Legislature(1999 - 2000)
03/20/2000 01:33 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 20, 2000
1:33 p.m.
MEMBERS PRESENT
Senator Mike Miller, Chairman
Senator Gary Wilken
Senator Drue Pearce
Senator Kim Elton
MEMBERS ABSENT
Senator Pete Kelly, Vice-Chairman
COMMITTEE CALENDAR
SENATE BILL NO. 261
"An Act relating to needle stick and sharps injury protections and
the use of safe needles by health care facilities and health care
professionals; and providing for an effective date."
-MOVED CSSB 261(HES) OUT OF COMMITTEE
SENATE BILL NO. 275
"An Act relating to the school year for purposes of the
postsecondary student loan program; and providing for an effective
date."
-MOVED CSSB 275(HES) OUT OF COMMITTEE
PREVIOUS SENATE COMMITTEE ACTION
SB 261 - See HESS minutes dated 3/8/00.
SB 275 - No previous action to report.
WITNESS REGISTER
Ms. Wanda Katiszki
Alaska Nurses Association
237 E 3rd
Anchorage, AK 99501
POSITION STATEMENT: Supports SB 261
Ms. Donna Thompson
No Address Provided
POSITION STATEMENT: Supports SB 261
Mr. Cle Wade
Alaskan Chapter of American Industrial Hygienists
3301 Eagle St.
Anchorage, AK 99510
POSITION STATEMENT: Supports SB 261
Mr. Tim Bundy
Assistant Chief
Occupational Safety & Health
Alaska Department of Labor
PO Box 107022
Anchorage, AK 99510-7022
POSITION STATEMENT: Available to answer questions
Ms. Maggie Flannagan
1722 Bellevue Loop
Anchorage, AK 99515
POSITION STATEMENT: Supports SB 261
Ms. Donna Libal
PO Box 1071
Homer, AK 99603
POSITION STATEMENT: Supports SB 261
Ms. Karen Willows
51305 Raven Canyon
Homer, AK 99603
POSITION STATEMENT: Supports SB 261
Mr. Jake Mater
Government Affairs
Aventis Pharmaceuticals
PO Box 490
Folsom, CA 95630
POSITION STATEMENT: Noted Aventis's concern about prefilled
syringes
Mr. Paul Neilsen
Pharmacia (ph)
No Address Provided
POSITION STATEMENT: Noted concern about prefilled syringes
Mr. Elmer Lindstrom
Special Assistant
Department of Health and Social Services
PO Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Commented on SB 261
Mr. Milt Byrd
Chairman
Alaska Commission on Postsecondary Education
3030 Vintage Blvd.
Juneau, Alaska 99801-7109
POSITION STATEMENT: Supports SB 275
Ms. Diane Barrans
Executive Director
Alaska Commission on Postsecondary Education
3030 Vintage Blvd.
Juneau, Alaska 99801-7109
POSITION STATEMENT: Supports SB 275
ACTION NARRATIVE
TAPE 00-11, SIDE A
Number 001
CHAIRMAN MILLER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:33 p.m. Present were
Senators Pearce, Elton, Wilken, and Chairman Miller. The first
order of business to come before the committee was SB 261.
SB 261-PROTECTION FROM NEEDLE & SHARPS INJURIES
CHAIRMAN MILLER announced his intention to move SB 261 today. He
asked those wishing to testify to keep their testimony concise so
that all participants can testify.
MS. WANDA KATINSZKY, President of the Alaska Nurses Association
(ANA), said the ANA represents a bargaining unit for the Central
Peninsula General Hospital and the Providence Alaska Medical
Center. She is also speaking to the committee on behalf of 6,000
registered nurses throughout Alaska. Ms. Katinszky gave the
following testimony.
First of all, I am a registered nurse and I was an Infection
Control Practitioner at the time the initial federal OSHA
guidelines on blood borne pathogens was published. I
implemented the first needleless devices at Elmendorf Hospital
in 1992, so I speak from first-hand experience.
I wish to also thank Senator Kim Elton and his staff member,
Angie Schmitz, for spearheading this issue on behalf of all
health care workers. They have truly done their homework, and
we are very grateful for their proactive stance on our behalf.
Your first question, most likely, is "Why do we need this
bill?" I wish we didn't. However, by an informal survey of
different facilities throughout Alaska this past couple of
weeks, we found wide variations in availability of safe needle
products. I applaud those facilities who have done a good job
implementing the federal guidelines, but what about those
health care workers who do not have employers who have been
responsive to these guidelines?
It is due to the lack of response by employers that the
American Nurses Association has championed this cause at a
national level, six states have already passed legislation,
and 20 other states are in some stage of enacting legislation.
This problem of compliance was highlighted in the executive
summary of the Maryland Study Group on Health Care Worker
Safety which states "Although the OSHA blood borne pathogen
standard includes language on the use of engineered sharps
protection, it has not been an effective tool in promoting
widespread use of engineered sharps injury protection." The
outcome of this study group was to recommend passing state
legislation there, which was enacted in 1999.
Now, health care workers [indisc.] statistics that health care
workers suffer annually between 600,000 and one million
injuries from conventional needles and sharps, and nurses
suffer the majority of these. We have to ask ourselves why
this is allowed to happen when 80 percent of needle stick
injuries are preventable with use of safer devices.
Nationwide less than 15 percent of facilities have employed
the use of these safer devices, even though they have been
available since the 1970's and with the blood borne pathogen
standards issued in the 80's, they've really proliferated and
there are over 250 products on the market right now. We think
it will take strong state legislation, instead of compliance
directives, which is what we currently have, to protect health
care workers.
A lot of people will say, well, we already have standards at
the national level, why are we doing this at the state level.
Part of that is because compliance directives are
interpretations of standards that can come and go with the
administration that's there so we need a permanent solution
which this legislation will provide. Passing a state law will
set the standard in stone, so to speak, and remove the
ambiguity of compliance directives.
I think this bill makes good business sense. It does not
require the employer to purchase any and all safety devices,
but rather requires them to evaluate products, using front
line workers to determine what works best in their facility.
A scientific approach should be used by assessing the needle
stick trends that they are having, then evaluate products to
decrease the incidence of needle stick injuries that are
occurring. If done correctly, the cost of implementing these
devices will decrease over time due to cost savings realized
from reduced exposure follow-up and treatment. Each hospital
should already have this needle stick injury data. It's also
been shown by Kaiser in California that the cost of needle
stick devices has gone down and they've been able to decrease
the amount of money they spent on post-exposure follow-up so
there is data to support this.
Now one of the things that I do want to bring up - there's
some criticisms of this bill as far as the length of time that
is required to evaluate products which is six months. Now,
speaking from experience, I believe this trial period -
anything less than this trial period of six months is
shortsighted. This evaluation period does not mandate a
device be used for six months, rather the evaluation period
should be six months. That evaluation period would begin when
you accept the needs of the service or that department based
on the information you have of your current needle stick
injury amounts or that the level of injury that you have -
then you get other potential alternative products - you decide
which ones you are going to trial.
Another criticism that I heard was, well we don't want to
trial period for six months if we know it doesn't work. Well,
the bill doesn't say that. It just says, within that six
month period, you want to be evaluating the products and part
of that evaluation will be actually using the product.
Another thing that I can speak from - from experience, is that
if you don't include every department, you really will
increase your costs so it's very important that those users at
the table represent every nook and cranny of the hospital
where a patient may start into the hospital - whether the ER
or the doctor's office, and go through until they are
discharged. Every player needs to be available to discuss
this. So that's another very, very important part of this
bill.
As you know, and you are going to hear from some health care
workers, once they have exposure to blood and body fluids,
they must treat their personal relations with significant
others as if they are carriers of blood borne pathogens. Now
their exposure risks extend to their families as well. This
can produce much fear and stress within the nuclear family and
it interferes with their privacy on different levels. It
includes taking measures to prevent transmission to disease to
their spouse and children. I again ask, why do health care
workers have to undergo this type of stress when we have
products available and yet they're not being accessible to the
health care workers?
Of those health care workers who will contract a disease, the
emotional and health concerns are much graver. It is
estimated that 1000 workers annually will become infected, and
I saw one statistic that said 5,000 health care workers every
year contract either HIV, Hepatitis C, or Hepatitis B.
According to the American Hospital Association, one serious
infection by blood borne pathogens can add up to $1 million or
more. Another nurse will hopefully be on to attest to a liver
transplant that she received as the result of exposure to
blood borne pathogens. Again, who will intervene for us to
help prevent these serious infections? We believe now is the
time to end this threat to our profession.
So, on behalf of the nurses of the State of Alaska, I express
our gratitude for your consideration of this bill. We believe
it is a protection long overdue to all health care workers and
we urge you to pass this legislation to protect not only our
safety, but the safety of our families as well. I appreciate
your time.
There being no questions of Ms. Katinszky, CHAIRMAN MILLER asked
Donna Thompson to testify.
MS. DONNA THOMPSON, a registered nurse, gave the following
testimony via teleconference. In December of 1989, while working
at a hospital in Anchorage, she contracted non-A, non-B, non-C
Hepatitis. In March of 1990, she was in a coma and was transported
to Seattle for a liver transplant. During those three months, she
had to have her children immunized and she had them stay at
friends' homes for fear of transmitting the disease to them. She
was unable to work due to profound weakness and an inability to
eat. She returned to work in May of 1991, after a battle with the
facility. Her medication costs about $600 per month. In 1992, she
received a needle stick while administering medication to a
patient. In 1998 she was diagnosed again with recurring Hepatitis,
the same variety she was diagnosed with in 1989. She has since had
two liver biopsies since then and is scheduled for a third next
month. It has been a very difficult time for her family. Her
oldest daughter had to quit college to care for her after her liver
transplant. She said a safe needle policy is of utmost importance.
Many nurses that she knows have received needle stick injuries -
some are reported, many are not. The emotional and psychological
stress a person goes through when they are facing an organ
transplant is enormous. She stressed the importance of protecting
health care workers in high risk areas.
Number 1030
MR. CLE WADE, President of the Alaska Chapter of the American
Industrial Hygiene Association, said his professional purpose as an
industrial hygienist is to minimize and, if possible, prevent
occupational illnesses. No one can debate the fact that exposure
to blood borne diseases by needle stick is a significant hazard -
not just to the employee, but to the employee's loved ones at home.
It is a hazard that his organization is committed to minimizing.
The Alaska Chapter supports SB 261.
MR. TIM BUNDY, Assistant Chief of Consultation and Training, for
the State of Alaska's OSHA Program, said he was available to answer
questions.
MS. MAGGIE FLANAGAN, a registered nurse and the health and safety
officer for her union which represents nurses and a huge health
care facility in Alaska, said that everyday that her co-workers go
to work, they face deadly risks from dangerous needles. These
risks are unnecessary and could be prevented with safer needle
devices. Needle stick injuries are a serious problem at our
facilities but this problem already has a solution in safer
devices. Nurses are angry that in the facility where she works,
one person in authority can block hundreds of health care workers
from having the protection offered by these devices. These devices
are on site, but some health care workers do not have access to
them. SB 261 will give nurses the chance to participate in an
evaluation committee that includes participation with front line
workers of all medical specialties at her facility. SB 261 will
provide for a better tracking system for needle stick injuries with
a well defined sharps injury log. More data will be collected and
facilitate the identification of high-risk situations or procedures
which will enable supervisors to reduce or eliminate such hazards.
Needle stick injuries are a silent epidemic. For the most part,
you will not see the health care workers at Providence that have
had the most serious consequences from these injuries. These
people have had their lives devastated from acquiring diseases and
they will not testify in public about their personal tragedies. To
testify and go public with this only furthers their pain. She
asked committee members to hear their voices through her words.
Many of these people have suffered the consequences of their
injuries in silence. They are afraid to tell their friends, their
co-workers and their family members. It is known that 20 diseases
can be transmitted through these types of exposures. The amount of
personal suffering is unimaginable. There is a waiting time of
months to see if a disease has been transmitted. Nurses worry
about transmitting these diseases to their family members, a
terrifying situation. Since talking to co-workers about this bill
in the past couple of weeks, many have come to her in confidence
and told her about pregnancies they have lost mid-term after
contracting Hepatitis C from a needle stick. She has had transport
nurses tell her they received needle stick injuries from
transporting patients.
Safer products also protect health care consumers. In Anchorage in
December, a young child was exposed by a contaminated needle when
a school nurse accidentally reused a needle on her. Had the safer
needle device been used, that could not have happened.
MS. FLANAGAN noted, as an ICU nurse for 19 years in several
hospitals, she has found infants with needles in their beds,
infants laying under bare needles, and needles in blankets with
children. None of those incidences would have occurred with safer
devices. In her unit, it is considered safe practice to tape
needles into their IV lines when giving medication. The tape is
not enough as this system fails with the best technique. Other
patients at risk for these injuries are those who are sedated,
confused, combative or having seizures. In the mental health
setting, needs can be used as potential weapons against health care
workers.
In talking with her co-workers, she has heard stories of people
being injured through needle sticks through no fault of their own.
She asks that the blaming stop, no matter what the cause of the
exposure. She has had a high-risk needle stick injury when drawing
blood from an infant of a known IV drug abuser. She has had other
near misses and she has had people tell her they have been
reluctant to report these injuries. She asked committee members to
support SB 261.
Number 1396
MS. DONNA LIBAL made the following comments in support of SB 261
via teleconference from Homer. She has worked in the nursing
profession for over 35 years and has been employed at South
Peninsula Hospital for the past four years as an employee health
nurse and infectious control nurse. She is also a member of
Teamsters Local 959. Fortunately, the administration at South
Peninsula Hospital is reactive and proactive in its concern about
needle stick and sharps injuries. Its program evolved both in
response to incidents and by considering the potential for
injuries. Two years ago, the hospital found that manipulating
needle "piggy-backing" connections for IV set ups was one of the
major causes of needle sticks. They went to a needleless system.
The South Peninsula Hospital is a small facility and between 5 to
8 exposures are reported each year, and half of those are due to
needle sticks and sharps. Although the hospital does not have a
reduction of big numbers to show a remarkable improvement,
percentage-wise the picture is not worthy. Since 1996, there has
been a 60 percent reduction in overall needle sticks and a 100
percent reduction in needle sticks due to piggy-backed IVs.
MS. LIBAL said she has been asked about the need for SB 261 in
light of the blood borne pathogen standards and whether the bill
duplicates what is already in place. This is a matter of
perspective. The OSHA blood borne pathogen standards address
safety devices but the sections on engineering controls and
workplace practices need enhancement and revision. To fully
understand what OSHA expects, one would have to go to the federal
enforcement directives. Regarding duplication, page 4 of the new
OSHA directives is applicable. It states, "Although adoption of
this instruction is not required, states are expected to have
standards, enforcement policies and procedures which are at least
as objective as those of federal OSHA." SB 261 will change lives,
and that is the bottom line.
Number 1536
MS. KAREN WILLOWS, a registered nurse since 1975, a South Peninsula
Hospital employee for eight years, and a member of Teamsters Local
959, made the following comments via teleconference from Homer.
She cares for many patients who are potential sources of blood
borne pathogens. Since South Peninsula Hospital began using a
needle-less IV system, nurses have been impressed with the ease of
the transition and the general improvement of worker safety. It is
now hard for nurses to imagine not using the safer system. Even
though most IV needle sticks are relatively clean compared to
intramuscular injections, the use of the needleless system when
dealing with chemotherapy is essential to protect the nurse. Some
of these medications used to combat cancer are so caustic that they
require surgery and tissue removal if they leak out of the
injection site or are inadvertently injected outside the vein. She
encouraged members to pass a needle stick protection law.
MR. JAKE MATER, Aventis Pharmaceuticals, informed committee members
that he testified at a previous hearing but noted his company's
exception to prefilled syringes. He pointed out an amendment had
been proposed to address that concern.
MR. PAUL NEILSEN, representing Pharmacia (ph), an Upjohn Company,
noted he shares Mr. Mater's concern. He added that his wife is a
nurse and she has had needle sticks - he believes this is an
important issue.
Number 1675
SENATOR ELTON commented that because OSHA is making new
requirements, DHSS's fiscal note will probably have to be adjusted.
MR. ELMER LINDSTROM, Special Assistant to the Department of Health
and Social Services, informed committee members that when SB 261
was introduced, DHSS was not fully aware of pending OSHA
regulations. After DHSS spoke to Mr. Bundy, it re-evaluated the
fiscal impact of SB 261. Depending on the adoption of the proposed
amendments, it is likely the fiscal impact will be reduced
significantly, if not to zero. DHSS is concerned about a statement
on page 1, line 12, regarding the production evaluation period of
at least six months. The suggestion that the statement does not
require that an item be in use for six months if it is deemed
unsuitable in a shorter time period is not self evident. DHSS's
understanding was that the product must be in use for at least six
months in order to be evaluated. He asked for clarification of
that language or that it be deleted.
CHAIRMAN MILLER noted that no one else wished to testify on this
legislation. He asked Senator Elton to give a brief explanation of
the proposed amendments.
Number 1776
SENATOR ELTON explained that Amendment 1 addresses, on page 4, the
concerns of the manufacturers of prefilled needles. The amendment
provides for a three year period of time before the standards
envisioned in SB 261 apply to prefilled needles. Amendment 1 reads
as follows.
A M E N D M E N T 1
OFFERED IN THE SENATE BY SENATOR ELTON
TO: SB 261
Page 4, following line 7:
Insert a new subsection to read:
"(g) Standards adopted under (b) of this section do not
apply to the use of a drug or biologic prepackaged within an
administration system or used in a prefilled syringe that is
approved for commercial distribution or investigational use by
the federal Food and Drug Administration if the standards
exceed the requirements of the comparable Occupational Safety
and Health Administration standards."
Page 5, following line 12:
Insert a new bill section to read:
"* Sec. 2. AS 18.60.880(g) is repealed December 31, 2003."
Renumber the following bill section accordingly.
SENATOR ELTON moved to adopt Amendment 1. There being no
objection, the motion carried.
SENATOR ELTON explained that Amendment 2 speaks to the requirements
of the Department of Labor. After speaking to staff at the
Department of Labor, it was decided that a requirement that they
compile and maintain a list of safer device information is
unnecessary because other entities already do that. Amendment 2
requires the department to compile a list of sources of that
information and reference them rather than to maintain its own
list. A few of the entities that maintain these lists are the
University of Virginia, the Food and Drug Administration, and the
Centers for Disease Control.
SENATOR ELTON moved to adopt Amendment 2 which reads as follows.
A M E N D M E N T 2
OFFERED IN THE SENATE BY SENATOR ELTON
TO: SB 261
Page 3, line 28, following "of":
Insert "sources of information on"
Page 3, line 31, through page 4, line 3:
Delete "The list may be developed from existing sources of
information, including the federal Food and Drug Administration,
the federal Centers for Disease Control, the National Institute of
Occupational Safety and Health, and the United States Department of
Veterans Affairs."
There being no objection, CHAIRMAN MILLER announced that Amendment
2 was adopted.
SENATOR ELTON explained that Amendment 3 makes a technical change
suggested by the bill's drafter. The provision that provides for
the vaccination of health care workers was not covered in the title
of the bill so Amendment 3 adds a short statement to the title and
better defines the language.
SENATOR ELTON moved to adopt Amendment 3 which reads as follows.
A M E N D M E N T 3
OFFERED IN THE SENATE BY SENATOR ELTON
TO: SB 261
Page 1, line 2, following ";":
Insert "relating to the vaccination of health care workers
against diseases transmitted by blood borne pathogens;"
Page 3, line 24:
Delete "increase vaccinations"
Insert "encourage the vaccination of health care workers
against diseases transmitted by blood borne pathogens"
There being no objection, CHAIRMAN MILLER announced Amendment 3 was
adopted.
SENATOR ELTON moved SB 261 as amended with the attached and
hopefully changing fiscal note. There being no objection, CSSB 261
(HES) moved from committee.
SB 275-POSTSECONDARY LOAN PROGRAM:SCHOOL YR
CHAIRMAN MILLER noted SB 275 was introduced by the Senate HESS
Committee. The bill changes the definition of the school year to
provide student loans for students attending schools that offer a
two year degree within a 15 month time period. Charter College
offers such a degree, and it is working on a four year degree
program that a student could earn in 2+ years. SB 275 changes the
requirement that loans be granted only according to the traditional
school year.
MR. MILT BYRD, President of Charter College and a member of the
Alaska Commission on Postsecondary Education (ACPE), explained that
the modification of the definition of a school year is consistent
with the definition of the U.S. Department of Education.
Historically, colleges and universities have offered two semesters
of 15 weeks each or three quarters of ten weeks for a total of 30
weeks for the academic year. Language in the current statute
assumes that students will go to school for nine months of the year
to achieve 30 weeks of instruction. One can put together a fast
track program whereby the 30 week instructional year can be offered
in about 7+ months. That permits a student to complete a four year
degree in 30 months or 2+ years. Charter College uses that
structure. Currently, it offers a two-year degree and plans to
develop into a four year institution. Charter College is concerned
that students will need to pay four years of tuition for the fast
track program but will be unable to get four years of loans. The
modification of the current statute will simply provide that a 30
week period of academic instruction constitutes a full year and
provides for one full loan.
MR. BYRD said the House companion bill was slightly modified. The
word "occurs" was changed to "begins" on page 1, line 6, to allow
students who are on a fast track program to apply for two loans
during the period from September 1 to August 31. That change was
approved by the Alaska Commission on Postsecondary Education at its
meeting last Thursday.
SENATOR ELTON asked, if the word "begins" is used, why the dates of
September 1 and August 31 are necessary. He asked if the bill
could say that a school year means an academic period that is a
minimum of 30 weeks of instruction time.
MR. BYRD replied that would be fine from his point of view, but
ACPE staff is concerned that the additional loan year be part of
the record for reasons unrelated to this particular change.
MS. DIANE BARRANS, Executive Director of the Alaska Commission on
Postsecondary Education, forwarded to the committee the endorsement
taken by the ACPE the previous week. In regard to Senator Elton's
question, she said the terms and conditions for each school year
are set and disclosed within the Alaska Student Loan Corporation's
official statement. In order to accurately track those terms and
conditions from one year to the next, a time period is set that
they will apply to - the reason the dates are needed in SB 275.
There being no further testimony on SB 275, CHAIRMAN MILLER moved
to replace the word "occurs" with "begins" on page 1, line 6.
There being no objection, the motion carried.
SENATOR WILKEN moved CSSB 275(HES) from committee with individual
recommendations and its zero fiscal note. There being no
objection, it was so ordered. CHAIRMAN MILLER noted the bill has
no fiscal note.
MS. BARRANS told committee members the bill has no fiscal impact
but that she would provide a zero fiscal note for the next
committee of referral.
There being no further business to come before the committee,
CHAIRMAN MILLER adjourned the meeting at 2:20 p.m.
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