Legislature(2021 - 2022)DAVIS 106
03/18/2021 08:00 AM House TRIBAL AFFAIRS
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| Audio | Topic |
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| Start | |
| Presentation: Role of Tribal Health Organizations in Covid-19 Response | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE SPECIAL COMMITTEE ON TRIBAL AFFAIRS
March 18, 2021
8:01 a.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Chair
Representative Dan Ortiz
Representative Zack Fields
Representative Geran Tarr
Representative Mike Cronk
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION: Role Of Tribal Health Organizations in COVID-19
Response
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
DR. BOB ONDERS
Administrator
Alaska Native Tribal Health Consortium
Anchorage, Alaska
POSITION STATEMENT: Gave a PowerPoint presentation during the
overall presentation, entitled "Role Of Tribal Health
Organizations in COVID-19 Response."
DR. ELLEN HODGES
Chief of Staff
Yukon-Kuskokwim Health Corporation
Bethel, Alaska
POSITION STATEMENT: Gave a PowerPoint presentation during the
overall presentation, entitled "Role Of Tribal Health
Organizations in COVID-19 Response."
ANGEL DOTOMAIN
Alaska Area Director
Indian Health Service
Rockville, MD
POSITION STATEMENT: Testified during the presentation, entitled
"Role Of Tribal Health Organizations in COVID-19 Response."
DR. MARK PETERSON
Medical Director
Norton Sound Health Corporation
Nome, Alaska
POSITION STATEMENT: Testified during the presentation, entitled
"Role Of Tribal Health Organizations in COVID-19 Response."
DR. ELLIOT BRUHL
Chief Medical Officer
Southeast Alaska Regional Health Consortium
Juneau, Alaska
POSITION STATEMENT: Testified during the presentation, entitled
"Role Of Tribal Health Organizations in COVID-19 Response."
ACTION NARRATIVE
8:01:27 AM
CHAIR TIFFANY ZULKOSKY called the House Special Committee on
Tribal Affairs meeting to order at 8:01 a.m. Representatives
Ortiz, Cronk and Zulkosky were present at the call to order.
Representative Field and Representative Tarr (via
teleconference) arrived as the meeting was in progress.
^PRESENTATION: Role of Tribal Health Organizations in COVID-19
Response
PRESENTATION: Role of Tribal Health Organizations in COVID-19
Response
8:02:31 AM
CHAIR ZULKOSKY announced that the only order of business would
be a presentation on the role of tribal health corporations in
COVID-19 response.
8:03:00 AM
DR. BOB ONDERS, Administrator, Alaska Native Tribal Health
Consortium, shared a PowerPoint on the role of the Alaska Native
Tribal Health Consortium (ANTHC) during the COVID-19 pandemic.
Early on, efforts centered on mitigation, early identification,
and eradication, he stated; securing Personal Protective
Equipment (PPE) and testing were also key. When early
identification and eradication was no longer possible, case
counts surging in late fall 2020, the effort became centered on
response, he shared. Currently, efforts were focused on
vaccination and recovery. How the COVID-19 pandemic will
respond to ANTHC's efforts to mitigate cases across Alaska
remained to be seen, he said. Regions' implementation of
quarantine policies and airport testing have significantly
helped prevent hospitalizations, he imparted. High case counts
on the road system eventually became so high that it became a
challenge to keep COVID-19 out of rural areas, he stated. He
shared slide 5, which showed on a line graph there had been
fewer than 100 cases of influenza throughout the 2020-2021
season, compared to as many as 1,200 lab reports in seasons
prior. This showed mitigation measures worked, he said.
8:07:26 AM
DR. ONDERS shared slide 6 on ANTHC response to COVID-19, which
noted systems became overwhelmed with many staff contracting
COVID-19 and entire hospital wings full of patients who had
tested positive for the virus. Staffing was made available
through Indian Health Service (IHS) for ANTHC's alternate care
facility at a critical time, he shared; without the additional
facility ANTHC would have had to close earlier than it had.
There were times in Fall 2020 when all three hospitals in
Anchorage were closed, he stated, and the closures made a
significant difference for Rural Alaska: for critical care
patients and adult in-patients, ambulances could rotate around,
but air transfers presented a challenge, he said. Every
ambulance would be taken in, but it happened in the fall that
ANTHC was not able to take air transfers. Alaska lacked
redundancy in critical care physicians, critical care nurses,
and even critical care beds, so mitigation measures and
prevention became key.
8:10:11 AM
DR. ONDERS shared slide 7 on COVID-19 vaccine allocation, which
he called the most beneficial of all the phases thus far. The
"Sovereign Nation Supplement," as it was called, through IHS
with its unique government-to-government relationship with
tribes in Alaska, allowed for additional vaccines on top of what
had already been allocated. This significantly improved the
vaccination effort across the state in terms of per-capita
allocations, he shared, adding that tribal health organizations
had the flexibility to prioritize locally and get the vaccine
out quickly. Tribal healthcare systems prided themselves on
relationships with patients, and the extensive databases made it
easy to identify who was high-risk early on. Up-to-date contact
information made it easy to roll the vaccine out to vulnerable
populations expediently, he imparted.
DR. ONDERS shared there were 27 tribal health organizations and
12 major tribal regions across Alaska. From the standpoint of
ANTHC, with the vaccine out, working with tribal health
organizations across the state to get the vaccine to where it
was most needed was the main thing. Areas have been more
successful at getting the vaccine out and areas have been
challenged, he stated, and there has been some reallocation of
the vaccine to those areas it was still needed. He emphasized
the protection of everyone in the community, not just the tribal
members. To successfully mitigate the spread of COVID-19,
everyone must be kept safe, he added.
8:14:03 AM
CHAIR ZULKOSKY asked if there was a sense of the total number of
vaccines made available through the Sovereign Nation Supplement.
DR. ONDERS replied no, but he could find out.
DR. ONDERS moved onto slide 9, a bar graph which showed
variability of vaccine rollout among tribal regions, looking at
both boroughs and tribal health organizations which served those
boroughs. The goal was to get the vaccine to communities which
needed to get their immunization rates higher, he related. On
slide 10, gleaned from State of Alaska data, Dr. Onders
presented a line graph showing in November and December of 2020
Alaska Native people having about three times higher COVID-19
case counts, hospitalizations, and mortality rates than the rest
of the population. The Sovereign Nation Supplement, which
allowed for early administration to areas of need, changed that.
This was indicated on the graph, he pointed out, as the
supplement was able to provide a disproportionate advantage to
communities at risk.
8:18:10 AM
DR. ONDERS went over slide 11, the morbidity and mortality
report from March 17, 2021. Alaska ranked number two in states
getting out vaccines to communities most at risk. Fifteen
different variables were used to determine social viability
across the US, he shared. He once again gave credit to the
supplement for the expedient rollout.
8:21:19 AM
DR. ELLEN HODGES, Chief of Staff, Yukon-Kuskokwim Health
Corporation, presented a PowerPoint on the COVID-19 pandemic
response by the Yukon-Kuskokwim Health Corporation (YKHC). She
shared that over a year ago, in March 2020, YKHC's Incident
Command Team had been activated. While the virus was not known
to be in the region at that time, YKHC had been preparing for
the outbreak with planning, training, and drills. In response
to the worldwide PPE shortage, YKHC began making masks for
internal and village clinic distribution. Moving onto slide 3,
Dr. Hodges shared between April and August 2020 YKHC prepared
for an influx in patients by doubling available beds and
identifying alternative care sites, as well as by developing
strategies for staff to follow if a major surge hit. They set
up an internal contact tracing team, developed expanded
telehealth capabilities to serve communities while travel was
not feasible, and set up widespread testing with drive-through
and walk-in testing in the hospital parking lot, as well as
testing at hub airports in the region, meeting every flight that
landed in Bethel, Aniak and St. Mary's to offer testing, and by
beginning widespread testing in villages that had positive
cases.
DR. HODGES shared by July over 7,000 tests had been performed
and 22 positive cases had been found. Rapid response teams were
developed to travel to villages with positive cases and assist
in treatment and testing.
8:23:51 AM
CHAIR ZULKOSKY asked how many contact tracers were on YKHC's
COVID-19 response team.
DR. HODGES said at first four, then five, then with the advance
of the pandemic, about 12.
DR. HODGES shared between September and December 2020 YKHC set
up weekly meetings to discuss precautions and answer questions.
Participants included tribal and city governments, school
districts, individual villages, and internal YKHC staff.
Village trips for testing and assisting with positive patients
continued, she added, as did the emphasis on testing into 2021.
As of March 2021, upwards of 74 thousand tests had been
completed, she shared. By the end of December there were 3,644
cases in the Yukon-Kuskokwim Delta (Y-K Delta); the average was
50 100 new cases per day; and the peak of 135 cases in one day
occurred in mid-November, she shared.
8:25:29 AM
CHAIR ZULKOSKY asked if there was an assessment of what
percentage of tests conducted in the YKHC service area were
processed through the state public health lab, and the
percentage processed commercially or otherwise not through a
state lab.
DR. HODGES said a small percentage; YKHC relied heavily on the
Alaska Native Medical Center to process most tests.
DR. HODGES pointed out by way of a bar graph that the Y-K Delta
had the highest COVID-19 rates in Alaska, especially during the
months of October - December 2020 and January 2021. For many
weeks these were also the highest case rates in the US, she
added. From December 2020 to present, when vaccines had become
available, a distribution plan was set up to get to all 47
villages using charters: to begin with, 30 villages were
visited in four days with multiple teams to administer vaccines
to health care workers. Vaccine eligibility was then expanded
to the elder population shortly into this effort, and
eligibility was immediately opened on trips to villages as it
was understood that everyone in a village must be vaccinated to
get the pandemic under control.
DR. HODGES shared between December 18, 2020 and January 9, 2021
YKHC completed 57 village visits throughout the Y-K Delta, and
that all YKHC villages with clinics were visited with some
receiving multiple visits. Village trips continued, on a weekly
basis, to administer the second shot as needed, and the first
shot to new people. A vaccine administration space was set up
at the hospital in Bethel in mid-December, she shared. As of
March 17, 2021, patients 16 years old and older were eligible to
receive the vaccine, and 53.2 percent have received at least one
shot, 43.8 percent have received both.
8:29:53 AM
CHAIR ZULKOSKY asked how quickly the YKHC service region was
able to expand vaccinations at tribal health facilities to non-
tribal health beneficiaries.
DR. HODGES replied within two weeks, especially elders. By
December 23, 2020, all residents 65 and older were eligible; by
mid-January, all residents were eligible. The vaccination rate
played a huge part in the enormous drop in cases [by the end of
January], she pointed out.
8:31:40 AM
REPRESENTATIVE ORTIZ asked if there had been an assessment as to
why the high case counts happened.
DR. HODGES replied three or four different factors were at play:
crowded, multi-generational homes with poor ventilation; lack of
access to adequate sanitation (60 percent of homes in the region
did not have sewer) increasing rate and severity of respiratory
illness; infrastructure issues regarding housing and access to
medical care.
REPRESENTATIVE ORTIZ stated these imbedded and difficult
problems needed to be truly addressed, COVID-19 pandemic
notwithstanding.
DR. HODGES shared in terms of future efforts YKHC would continue
vaccination distribution in all villages utilizing both health
aides and visiting providers. Some villages have achieved over
95 percent [vaccinated] of those eligible, she stated. In terms
of future efforts, YKHC would resume routine village visits by
providers as often as possible for medical, dental and vision
appointments and provide public information on the status of the
virus in the region. Lastly, she stated, YKHC kindly requested
the Legislature pass House Bill 76, which would allow tribal
health services to continue to grow, especially in the light of
decreased ability to transfer patients by air. She expressed
gratitude for telehealth services and shared resources.
8:37:24 AM
REPRESENTATIVE TARR asked if, after the public health
declaration, telehealth services should be made permanent.
DR. HODGES replied yes, telehealth had been very well-received,
and it should remain, for the well-being of all people.
Especially for routine follow-up appointments this would be
desirable, she added.
DR. HODGES stated variants to COVID-19 continued to emerge in
the Y-K Delta, and the best defense was to get as many people
vaccinated as possible, maintain masking and social distancing,
and minimize group activities.
8:40:12 AM
REPRESENTATIVE ORTIZ asked if "vaccine breakthrough cases" meant
fully vaccinated people had acquired the virus.
DR. HODGES replied yes, and those folks were almost always
asymptomatic.
REPRESENTATIVE ORTIZ asked if there was any state or national
data that indicated the effectiveness of current vaccinations on
the variants.
DR. HODGES replied yes, both Pfizer and Moderna vaccines had
proven effective against known variants.
8:42:54 AM
REPRESENTATIVE FIELDS, referencing an Alaska Daily News article
about low vaccination rates and high infection rates in the
Matanuska-Susitna valley, asked about the risk of such an area
for the rest of Alaska, given the reality of travel, and how it
endangered folks in the rest of the state.
DR. HODGES replied it was very dangerous as such an area would
allow the virus to replicate and potentially create more
variants. She added the best defense was to vaccinate and not
leave such "reservoirs" of unvaccinated people. She pointed out
that Alaska already had such a reservoir with people aged 16 and
under.
REPRESENTATIVE FIELDS asked what guidance she had to encourage
folks to get vaccinated
DR. HODGES replied that continuing education and accurate
information including risks of not getting vaccinated. She
cautioned against inaccurate information spread on social media
and recommended instead engagement with public health officials
and respected leaders in the community.
8:45:41 AM
CHAIR ZULKOSKY asked about the arc of eligibility expansion that
occurred in the Y-K Delta with respect to the initial wave of
vaccinations that came out in mid-December 2020.
DR. HODGES replied the first vaccines arrived December 16, 2020
and went out to villages December 18. Six or seven days later,
it was realized elders could be vaccinated in the villages and
elsewhere. It was made sure there was good outreach to tribal
councils so Village Public Safety Officers and others responding
to the pandemic would be able to receive the vaccine. Each
village had some method of responding to folks who had to be in
quarantine or who tested positive, she said. She continued by
adding by the second week of January 2021 it had been decided
there was enough vaccine and enough interest to offer vaccine to
anyone 16 and over in villages; shortly thereafter in Bethel.
8:49:52 AM
CHAIR ZULKOSKY asked Dr. Onders how many COVID-19 tests had been
processed through ANTHC's lab and when testing had been
expanded.
DR. ONDERS replied he would send numbers, and testing had been
expanded March 22. He added ANMC had the first high-capacity
analyzer in the state.
8:53:48 AM
ANGEL DOTOMAIN, Alaska Area Director, shared in FY 20 the Alaska
Native Health Service distributed more than $161 million to
tribal health partners from the Alaska CARES Act and other
supplemental funding. Through the IHS National Service Center,
PPE and Abbott ID analyzers for COVID-19 testing were also
distributed. The IHS helped with staffing shortages and data
collection for vaccine preparation as well, she explained. The
IHS worked to distribute vaccines as tribes all chose the State
of Alaska for their jurisdiction. Ms. Dotomain also expressed
her happiness with the Abbott ID testing system.
8:57:25 AM
REPRESENTATIVE TARR asked what it meant that tribes chose Alaska
as their jurisdiction in terms of vaccine distribution.
DR. DOTOMAIN replied that tribes across the US had the option of
selecting their state for jurisdiction or the IHS. Since Alaska
had a longstanding vaccine process which had been perfected over
many years it was the better choice, especially with the
knowledge that data management was going to be difficult, and it
would have been harder to report into the IHS system.
9:00:09 AM
DR. MARK PETERSON, Medical Director, Norton Sound Health
Corporation, shared Norton Sound Health Corporation (NSHC) knew
they had to have a very aggressive prevention strategy. Only
about 10 thousand people resided in NSHC, he stated, and some
still had a healthy fear of pandemics dating back to the Spanish
Flu. Nome had been shut down to very limited air travel
initially, and they were also able to hold off the virus until
they developed a good testing strategy, he shared. It was
decided to put an Abbott ID testing system in every village, he
imparted, adding that NSHC had looked for a large-capacity
testing system but couldn't get one. They were just putting one
in at the time of the hearing, he said. Each village as well as
the city of Nome had mandatory quarantine requirements, he said.
9:07:14 AM
DR. PETERSON showed a slide on COVID-19 data from The Norton
Sound/Bering Strait Region from January 1 to March 14, 2021. He
pointed out that the close to 67 thousand tests were mostly done
on the Abbott ID analyzers, and that since the region only had
12 thousand people each person had been tested six times early
in the pandemic. There have been 324 total positive cases by
this time, and two villages with large outbreaks. By the time
of the outbreaks, analyzers, aggressive testing, and contract
tracers were in place, he stated. The region was now on the
life-saving vaccine tract, he said, crediting the combination of
statewide allocation and IHS distribution. He shared a slide on
vaccination percentages, sharing the first half of the
population was "not a problem" to get vaccinated, but the second
half may be "a little more difficult." He pointed out the
region had "pretty good numbers," with most villages being well
over 50 percent vaccinated and 63 percent of all eligible folks
having received the vaccine. It was still an uphill battle to
get to 70 percent, he said. Testing has eased a bit since
vaccines have proven effective, he said.
9:12:04 AM
REPRESENTATIVE FIELDS asked if NSHC was doing all vaccinations
in Nome or if another entity was providing vaccinations for non-
Tribal citizens.
DR. PETERSON replied that the clinic in Nome had traditionally
done all vaccinations for tribal beneficiaries and non-
beneficiaries and would continue to do so. He echoed others'
appreciation for telehealth as well. Educated folks in the
region were worried about the large number of COVID-19 cases in
the Matanuska-Susitna valley, he shared.
9:15:35 AM
REPRESENTATIVE CRONK said he would be looking into why the
basketball tournament would be taking place in a hotspot.
DR. PETERSON agreed and said residents had expressed discontent
that no rapid testing was available at the tournament.
REPRESENTATIVE CRONK expressed his belief a double standard was
at play, there were many safer places in the state in which to
hold the tournament, and student athletes' best interest was not
at the forefront.
9:18:51 AM
CHAIR ZULKOSKY asked about the arc of decision making regarding
expanding eligibility criteria for vaccinations in the Norton
Sound region, especially how quickly decisions to expand were
able to be made.
DR. PETERSON replied that the whole region had been open to
people aged 16 and older since January 2021, which has been very
effective, adding anything that reduced roadblocks to getting
more people getting vaccinated would be helpful.
9:22:00 AM
REPRESENTATIVE CRONK asked if there was a preference in brands
of vaccines.
DR. PETERSON replied that the vaccine that is available is the
one to get.
REPRESENTATIVE CRONK asked if the vaccine would help with
chronic symptoms of COVID-19.
DR. PETERSON said he didn't believe so, and that COVID-19 was
also not as simple a disease as was once thought, with a good
percentage of people showing chronic symptoms.
9:25:25 AM
DR. ELLIOT BRUHL, Chief Medical Officer, Southeast Alaska
Regional Health Consortium, stated Southeast Alaska Regional
Health Consortium (SEARHC) provided a different tapestry of care
to 27 different locations. He shared a timeline which tracked
SEARHC's actions since the beginning of the COVID-19 pandemic,
beginning with the establishment of an incident command center
to allow for consistent communication with employees and outside
agencies. Weekly meetings were held with IHS regarding
resources and PPE, and emergency operations centers set up.
Supplies including PPE and ventilators were obtained, the former
through IHS. Increased training for respiratory care,
particularly in remote areas, was a focus, he stated, as was
gaining access to testing.
9:31:36 AM
DR. BRUHL also expressed appreciation for Abbott ID analyzers.
Regarding the Governor's orders regarding care, practices at
SEARHC were being constantly retooled and ultimately testing
every employee every week. Telehealth helped maintain
continuity of service, he stated, and allowed for safe
engagement of patient care. He did express hesitation for the
"Wild West" nature of telehealth that was developing nationally
and the vulnerability of the health care system in Alaska to
clinics and providers outside the state drawing care out of our
own systems, especially in remote locations in which the result
could be a corrosive effect. It was expensive to provide
services anywhere in the state, he said, so to have them being
drawn upon from outside was highly concerning.
9:35:51 AM
REPRESENTATIVE ORTIZ asked if there was a direct connection
between the continued ability of the state to deliver telehealth
medical services and the extension of the emergency declaration
specifically titled "emergency declaration;" if, he offered,
House Bill 76 were to be adopted without the title "emergency
declaration" it would be problematic in terms of receiving
telehealth services.
DR. BRUHL replied yes, special relationships were in place and
the cancellation cut off those special relationships. Patients
and clinicians alike had come to rely on telehealth and those
relationships, he stated. It was concerning that patients may
be drawn away by other telehealth providers who were not aware
of patients' situation in Alaska, he stated.
DR. HODGES said having [emergency] extension is essential for
telehealth, particularly with regard the handling of the
behavioral health crisis in her region. It was also good to
receive specialty care through ANTHC, she said, but regarding
behavioral health it was essential.
REPRESENTATIVE ORTIZ said he in no way doubted telehealth for
state residents, but the problem was there seemed to be
political considerations; he asked if it would it be a problem
if for telehealth's continuance if "an extension of the
emergency declaration" were not included in the title of
legislation.
DR. HODGES said she didn't think so, especially if the
legislation allowed for the services to continue, and a
permanent solution were on the way.
DR. PETERSON agreed with the summation telehealth was essential
for behavioral health.
REPRESENTATIVE ORTIZ clarified his question was based on a
constituent's inability to receive telehealth benefits because
the emergency declaration was no longer in place, and if out-of-
state providers were then required to go back and look at
specific pieces of passed legislation to determine they could
still provide services.
9:45:35 AM
CHAIR ZULKOSKY asked if the flexibilities afforded through a
disaster declaration such as House Bill 76 provided the
expansion support that health providers were looking for but
also provided finite sunset to expansions so that Alaskan
medical professionals could tease out any problems with drawing
Alaskan entities outside the state; the temporary measure needed
to have a sunset provision to protect Alaska institutions, she
stated.
DR. BRUHL said the emergency declaration has been essential to
being able to respond to the crisis, and leaders needed to be
creating systems that were safe. If systems were unable to be
maintained because predatory health systems were projecting
opportunities for patients to go outside of the state looking
for care, in the end it will be destructive to the system,
undermining its infrastructure, he said. Coming to a
legislative structure should be paramount, he stated.
9:50:13 AM
REPRESENTATIVE ORTIZ said he was wondering how important it was
to include the title "emergency declaration," and if it didn't,
how much out-of-state providers would be expected to "delve into
the weeds" regarding their continuation of providing telehealth
services.
9:52:43 AM
DR. BRUHL turned back to the timeline, talking about
partnerships with school districts and mitigations that
reflected CDC guidelines dovetailed with local school board
preferences. He shared SEARHC had performed over 107 thousand
tests. Vaccine began to arrive in December, he shared, and
SEARHC attended and distributed vaccine in a steadfast manner
which made him proud, in storms, by boat, and by float plane, he
shared. This reflected medical needs of communities and gave a
lot of hope, he stated, particularly regarding past pandemics'
ravaging of remote areas. A system using QR codes allowed
patients to sign up using their smartphones which has been key
to success, he stated.
9:58:07 AM
DR. BRUHL shared the availability of vaccine exceeded
recommendations of the state, so they moved quickly, already
vaccinating anyone 16 and older regardless of risk group. Over
11 thousand people have received the first vaccine and 9
thousand their second, he stated. Well over 70 percent in
smaller communities and 50 percent of larger communities had
also been vaccinated, he shared. Vaccine had been provided to
communities which did not have a strong IHS presence, including
Juneau, Petersburg, and Skagway, he shared.
10:02:58 AM
ADJOURNMENT
There being no further business before the committee, the House
Special Committee on Tribal Affairs meeting was adjourned at
10:02 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| ANTHC Presentation 3.18.21.pdf |
HTRB 3/18/2021 8:00:00 AM |
|
| NSHC Presentation 3.18.21.pdf |
HTRB 3/18/2021 8:00:00 AM |
|
| YKHC Presentation 3.18.21.pdf |
HTRB 3/18/2021 8:00:00 AM |
|
| SEARHC Presentation 3.18.21.pdf |
HTRB 3/18/2021 8:00:00 AM |