Legislature(1997 - 1998)
02/16/1998 09:00 AM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 16, 1998
9:00 a.m.
MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice-Chairman
Senator Lyda Green
MEMBERS ABSENT
Senator Jerry Ward
Senator Johnny Ellis
COMMITTEE CALENDAR
ALASKA PUBLIC HEALTH IMPROVEMENT PLAN - Update by Dr. Peter
Nakamura
SENATE CONCURRENT RESOLUTION NO. 14
Establishing the Alaska Task Force on Parity for Mental Health.
MOVED CSSCR 14(HES) OUT OF COMMITTEE
PREVIOUS SENATE COMMITTEE ACTION
SCR 14 - See HESS minutes dated 4/30/97, 1/30/98, 2/4/98 and
2/11/98.
WITNESS REGISTER
Dr. Peter Nakamura
Division of Public Health
Department of Health and Social Services
P.O. Box 110610
Juneau, Alaska 99811-0610
POSITION STATEMENT: Gave the presentation on the Alaska Public
Health Improvement Plan
Deborah Erickson
Division of Public Health
Department of Health and Social Services
P.O. Box 110610
Juneau, Alaska 99811-0610
POSITION STATEMENT: Provided information about the Alaska Public
Health Improvement Plan
Delisa Culpepper
Alaska Public Health
1874 Wickersham Drive
Fairbanks, Alaska 99507
POSITION STATEMENT: Provided information on the Alaska Public
Health Improvement Plan
Christine Huss
Health Community
P.O. Box 587
Kenai, Alaska 99611
POSITION STATEMENT: Provided information on the Alaska Public
Health Improvement Plan
Jerry Near
Health Community
Drawer 448
Soldotna, Alaska 99669
POSITION STATEMENT: Provided information on the Alaska Public
Health Improvement Plan
Walter Majoros
Executive Director
Alaska Mental Health Board
431 N. Franklin St.
Juneau, Alaska 99801
POSITION STATEMENT: Commented on SCR 14
ACTION NARRATIVE
TAPE 98-11, SIDE A
Number 001
CHAIRMAN WILKEN called the Senate Health, Education and Social
Services (HESS) Committee to order at 9:07 a.m. Present were
Senators Wilken and Green. The first order before the committee
was the Alaska Public Health Improvement Plan update by Dr. Peter
Nakamura. CHAIRMAN WILKEN noted a Public Health Steering Committee
was formed last interim. The presentation will be an update on the
Steering Committee's work to date.
DR. NAKAMURA, Director of the Division of Public Health (DPH), made
the following comments. He came to Alaska to work as a
pediatrician in 1969, and then became the director of the Public
Health Program in Bethel. Many health related problems existed in
Bethel at that time, and clinicians were able to diagnose and treat
those health disorders. The major strides made in the field of
public health have been in the elimination of deaths from
tuberculosis, cholera, typhoid, and diphtheria. Public health
officials made these strides in partnership with clinical
practices. Despite that progress, Alaska still has a long way to
go. Alaska was ranked number 48 out of 50 states in its
immunization status. The population of children in the state
doubled between 1980 and 1996. The number of vaccines now required
to immunize children by the age of 19 is over 3 million doses.
DR. NAKAMURA said no environmental health element existed within
DPH when he became director in 1991. Today DPH is more able to
respond to community health concerns about radiation and cancer or
toxic waste. As a very young state, Alaska's public health system
was developed by responding to crises, by using federal or oil
industry dollars when available, and by focusing on special
interests of individuals with influence. The Alaska Public Health
Improvement Process will eventually lead to a plan. The Steering
Committee needs to know what health services and systems are
available to respond to public health issues in Alaska, not only
within the state infrastructure, but in private health care
systems, tribal corporations, and municipalities.
DR. NAKAMURA stated the Steering Committee will also determine what
capacities are available. With the assistance of federal agencies,
some capacities to respond to environmental health issues were
developed in the state but they have never been evaluated. Those
systems and capacities need to be tied in with disease status to
determine how Alaska fares relative to the rest of the nation.
Health outcomes also need to be identified to determine where we
could be. Once the systems, services, and capacities are
evaluated, and the health outcomes are identified, a plan will be
developed. The Steering Committee hopes to create a package that
will allow policy makers to make decisions and pass legislation
that will have the greatest impact based on health status, rather
than on special interests, special opportunities, or prices.
DR. NAKAMURA said the Alaska Public Health Improvement Plan is a
significant and important process that requires the involvement of
people with power, influence and knowledge, First, a Steering
Committee was established, comprised of 35 individuals, including
legislators. The process must be broad enough to identify the
needs of communities and individuals, not those of the Division of
public Health. The Steering Committee has formed partnerships with
communities to ensure that true community needs are addressed.
That process should be completed within two years. One community
has health powers which allows that community to collect some
funding on a tax basis to support health issues. No one knows
whether specific communities can assume health powers, and to what
degree.
DEB ERICKSON, Health Program Manager in the Division of Public
Health, DHSS, stated she has been coordinating the Alaska Public
Health Improvement Process. The group received a $300,000 grant
from the Robert Wood Johnson Foundation to fund staff support, and
travel costs for the Steering Committee and a large workgroup who
is conducting an assessment of the current system.
MS. ERICKSON explained the project is divided into two phases.
Assessment of the current system will occur during the first phase,
which should be complete in six to eight months. Information is
being gathered on the resources in the system, the rules,
responsibilities and authorities, and the different players in the
system. The focus of the second phase will be to determine what
capacities will be needed in the public health system in the
future, what the roles, responsibilities, and authorities of the
different players should be, and identifying any necessary legal
changes that need to be made to support that system.
MS. ERICKSON said the three communities that were funded by the
Kellogg Foundation are Fairbanks, the communities on the Kenai
Peninsula, and Sitka. Those communities are working through the
two-phase process at the local level and that information will be
integrated in the state level process.
Number 250
CHAIRMAN WILKEN asked who is involved from the Fairbanks community.
MS. ERICKSON answered some of the key members are Rick Solie, Ellen
Ganley, and Cheryl Kilgore. CHAIRMAN WILKEN asked if they are
participating as representatives of groups. MS. ERICKSON replied
people from the hospitals and health care sector have been very
involved, and that the Public Health Nursing Center has been
helping to coordinate the application process. CHAIRMAN WILKEN
questioned whether the group of people is part of an agency or the
Borough. MS. ERICKSON said there is a workgroup that is working
with the Borough Assembly. The Assembly is considering passing a
resolution in support of the process and is looking at being the
funding agency for the grant.
CHAIRMAN WILKEN asked if that same type of membership applies to
Sitka and the communities in Kenai. MS. ERICKSON said yes, they
are community coalitions and not specific organizations.
CHAIRMAN WILKEN questioned whether the money flows directly to
those groups, or through the state. MS. ERICKSON said the money is
going directly to the communities from the Kellogg Foundation.
DR. NAKAMURA explained all communities were invited to express an
interest in partnership in this process by the Kellogg Foundation.
Originally 30 communities were interested, but the application
process was a year-long, time-intensive process, during which time
a number of communities dropped out. The Foundation determined who
was eligible.
CHAIRMAN WILKEN asked where, on the process chart, would
suggestions for new legislation be considered. DR. NAKAMURA said
that will occur at the end point of the process. Throughout the
process, public health law experts will be consulted to give
guidance as to what other states have established and what issues
should be addressed.
SENATOR LEMAN noted that he has introduced SB 205 which pertains to
the issue of health and safety self-audits. The Legislature passed
the environmental audit part of the program last year. He believes
the health and safety self-audits and environmental self-audits may
have some affect on public health concerns. He encouraged the
working group to look at that legislation and inform him of any
concerns it may have.
Number 335
MS. ERICKSON asked if the bill will increase accountability in the
system and identify performance and outcome measures. SENATOR
LEMAN answered the bill provides two incentives, limited immunity
and limited privilege, to individuals and companies who audit their
own operations and make required changes based on the audit
results.
DELISA CULPEPPER, representing the Alaska Public Health Association
(APHA), made the following statements. The APHA represents about
200 public health professionals statewide, and has been working
toward an organized public health plan for the past 11 years. It
is pleased to be engaged in a formal process that will lead to a
more structured view of public health needs in the state. It is
increasingly important, during these times of increasing
accountability and downsizing, that the APHA be engaged in
determining the most effective public health activities. A clear
and prioritized public health policy needs to be determined, along
with a way to track progress. Some of the functions and activities
that need to be addressed and prioritized are epidemic prevention,
protecting the environment - housing, food, and water, promoting
healthy behaviors and healthy public policy, monitoring the health
conditions of the population, mobilizing communities to action
around health issues, and training specialists and investigating
and preventing disease. Alaska needs to create an infrastructure
that will reflect those activities for the future.
Number 391
CHRISTINE HUSS testified as a member of Healthy Communities in
Kenai. Healthy Communities was a recipient of the Turning Point
grant from the Kellogg Foundation. In the early 1990's a group
formed to find funding sources for health insurance for people in
Kenai communities. That goal did not carry through, so the group
developed a program to look at all of the health needs of the
community. One of the group's objectives is to develop new
indicators. The group has promoted many new programs on the Kenai
Peninsula. One apparent problem is the need to expand the public
health facilities in the area. The current space is inadequate and
prevents some services from being adequately provided.
Number 418
JERRY NEAR, representing Healthy Communities, gave the following
testimony. All communities are beginning to foresee the need to
take responsibility for the assumption of various community needs,
in view of pending budget constraints. A community foundation was
recently formed and incorporated as a 501(c)(3) entity so that
individuals can donate to the community and designate what the
funds are to be used for. He informed committee members that he
and Representative Gary Davis have put together a preliminary draft
of a bill that deals with intestacy. Under this proposal, if heirs
cannot be located, property will be held by the state for five
years and then distributed to the various communities with
foundations. The intent is to turn estates back to communities to
be used as a resource for programs.
Number 453
CHAIRMAN WILKEN asked how the money from the Turning Point grant
will be used, and how it flows into the statewide effort. MR. NEAR
said Healthy Communities has prepared a budget time line that
encompasses a three year period. The money will be used to hire
consultants. to take care of meeting costs, to pay for travel, and
to pay some direct office expenses. The budget is still in the
design phase.
CHAIRMAN WILKEN asked what the end product will look like. MS.
HUSS answered that their goal for the next year is to do an
assessment of community needs which they hope to do by developing
initiative teams to do the studies. She added most of the people
working on this project are volunteers.
CHAIRMAN WILKEN asked if Health Communities will be interacting
with those involved from Fairbanks and Sitka. MR. NEAR said those
people will meet with Healthy Communities, as well as with other
community representatives around the nation.
CHAIRMAN WILKEN asked what other states are undertaking such a
project. DR. NAKAMURA said the State of Washington has been at
this process for about eight years and is not quite finished.
Washington participants have offered guidance to Alaska but Alaska
is approaching its public health project in a different manner.
MS. ERICKSON pointed out that originally 47 states admitted
applications to the Foundation to fund similar projects; 14 were
funded. The Foundations are supporting these projects because the
public health community nationwide is recognizing the changing
nature of health problems that affect communities, other health
care systems, welfare reform, political climates, and increased
recognition of the need for more local control and personal
responsibility. This process will allow everyone to review what
steps the public health system has taken over the last 50 years and
what improvements need to be made for the next century. She
thought Alaska will review parts of other states' models for the
purpose of comparison, but believed that other states will
eventually look to Alaska's redeveloped system as a model.
CHAIRMAN WILKEN asked if the State of Washington has developed
standards of measurement to determine whether any progress has
occurred, and whether Alaska's group has discussed using similar
standards. DR. NAKAMURA said he wants the state to know what is
available by way of health systems and services and to feel
comfortable in knowing what the capacity of those systems are and
how they impact the things we read about in the newspaper: the
number of accidental deaths, homicides, suicides, environmental
issues, etc. He noted this process is energy intensive. He is
concerned that if the goals are not achieved at this go-around, it
will take a lot of convincing to get people to re-enter this
process for a second time. Throughout this process the group needs
the continued commitment and participation of the Legislature.
CHAIRMAN WILKEN indicated he would like to see the development of
standards of measurement in Box 5 on the process chart. He also
suggested including the word "legislation" in Box 5.
Number 520
CHAIRMAN WILKEN asked if Alaska's birth rate is increasing or
decreasing. DR. NAKAMURA answered it is decreasing, as it is
nationwide. CHAIRMAN WILKEN asked how Alaska compares nationwide.
DR. NAKAMURA offered to provide that information at a later date.
CHAIRMAN WILKEN inquired about the status of the new laboratory in
Anchorage. DR. NAKAMURA stated DHSS is still in the process of
determining the scope of the laboratory and taking into account the
services the state will need over the next 50 years. He believes
the laboratory will be a focal point of excellence for Alaska.
CHAIRMAN WILKEN asked about the Life Alaska group. DR. NAKAMURA
explained that Life Alaska provides human tissue services. DHSS
recognizes the value of offering such a service in conjunction with
its medical examiner lab. DHSS is reviewing Life Alaska's needs in
conjunction with the other services as the priorities for the
laboratory are being developed.
SENATOR LEMAN noted that he has been very impressed with the Crime
Lab. He encouraged Dr. Nakamura to think about designing the new
facility with the understanding that it may need to be expanded in
the future to consolidate all laboratory services in one location.
DR. NAKAMURA maintained that possibility is being considered, and
not only in the event that state services are consolidated, but
also so that duplication with non-state services does not occur.
CHAIRMAN WILKEN thanked Dr. Nakamura for updating the committee.
SCR 14 - PARITY FOR MENTAL HEALTH TASK FORCE
SENATOR LEMAN moved to adopt CSSCR 14(HES), version K. There being
no objection, the motion carried.
TAPE 98-11, SIDE B
CHAIRMAN WILKEN explained version K incorporates the five
amendments adopted at the previous meeting.
SENATOR LEMAN referred to item #1 on page 2, lines 7-8, and
expressed concern that the current phrase presumes that
discrimination against people with mental disorders is occurring in
health insurance policies. He maintained that if the word
"discrimination" is understood to mean differences in policies then
its use is legitimate.
CHAIRMAN WILKEN asked Senator Leman if his concern is taken care of
in the paragraph above which charges the Task Force with defining
the four different classifications. SENATOR LEMAN maintained that
insurance policies are designed to discriminate among users because
certain classes of users are higher risks, such as teenage drivers,
therefore such discrimination is appropriate.
SENATOR GREEN suggested using the phrase "review health insurance
coverage of persons with mental disorders," because the concern is
coverage rather than policies.
SENATOR LEMAN thought the existing language is acceptable as long
as the intent is clear.
CHAIRMAN WILKEN suggested deleting lines 7-8 altogether to
eliminate the suggestion of discrimination.
WALTER MAJOROS, Executive Director of the Alaska Mental Health
Board, stated his interpretation of the word "discrimination" would
mean the Task Force is to study differential treatment of people
with mental illnesses versus people with physical disorders, which
is the heart of the issue.
CHAIRMAN WILKEN asked if that is taken care of on line 10, with the
phrase, "special emphasis on parity, ...." SENATOR GREEN thought
the first "WHEREAS" clause contains that intent.
SENATOR GREEN moved to delete lines 7-8 on page 2.
MR. MAJOROS stated the issue is one of clarity, and that if the
Legislature wants the Task Force to look at the issue of
differential treatment, lines 7-8 provide that mandate. CHAIRMAN
WILKEN suggested adding the words "differential treatment" to lines
9-11.
SENATOR LEMAN suggested using the language, "differential treatment
in health insurance policies between coverage for mental and
physical disorders" because it will clarify the heart of the issue.
MR. MAJOROS felt that language would be acceptable.
CHAIRMAN WILKEN announced the motion to delete lines 7-8 on page 2
carried with no objection.
SENATOR LEMAN moved to create a new item #1, beginning on line 7,
to read, "differential treatment in health insurance policies
between coverage for physical and mental disorders;". There being
no objection, the motion carried.
SENATOR LEMAN moved to pass CSSCR 14(HES) as amended out of
committee with individual recommendations and its accompanying zero
fiscal note. There being no objection, the motion carried.
CHAIRMAN WILKEN announced a Joint House and Senate HESS committee
meeting is scheduled at 8:15 a.m. on Wednesday to hear about the
Education Week "Report Card for Alaska" and the Traumatic Brain
Injury Act. At 9:00 a.m. on Friday, the committee will hear a
brief presentation from President Kelly of the University of Alaska
Board of Regents, and at 10:00 will discuss SB 203. He adjourned
the meeting at 10:10 a.m.
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