is correct. He noted that in the
past ten years there have been three injuries stemming from
search and rescue missions that have resulted in minimal medical
costs.
3:17:27 PM
REPRESENTATIVE GARDNER inquired as to whether the purpose of HB
320 is preemptive or if it would cover the professionals who are
often called in to volunteer such as firefighters or law
enforcement officers.
MR. PAWLOWSKI answered that HB 320 is entirely preemptive and
stems from the concern that volunteers incur substantial risk in
order to rescue people during missions such as an avalanche or
mountain rescue. Current statutes prohibit search and rescue
volunteers from suing the state, yet these volunteers fulfill an
important role for the state. If one volunteer suffers a major
accident it could result in financial hardship for the person or
his/her family, he opined.
REPRESENTATIVE NEUMAN, in response to an earlier concern, opined
that the committee is capable of reviewing the bill so HB 320
does not need a further referral to the House Judiciary Standing
Committee. He offered that the bill contains several
safeguards, including developing regulations for necessary
oversight, that help ensure injured search and rescue volunteers
are covered by workers' compensation. The DPS and search and
rescue organizations have the necessary expertise to develop the
regulations and the process since they routinely work with
volunteers, he opined.
3:20:09 PM
REPRESENTATIVE GARDNER moved to report the proposed CS for HB
320, Version 25-LS1176\E, Bailey, 2/5/08, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 320(L&C) was reported out of the
House Labor and Commerce Standing Committee.
The committee took an at-ease from 3:20 p.m. to 3:24 p.m.
HB 316-PRESCRIPTION DATABASE
3:24:54 PM
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 316, "An Act relating to establishing a
controlled substance prescription database."
3:25:34 PM
REPRESENTATIVE NEUMAN moved to adopt proposed committee
substitute (CS) for HB 316 labeled 25-LS1283\M, Luckhaupt,
2/4/08, as the working document. There being no objection,
Version M was before the committee.
3:26:05 PM
EMILY BEATLEY, Staff to Representative Jay Ramras, Alaska State
Legislature, on behalf of the prime sponsor of HB 316,
Representative Jay Ramras, offered to present the bill. She
informed committee members that all states have laws and
regulations that govern the distribution and handling of
controlled substances and other pharmaceuticals. As of December
2007, 35 other states have enacted programs that require
prescription monitoring programs with another 14 additional
states, including Alaska, that are in the process of considering
such legislation. Goals for prescription monitoring programs
vary, but the major objectives include programs such as
education and information, public health initiatives, early
intervention and prevention, investigations and enforcement, and
confidentiality. States with prescription monitoring programs
reported the programs provide effective tools to identify and
prevent drug diversion at the prescriber, pharmacy, and patient
levels, she offered. Prescription monitoring programs are
designed to be the least disruptive to medical and pharmacy
practices, she opined. In fact, some states report that the
time to use the prescription monitoring program takes less than
three to five minutes.
MS. BEATLEY noted that under HB 316, prescription drug data
would only be available to entities that currently have the
right to access and obtain prescription data under state law.
The proposed database for monitoring prescription drug use is a
tool that would assist prescribing and dispensing practices to
improve health care for Alaska's citizens, she opined. The
proposed program is not intended to target possible subjects for
investigation, but is to help law enforcement perform their
investigations after an official complaint has been made.
MS. BEATLEY offered that the Department of Commerce, Community,
& Economic Development (DCCED) has already received some federal
funding, but that approximately $400,000 in additional federal
funds is available to states that adopt legislation for
prescription drug monitoring programs. In 2006, the National
Survey on Drug Use and Mental Health reported that nationally
over 7 million people ages 12 or older used prescription drugs
non-medically over a one-month period, she stated. According to
the survey, of those 55.7 percent said that the source of the
drug they most recently used was from a friend. Further, the
Drug Enforcement Administration (DEA) reported in a recent fact
sheet that Alaska has the highest rate of controlled substance
use. The misconception that the misuse of prescription drugs is
safer than using illicit street drugs makes this type of drug
abuse particularly dangerous, she opined. Oftentimes, kids will
steal prescription drugs from their home medicine cabinet, take
the drugs to parties, and throw them in a bowl for others to
use, she noted.
MS. BEATLEY gave an overview of the prescription monitoring
program established in HB 316. Under HB 316, the DCCED would
establish a controlled substance prescription database
administered by the Board of Pharmacy and provide the board with
the necessary staff to implement the program. The database
would contain data for every prescription for federally
controlled substances contained in schedule I, II, III, IV, or V
under state and federal law. Some provisions in the bill
outline the requirements for reporting information, such as who
is responsible for reporting information to the board, the
specific uses of the database, and who has the authority to
access information contained in the database, such that
individuals could also request their own data for a fee with the
maximum fee set at $10. She outlined the safeguards to keep
information confidential and the penalty provisions contained in
HB 316. The prescription monitoring database is for use by
practitioners when considering or dispensing prescriptions for a
current patient in their office, by licensed pharmacists when
dispensing drugs, and by law enforcement officers pursuant to a
search warrant. Failure to report data is grounds for
disciplinary action by the Board of Pharmacy, she said. This
bill would also authorize the state to enter into agreements
with tribal and military dispensers and practitioners.
3:33:21 PM
MS. BEATLEY said that it is not the sponsor's intent to pass on
costs of the prescription monitoring database to the
professionals who use it. Thus, the board must notify the
legislature if federal funding ceases to cover the program costs
for the prescription monitoring database. Funding from federal
grants and state appropriations should cover the program costs,
she opined. Practitioners are not obligated to use the
database, she offered. Instead, the database is a tool for
dispensers to use to identify misuse of prescription drugs. The
penalty provisions of HB 316 make it a class A misdemeanor to
unlawfully disclose information and a class C felony to alter or
destroy information contained in the database, she said. The
prime sponsor considered testimony given on the companion bill
when making changes to HB 316 that are contained in proposed
Version M.
REPRESENTATIVE RAMRAS added that another genesis for HB 316
stems from the methamphetamine forum he attended in October
2007, which was held at the Anchorage Loussac Library. The
group that met included a representative from the DEA, who
expressed interest and support of Alaska initiating a
prescription monitoring database. The legislature has
previously considered programs similar to this, but the
technology and federal funding now make the prescription
monitoring database feasible, he opined. He also stressed the
importance of controlling substances that people ingest and
noted the risks of drug addiction. This bill could help curb
what is coined "doctor shopping" and the resale of prescription
drugs referred to as "diversion," he said. Further, curbing
diversion and inappropriate pharmaceuticals could actually
result in a negative fiscal note. He characterized HB 316 as
"good for society."
3:36:48 PM
REPRESENTATIVE GARDNER inquired as to whether HB 316 addresses
the Health Insurance Portability and Accountability Act (HIPAA).
She further asked whether other states currently using a
prescription monitoring database have experienced any problems
and how often pharmacists, dispensers, and other authorized
users in other states access the prescription monitoring
database. She asked what liability the state would incur if
data was lost or stolen since the DCCED and the Board of
Pharmacy are responsible for security of the prescription
monitoring database. Lastly, she inquired as to whether federal
grants would be ongoing or if funding will end.
MS. BEATLEY answered that HIPAA provides an exemption for states
with prescription monitoring programs so long as the program and
provisions of state law are necessary to prevent fraud and abuse
related to the provision of health care and its principal
purpose is the regulation of the distribution, dispensing, or
other control of any controlled substance. Since the voluntary
prescription monitoring database has proven to be such a helpful
tool to those who use it, some states would like to change their
programs to mandatory programs to increase the overall
effectiveness. She offered to provide committee members with
additional statistics. She recalled conversations she held with
program administrators in other state, during which they
characterized their prescription monitoring database program as
a valuable and successful tool to help curb drug abuse.
MS. BEATLEY explained the stages of federal funding such that
the first stage would fund research, the second stage would fund
implementation with a limit of $400,000, and the third stage
would be enhancement grants. Some states have continuously
received enhancement grants, she noted. However, there is no
guarantee or certainty that federal funding for the prescription
monitoring programs will continue.
3:40:52 PM
REPRESENTATIVE GARDNER expressed concern that busy
pharmaceutical dispensers might not have time to query the
prescription monitoring database. She requested information on
the number of states with active voluntary programs.
REPRESENTATIVE NEUMAN expressed concern for government programs
that obtain and store confidential information contained in
records. He referred to page 4, lines 2-7, that require the
Board of Pharmacy to ensure the security and confidentiality of
the database and the information contained within the database.
He expressed further concern for a security breach of the
prescription monitoring database.
MS. BEATLEY referred to page 5, lines 18-22, and outlined the
penalty provisions of the bill. She pointed out that
intentional disclosure of information or access to the database
would be a class A misdemeanor, while someone who intentionally
obtains access or alters or destroys information in the database
would be subject to a class C felony.
3:43:10 PM
REPRESENTATIVE RAMRAS noted that a class A misdemeanor is
punishable with a fine up to $5,000 and 1 year in prison and
that a class C felony is punishable with a fine up to a $10,000
fine and 5 years in prison.
REPRESENTATIVE NEUMAN pointed out that there is not a mandatory
penalty listed in HB 316. He offered his understanding that the
district attorney offices are busy offices that must prioritize
which cases to prosecute. He expressed concern that crimes of
this nature would not be considered high priority crimes to
pursue. People routinely hack into databases, he opined. He
maintained his concern about security breaches to the database.
He further inquired as to whether there is a seal of
confidentiality in circumstances in which a court obtains
information contained in the prescription monitoring database or
whether that information becomes public.
MS. BEATLEY offered her belief that the information would be
held confidential.
3:45:25 PM
REPRESENTATIVE NEUMAN asked whether it is the sponsor's intent
that information contained within the prescription monitoring
database would be kept under seal and not be open to the public
except under the strictest regulations controlled by a judge.
MS. BEATLEY offered that the database would be kept under the
strictest confidentiality and the language [on page 2, line 6 of
Version M] specifies the six categories of persons who can have
access. She noted that law enforcement access is limited in
scope and officers would not be allowed to log into the
database, but could only access information through a court
order.
3:46:28 PM
MS. BEATLEY, in response to Representative Neuman, said that she
could not find any evidence in the research that spans 10-15
years that someone hacked into a prescription monitoring
database. Further, all states with prescription monitoring
databases contract with vendors that use sufficient firewalls to
protect the data, she offered.
3:47:22 PM
REPRESENTATIVE NEUMAN referred to Version M, page 3, lines 27-
30, of proposed AS 17.30.200(c)(3), which read: .."relates to
controlled substances from a drug outlet in quantities or with a
frequency inconsistent with generally recognized standards of
dosage for a controlled substance;". He asked whether doctors
might be targeted if they were to prescribe medication to a
patient that falls outside the norm. He expressed concern that
HB 316 might capture legitimate uses of controlled substances
prescribed by reputable doctors. He related several instances
in which doctors may routinely prescribe a number of controlled
substances, for example, to cancer patients.
MS. BEATLEY acknowledged that pharmacists would be required to
check with the doctor to verify the drug and dosage being
prescribed. She offered that one reason for housing the
administration of the prescription monitoring database within
the Board of Pharmacy is to allow the board to establish the
norms for prescribing practices. She offered that doctors who
demonstrate a continual pattern of overprescribing would trigger
flags in the database.
3:50:49 PM
REPRESENTATIVE NEUMAN referring to the sponsor's memo outlining
the changes included in Version M, inquired as to the reason for
removing the language from the original HB 316, proposed AS
17.30.200(b)(4), which read: "the name and address of the
person for whom the prescription was written and the name and
address of the person who picked up the prescription."
MS. BEATLEY explained that the language, "and the name and
address of the person who picked up the prescription" was
removed from the original bill because the Alaska Nurses
Association expressed concern about nurses' personal information
being logged since health care workers routinely pick up
medication for patients in licensed-care facilities.
Additionally, the requirement would also capture information not
currently reported by pharmacists. Pharmacists said it would be
burdensome to report it, she related. In further response to
Representative Neuman, Ms. Beatley explained the information
that would be recorded in the database includes the date of the
prescription, date filled, method of payment, name and address
of the patient, name and national code of the controlled
substance, its strength, the name of the drug outlet, the
pharmacist or practitioner prescribing the controlled substance,
and other pertinent information. She noted that "other
pertinent information" was added to give the Board of Pharmacy
the flexibility to capture additional information by regulation.
3:54:18 PM
MS. BEATLEY, in response to Representative Neuman, explained
that Version M removes proposed AS 17.30.200(b)(7) from the
original bill, which read: "the dosage, quantity, and frequency
as prescribed;" because it captured essentially the same
information as proposed AS 17.30.200(b)(6), which read: "the
quantity and strength of the controlled substance prescribed or
dispensed;" so it was removed.
3:55:24 PM
REPRESENTATIVE LEDOUX asked for clarification of the process.
She related her understanding that a person would go to the
pharmacy to submit a prescription and the pharmacist would query
the database to retrieve the person's medical and prescription
history.
MS. BEATLEY offered her understanding that several different
databases exist and the information stored in the databases
varies. The Board of Pharmacy and DCCED will select from
several different databases since there is not one standardized
format. She elaborated that one type of database under
consideration uses web-based access. Users would use a unique
login code and confidential password to query patients, view a
list of prescribed medications, along with the name of the
doctor or medical professional who prescribed the controlled
substance. She offered that this information is currently being
captured by medical staff, but that the proposed Version M would
place the information in one location. Thus, pharmacists will
not have to call numerous doctors to obtain the patient's
prescription profile.
3:57:18 PM
MS. BEATLEY, in response to Representative LeDoux, answered that
it is the sponsor's intent to allow pharmacists to access
information for a current patient only. Thus, a pharmacist
would not be able to "fish" for information regarding random
persons.
3:58:13 PM
MS. BEATLEY, in further response to Representative LeDoux,
answered that pharmacists or other medical professionals who
misuse the prescription monitoring database would be in
violation of the penalty provisions in proposed AS 17.30.200(i).
She offered that a person who intentionally discloses
information in the database or allows an unauthorized person
access to the database is subject to a class A misdemeanor. The
prime sponsor is considering a specific amendment to address
"fishing for information". However, the legal drafter assured
the prime sponsor that the aforementioned activity is currently
covered in this subsection, she offered.
REPRESENTATIVE LEDOUX noted her agreement that the penalty
provision described would address intentional disclosure of
information. However, she expressed concern that if someone
used information to satisfy his/her own curiosity, the penalty
provision would not apply.
3:59:48 PM
GINGER BLAISDELL, Staff to Senator Lyda Green, Alaska State
Legislature, speaking on behalf of the prime sponsor of the
companion bill, SB 196, clarified that under both bills
pharmacists would have access to the specific prescription
number being filled or refilled. Since the pharmacist is
interested in determining whether or not to fill a prescription,
the pharmacist does not need to have access to the patient's
condition, she offered. She explained the process pharmacists
would use to access the prescription database. The pharmacist
would enter the specific drug code for the federally controlled
drugs from the prescription. Information contained in selected
records would be compiled and transmitted daily or weekly to a
secure data warehouse for access by the Board of Pharmacy,
pharmacists or other authorized users. When a pharmacist enters
the patient's name, specific information that pertains to the
prescription for the federally controlled substance will appear,
not the patient's high blood pressure medication or other
medication, she noted.
REPRESENTATIVE LEDOUX inquired as to the specific language in
the bill that would limit the information to the prescription.
MS. BLAISDELL referred to page 3, line 14, of Version M,
proposed AS 17.30.200(b)(5) which read: "the name and national
drug code of the controlled substance;" and explained that
refers to the specific information that would be collected in
the prescription monitoring database. In further response to
Representative LeDoux, Ms. Blaisdell said that controlled
substances vary slightly in state and federal schedules. She
noted that schedule I drugs generally include illicit drugs or
illegal drugs such as OxyContin and codeine, schedule II drugs
include pain relievers, schedule III drugs include drugs such as
Ritalin and stimulants, and lastly schedule V drugs would
include low-dose narcotics such as cough syrup containing
codeine.
4:04:03 PM
REPRESENTATIVE LEDOUX inquired as to funding sources for the
prescription drug monitoring program if the federal funding for
the program "dries up". She related her understanding that the
sponsor's intent is not to pass on the cost of monitoring
prescription drugs to the medical professionals who would access
the prescription monitoring database.
MS. BEATLEY answered that was the reason for adding
proposed AS 17.30.200(g) to HB 316, which read:
The board shall notify the president of the senate and
the speaker of the house of representatives if, at any
time after the effective date of this Act, the federal
government fails to pay the costs of the controlled
substance prescription database.
MS. BEATLEY noted that the prime sponsor of the companion bill,
authored a letter of intent and the prime sponsor of HB 316 has
drafted a similar letter. She offered to provide a copy to
Chair Olson or to the House Finance Committee since the bill has
a further referral to that committee.
4:05:45 PM
REPRESENTATIVE GARDNER, in response to an earlier question,
offered her understanding that evidence entered into a criminal
record becomes part of the record and the public has access to
the court record, with some exceptions.
REPRESENTATIVE LEDOUX offered her understanding that the
information becomes public in the event that the person is
convicted of a crime, otherwise it is not normally part of the
public record.
REPRESENTATIVE GARDNER opined that the bill could help identify
and prevent "doctor shopping" by drug addicts or could help
identify corrupt doctors who sell prescriptions.
4:09:05 PM
REPRESENTATIVE NEUMAN inquired as to whether the Board of
Pharmacy would have access to medical records of federally
controlled prescription drugs that have been prescribed.
MS. BLAISDELL answered that the Board of Pharmacy would adopt
regulations to more clearly define how the program would work,
its reporting functions, and the information that would be
captured in the database. Thus, the structure the board elects
to use will determine the level of direct access users will
have. In some states, the board does not have direct access to
the database and only its investigator and technical staff have
access to the database. Technical staff has access to the
database since they need to determine whether the data captured
migrates to the correct field. Other boards have elected to
receive data only when specific flags appear, in the form of an
automated report. Such a report might list a single person who
accessed 20 pharmacists and 30 doctors in the past 12 months.
The board could assign its investigator to review the matter for
potential criminal activity, she offered.
4:11:51 PM
BRIAN HOWES, Investigator III, Division of Corporations,
Business, and Professional Licensing, Anchorage Office,
Department of Commerce, Community, & Economic Development
(DCCED), said that as senior investigator he supervises staff
that provides investigative services to occupational licensing
boards serving 35 professions. The Board of Pharmacy is
currently authorized to release confidential information to the
division's investigators.
MR. HOWES explained that through the current state, federal, and
HIPAA exemptions, the data gathered by the program is currently
available to the division and to prescribers, dispensers or law
enforcement personnel. However, HB 316 would help reduce
prescription drug abuse such as "prescription forgery", "blanket
prescribing", and "doctor shopping." This bill would provide
investigators ready access to prescription information in a
searchable, electronic form which makes collection of
information easier and less intrusive, and reduces time and
effort to conduct investigations. Thus, investigators could
access multiple pharmacy locations without having to visit every
pharmacy, mail out letters, or physically review countless
copies of pharmacy prescriptions. He reviewed the current
investigative procedures and noted that HB 316 would help
investigators identify and make cases on prescription drug
abusers in cost effective ways. He recalled one case in which
pharmacists provided copies of over 10,000 prescriptions, which
required three months of data entry and analysis to enable
investigators to document the case. That same case could have
been completed in a few minutes using the prescription database
authorized by HB 316, he opined. He has contacted numerous
states with active prescription monitoring programs.
Prescribers, dispensers, professionals, board licensing staff,
and law enforcement all reported positive feedback on current
prescription monitoring programs in other states, he said. He
pointed out that Nevada provides patient prescription reports to
doctors to alert them when their patients are using multiple
doctors and prescribers simultaneously. Such reporting is often
the first step in acquiring drug abuse treatment for patients,
he opined.
4:17:14 PM
MR. HOWES, in response to Chair Olson, advised that the proposed
database would be able to track user access to provide a tool
for investigators to curtail unauthorized use of the
prescription monitoring database by pharmacists. In response to
Representative LeDoux, Mr. Howes explained that under the
program individual pharmacists would have a login, password,
access time, and length of time. He related that cases of this
type arise when suspected leaks are reported. Under HB 316,
investigators would have the necessary tools with the
prescription monitoring database that could result in
apprehension of some criminals such as stalkers.
4:18:52 PM
REPRESENTATIVE NEUMAN related his understanding that under HB
316, pharmacists and other prescription monitoring database
users would have limited access to information. However, the
board would be the entity with full access to information
contained in the database.
MR. HOWES answered that pharmacists would be able to access all
of a specific patient's prescriptions in order to identify any
contraindications to the prescription he/she was filling.
REPRESENTATIVE NEUMAN expressed concern that the only patients
being tracked are the ones requesting reimbursement from
insurance companies, but that patients who purchase with cash
would not be tracked in the proposed system.
MS. BLAISDELL pointed out that there are two separate databases.
She clarified that the prescription monitoring database
authorized by HB 316 is separate from the pharmacist's database.
She noted that only prescriptions for federally controlled
substances listed in federal drug schedules I-V would be
monitored in the proposed program. She explained that when a
pharmacist is suspicious of drug diversion, the pharmacist could
query the controlled substance database to determine whether
there is a pattern of multiple doctors prescribing restricted
substances to the patient. She offered that some pharmacists
may examine each patient's record, but others may only access
the database for patients they do not personally know. She
posed a scenario in which a pharmacist might average dispensing
from one to five federally restricted drugs per day. The Board
of Pharmacy could establish security guidelines to trigger an
automatic report be generated when a red flag showed the
pharmacist accesses a certain number of records, such as if a
pharmacist accessed 2,000 records during that same timeframe.
4:23:35 PM
REPRESENTATIVE LEDOUX expressed concern that a pharmacist might
review the records of a specific individual, such as his/her
next door neighbor and not just randomly review records in the
system. She inquired as to whether that type of access could be
detected in the proposed program.
MS. BLAISDELL answered that HB 316 would allow the Board of
Pharmacy to develop regulations to address potential drug abuse
and database access abuse. The board is the entity that will
have the best understanding of the issues and potential
problems, she opined.
4:24:41 PM
BARRY CHRISTIANSON, Pharmacist; Co-Chair, Alaska Pharmacists
Association, offered support for the proposed Version M, which
incorporates many issues that were worked out in the companion
bill.
REPRESENTATIVE NEUMAN expressed concern about unauthorized use
of the proposed prescription monitoring database.
MR. CHRISTIANSON offered his understanding that the prescription
monitoring program would be administered through the Board of
Pharmacy, but pharmacists, prescribing physicians, and other
medical professionals who prescribe, such as nurse
practitioners, would have access to the prescription monitoring
database. He said that the data transmitted on the federally
controlled substances would be limited to the Board of Pharmacy.
4:26:25 PM
REPRESENTATIVE NEUMAN inquired as to who will have access to the
individual's personal information.
MR. CHRISTIANSON said he believed that only pharmacists and
prescribers currently registered by the Board of Pharmacy would
have access to the personal information.
REPRESENTATIVE NEUMAN related his understanding that the program
would allow pharmacists, pharmacy technicians, physicians, and
the Board of Pharmacy access to the patient's information.
MS. BEATLEY referred to Version M, page 4, line 2, which would
limit access to the prescription monitoring program database.
She reviewed proposed AS 17.30.200(d)(3)-(6). Under proposed AS
17.30.200 (d)(3), a licensed practitioner could access the
database specifically to query a patient that the practitioner
is currently treating. Proposed AS 17.30.200(d)(4) would limit
a licensed pharmacist's access to information that relates
specifically to a current patient to whom the pharmacist is
dispensing a controlled substance. Proposed AS 17.30.200(d)(5)
would allow enforcement authorities to access printouts of the
information pursuant to a search warrant, subpoena or an order
issued by a court establishing probable cause for the access and
use of the information. Proposed AS 17.30.200(d)(6) would allow
individuals to access their own information for a fee.
4:29:14 PM
MR. CHRISTIANSON, in response to Chair Olson, offered that drugs
are classified by their potential for abuse, and schedule I
refers to experimental drugs. He noted that his pharmacy does
not stock any schedule I drugs. Schedule II drugs include
medications such as OxyContin, schedule III drugs include
medications such as Vicodin and Percocet, schedule IV drugs
include medications such as Valium, and schedule V drugs include
medications such as codeine-based cough syrups. In further
response to Chair Olson, Mr. Christianson noted that about 15
percent of all prescriptions fall under the federally restricted
drugs. Thus, about 85 percent of prescriptions would not be
addressed by HB 316.
4:30:51 PM
REPRESENTATIVE GARDNER inquired as to whether Mr. Christianson
could predict how often pharmacists will use the database if it
is voluntary to do so.
MR. CHRISTIANSON opined that the database would frequently be
used. Pharmacists are intuitive so when something seems amiss,
the pharmacist will call the prescriber's office to be certain
that the patient has advised their physician of other
prescriptions being filled, he offered. However, if a known
client submits a prescription for a painkiller from her dentist,
the pharmacist would probably not query the database. He
offered his preference for a program that allows for voluntary
use.
4:32:42 PM
MR. CHRISTIANSON, in response to Representative Neuman,
explained that under HB 316, pharmacists would voluntarily query
clients who submit prescriptions for controlled substances.
However, he clarified that HB 316 would require pharmacists to
report scheduled drug data to the Board of Pharmacy.
4:33:24 PM
REPRESENTATIVE LEDOUX inquired as to the cost for a pharmacist
to report and whether further costs are covered by the federal
grant.
MR. CHRISTIANSON answered that the major hurdle for the program
will be whether the prescription monitoring database will
interface with the portal to transfer the data. Since Alaska is
not the first state to initiate the prescription monitoring
program, he anticipated that sufficient federal funds will be
available to cover the state's startup costs. Once the
prescription monitoring database is online the costs are
projected to be minimal, he said.
4:34:29 PM
REPRESENTATIVE BUCH inquired as to whether there are other means
for cost recovery of the program if federal funding is cut.
KEITH MALLARD, Captain, Commander, Alaska Bureau of Alcohol &
Drug Enforcement, Division of Alaska State Troopers (AST),
Department of Public Safety (DPS), said that setup costs are the
main expense of prescription monitoring programs. Other states
have reported that their costs after setup have been rather low.
He offered that there are a number of respected programs in
other states and the combined queries tally about 5,000 queries
per month. Thus, physicians and pharmacists who are the primary
database users frequently access the system in states that
currently have a prescription monitoring program.
4:36:54 PM
MS. BLAISDELL reported that most states initially spend close to
$400,000 in federal setup grants for their prescription
monitoring programs for expenses such as establishing separate
servers and for hardware and software purchases. She noted that
New Mexico reports its ongoing costs at the low end in the
amount of $13,000 per year. However, other states such as
Wyoming hired additional staff and reported ongoing costs of
about $90,000 per year. She said she anticipates that the cost
in Alaska will drop dramatically after the initial setup costs.
REPRESENTATIVE BUCH referred to page 3 of an article in the
committee packet labeled "The Goals of Prescription Monitoring"
in the section titled, Protection of Confidentiality, and read:
"Over the decades during which prescription monitoring programs
have been operating, there have been no documented or anecdotal
causes of breach of confidentiality of data." That reference
should help members with questions about security of
prescription monitoring systems, he opined.
4:39:05 PM
WILLIAM STREUR, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), said that he
oversees the Medicaid and health care policy for the DHSS. The
DHSS supports HB 316, he related. He offered that similar
programs have been successful in other states. It is good for
legislators to strive to ensure confidentiality because of risks
involved, he opined. This legislation provides for a
prescription monitoring program that will bring a balance
between safe use of drugs and the need to prevent the illegal
activity associated with drug diversion of controlled
substances. He reported that in the Medicaid program he
oversees approximately $68 million is spent on prescription
drugs, of which $8.6 million, or approximately 15 percent, is
spent on schedule I-V drugs controlled drugs. "Drug diversion"
refers to drugs such as OxyContin or other prescription pain
relievers that are illegally sold to other uses. The cost for
unintended use adds to the overall cost of the Medicaid program,
he opined. The proposed prescription drug monitoring program in
HB 316 would help to ensure the safe use of medications beyond
what is currently done such as checking for contraindication of
prescribed drugs. This bill would help prevent drug diversion
and reduces "fragmented care", which is when a person obtains
health care from multiple doctors and pharmacists. This bill
can help health care professionals to work together for the
benefit of the patient. This bill would allow prescribers and
pharmacists knowledge of prescribed controlled substances for
specific patients. He related an example from another state
drug monitoring program that identified a patient who had
received prescriptions from over 40 doctors. Additionally, the
proposed database would assist in detecting forged prescriptions
when physicians report their name is associated with
prescriptions that they did not write.
4:43:36 PM
CHAIR OLSON, after first determining no one else wished to
testify, closed public testimony on HB 316.
4:43:49 PM
REPRESENTATIVE GARDNER made a motion to adopt Conceptual
Amendment 1:
Page 3, line 20
Delete "(9) other relevant information as
required by the board."
REPRESENTATIVE GARDNER explained that HB 316 carefully
delineates the data to be collected. Conceptual Amendment 1
would allow the legislature direct oversight over information
that is collected in the drug monitoring database. The Board of
Pharmacy may wish to collect information such as a patient's
social security number, she offered. Since the legislature does
not have direct oversight over the board, Conceptual Amendment 1
would allow the legislature the opportunity to review the
board's requests.
REPRESENTATIVE RAMRAS noted his agreement with Conceptual
Amendment 1, so long as it only deletes paragraph (9).
4:45:27 PM
REPRESENTATIVE LEDOUX objected for the purposes of discussion.
She expressed concern with HB 316. She then withdrew her
objection.
4:45:43 PM
CHAIR OLSON asked if there were any further objections to
adopting Conceptual Amendment 1. There being no further
objection, Conceptual Amendment 1 was adopted.
REPRESENTATIVE NEUMAN noted his concern with HB 316, but offered
that he does not wish to keep the bill from moving forward. He
offered to work with the sponsor to address his concern with HB
316.
4:46:38 PM
REPRESENTATIVE NEUMAN moved to report the proposed CS for HB
316, Version 25-LS1283\M, Luckhaupt, 2/4/08, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 316(L&C) was
reported from the House Labor and Commerce Standing Committee.
4:47:07 PM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
adjourned at 4:47 p.m.
| Document Name | Date/Time | Subjects |
|---|