Legislature(2001 - 2002)
02/27/2002 01:40 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE
February 27, 2002
1:40 p.m.
MEMBERS PRESENT
Senator Lyda Green, Chair
Senator Loren Leman, Vice Chair
Senator Gary Wilken
Senator Bettye Davis
MEMBERS ABSENT
Senator Jerry Ward
COMMITTEE CALENDAR
PRESENTATION BY SUSAN SCLAFANI, COUNSELOR TO THE US SECRETARY OF
EDUCATION
SENATE BILL NO. 283
"An Act relating to temporary permits and licenses by endorsement
issued by the Board of Nursing; and relating to the delegation of
nursing duties."
MOVED SB 283 OUT OF COMMITTEE
SENATE BILL NO. 325
"An Act relating to civil liability for use of an automated
external defibrillator; and providing for an effective date."
MOVED SB 325 OUT OF COMMITTEE
SENATE BILL NO. 293
"An Act relating to diversion payments, wage subsidies, cash
assistance, and self-sufficiency services provided under the
Alaska temporary assistance program; relating to the food stamp
program; relating to child support cases that include persons who
receive cash assistance or self-sufficiency services under the
Alaska temporary assistance program; and providing for an
effective date."
SCHEDULED BUT NOT HEARD
PREVIOUS SENATE COMMITTEE ACTION
SB 283 - No previous action to record.
SB 325 - No previous action to record.
WITNESS REGISTER
Dr. Ed McLain
Deputy Commissioner
Department of Education &
Early Development
th
801 W 10 St.
Juneau, AK 99801-1894
POSITION STATEMENT: Responded to questions about the No Child
Left Behind Act.
Senator Gary Wilken
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Sponsor of SB 283
Ms. Lynn Hartz
Board of Nursing
3104 Brookside Dr.
Anchorage, AK 99517
POSITION STATEMENT: Supports SB 283
Ms. Pat Senner
Alaska Nurses Association
PO Box 102264
Anchorage, AK 99510
POSITION STATEMENT: Supports SB 283
Ms. Nancy Sanders
Board of Nursing
4830 Kalenka Ct.
Anchorage, AK 99502
POSITION STATEMENT: Supports SB 283
Ms. Dorothy Fulton
Board of Nursing
3601 C St.
Anchorage, AK 99503
POSITION STATEMENT: Supports SB 283
Ms. Mary Weymiller
Board of Nursing
th
666 11 Ave.
Fairbanks, AK 99701
POSITION STATEMENT: Supports SB 283
Ms. Katherine Reardon, Director
Division of Occupational Licensing
Department of Community and Economic Development
PO Box 110800
Juneau, AK 99811-0800
POSITION STATEMENT: Supports SB 283
Ms. Wilda Rodman
Staff to Senator Therriault
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Testified for the sponsor of SB 325
Ms. Kathy McLaren
Emergency Medical Services
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supports SB 325
Mr. Tim Begaine
FNSB Emergency Operations
PO Box 55274
North Pole, AK 99715
POSITION STATEMENT: Supports SB 325
Ms. Pam Beale
Alaska Hospital Association
6704 Notting Hill
Anchorage, AK 99504
POSITION STATEMENT: Supports SB 325
F.X. Nolan
Municipality of Anchorage
1833 Cindylee Lane
Anchorage, AK 99507
POSITION STATEMENT: Supports SB 325
ACTION NARRATIVE
TAPE 02-13, SIDE A
Number 001
CHAIRWOMAN LYDA GREEN called the Senate Health, Education &
Social Services Committee meeting to order at 1:40 p.m. Senators
Wilken, Davis and Green were present. Chairwoman Green asked Dr.
Sclafani to present to the committee.
DR. SUSAN SCLAFANI, Counselor to the U.S. Secretary of Education,
informed members that this visit to Alaska is her first, and she
has realized that Alaska faces some similar and very different
challenges to other states. However, she believes all involved
will find a consistent and coherent message in the "No Child Left
Behind Act," organized around the following four major
principles.
1. Accountability for results.
The new act goes beyond the 1994 reauthorization by requiring
states to: set rigorous content standards; establish student
achievement standards; and develop assessments aligned to those
standards and available to students in grades 3-8 in reading,
language arts, and mathematics. Beginning in 2005, states must
create standards in science and have an assessment by 2007-2008
linked to those standards that would be given once in elementary
school, once in middle school and once in high school. The goal
is to address those areas critical to national security. The
government and private sector are finding that K-12 students are
not going into higher education or careers in the fields of math
and science. That problem has been solved short term with H1B
visas, but that is not a long term solution.
Accountability includes making public reports to communities and
parents to inform them of the progress of students and schools,
and enabling them to evaluate the quality of schools their
children attend, as well as the qualifications of teachers. In
addition, states will create a public report card that will
evaluate schools and how students are doing in a disaggregated
format. Categories have been established for all major ethnic and
racial groups, by gender, by migrant status, by special needs, by
children who are not yet proficient in English, as well as
economically disadvantaged students. The purpose of establishing
those categories is to ensure that no child is left behind.
Schools will be accountable for the performance of all students
and, within 12 years, all students who are tested should reach
proficiency levels as defined by the state. It will be up to the
state to create the accountability system that defines the levels
at which students and schools need to achieve at each year along
the way. While the initial level must be set for 2005, the bar
must be raised again in two years and again in three years to get
to the proficiency in 12 years.
2. State and local flexibility and local control.
The Bush Administration believes strongly that it is not the
federal government's role to tell states how to achieve these
standards and what programs they should put in place. The funding
mechanism provides the area of greatest flexibility. States can
take up to 50 percent of any one of the titles of the funding,
except for Title 1, and apply that to any purpose for which ESEA
funds are allowed. That means if safe and drug free schools is
not an issue in a community, that district can take up to 50
percent of those dollars and apply them to technology for
distance learning or another program. In addition, some of the
funding streams have been consolidated so that states don't get
small amounts of money for specific programs but instead have a
block grant to use as states see fit. The class-size reduction
dollars were fine for states and districts that were able to find
additional highly qualified teachers and had the facilities to
reduce class size, but many districts were unable to use those
funds.
The U.S. Department of Education wants to recognize that the
improvement of the quality of education for students is primarily
a factor of the quality of teachers. It is up to each state to
determine how to improve that quality. The block grant included
not just class size reduction funds but also the Eisenhower
program funds, which was initially focused on mathematics and
science exclusively. The Eisenhower fund program was later
broadened to include other subject areas. Congress is hoping that
school districts will continue to focus dollars on mathematics
and science because Congress sees this as a national security
issue, but no one will prescribe what proportion of those dollars
must be spent on science and mathematics.
Additional funds were added to make a block grant of $2.8 billion
available to spread among states so that they could determine how
to best improve the quality of their teachers. It is clear to
the U.S. Department of Education, from the studies done by Bill
Sanders in Tennessee, that teacher quality is the critical issue.
Mr. Sanders' value-added studies have a very rich longitudinal
database because he was able to look at the performance of
students over time. He found that students with similar
circumstances who had exemplary teachers over a three year time
period were 50 to 70 percentile points ahead of students with
mediocre teachers. Research on teacher quality concludes that
teachers must be well prepared in their content area and able to
work with resources that enable them to reach all of their
students - a national problem that is exacerbated in remote or
rural areas. Title 2 dollars can be used to create selection
criteria, recruitment and retention programs, and to train
teachers and principals. Title 2 funds require states to use a
definition of "highly qualified teachers" that includes
certification in their subject areas and to define "highly
qualified paraprofessionals" as being those people with either a
two-year associate degree or the equivalent as measured by an
assessment. Congress has been very concerned over the last seven
years about the use of paraprofessionals to deliver instruction,
particularly to Title 1 children who are already behind.
3. Do what works - focusing research on proven educational
methodology.
A lot of research on the teaching of reading has shown what works
and what does not, and has gotten away from the whole language
versus phonics battle, where practice was based more on belief
systems rather than research and evidence on how children learn.
The U.S. Department of Education is declaring that war over as
the research is clear. Congress has appropriated an additional
$900 million this year and $1 billion each of the next four years
for reading first, ensuring that K-3 teachers are well prepared
to teach scientifically based methodology in reading. The U.S.
Department of Education is looking for research based practice in
all areas so that as teacher-training programs are developed,
research on effective practices is built into the programs. She
commended legislators for joining the state education and early
learning programs because early childhood programs need to be
linked to what children will learn when they arrive at school.
The phrase "scientific research based practice" appears in the
Act 111 times. That practice means that rather than picking
ideas out of the hat as to how to move forward, movement should
be based on research that shows what has worked before. If no
research exists in a particular area, states should look at the
evidence from successful schools in one's own state.
CHAIRWOMAN GREEN asked Dr. Sclafani if she is referring to
curriculum selection.
DR. SCLAFANI said she is referring to curriculum selection,
training and professional development, reading programs, and
creating options for supplemental services for students. All of
these programs should be based on scientific research based
practices that show proven success.
SENATOR LEMAN said he hopes the U.S. Department of Education has
more success with that term than some committee members did last
year. They were loudly criticized for suggesting that some of the
changes should be based on science and medicine. He added that
last year the legislature passed legislation that allows people
who are not certified but have subject matter expertise to teach
in a school district if they work on certification at the same
time. He asked if those people will fit within the new definition
in the federal act.
DR. SCLAFANI said it does not. She said the Department of
Education was arguing that "highly qualified" not include
certification, but Congress insisted. She said the state will
have to define alternative certification programs that they can
participate in. Some states have provided local permits, which
are state approved permits for highly qualified uncertified
individuals. The permit allows the individual to teach only in
that district. She advised the state will have to come up with
structures that enable those individuals to become certified.
SENATOR LEMAN asked if Alaska's law allows an 18 month time
period to get certified.
DR. ED MCLAIN, Deputy Commissioner of the Department of Education
and Early Development, said that those individuals receive a
temporary certificate that is good for 18 months while they work
to obtain a permanent certificate.
DR. SCLAFANI pointed out the federal law is very specific as it
requires full certification. She noted it was influenced strongly
by people who feel strongly that certification is the only way to
go. She said there are no immediate consequences to employing a
teacher who is not fully certified as long as the state has a
plan to get them certified and Alaska's system does that.
CHAIRWOMAN GREEN asked Dr. McLain if he is making a list of the
changes in the federal law that will require changes in Alaska's
statutes.
DR. MCLAIN said DOEED is not only talking about what statutory
changes may be necessary, but also what regulatory and record
keeping changes might be necessary too.
CHAIRWOMAN GREEN asked if any statutory changes will have to be
made during this session.
DR. MCLAIN said SB 250, which changes the date for the school
designators, has already passed out of the Senate HESS Committee.
That bill will allow DOEED to meld the two systems [federal and
state] into one.
CHAIRWOMAN GREEN asked if the other changes can wait until next
year.
DR. MCLAIN said that DOEED might need to take on some issues
related to assessment systems. He noted he has raised those
issues with the U.S. Department of Education and he does not
believe they will require statutory changes.
DR. SCLAFANI said she believes most of the changes that need to
be done immediately are actions and decisions that must be made
by DOEED by next fall. They will not require legislative
changes.
DR. SCLAFANI continued her presentation.
4. Parental Choice.
"Parental choice" has been construed to mean that parents should
have some say in the school their child attends if that school is
low performing. Parents of children who attend Title 1 schools
will be offered the option of public school choice within the
district if the school has been low performing for two years,
upon the parents' request. There are funding requirements to
cover this cost that are taken out of federal funds, but 20
percent of the Title 1 allocation must be reserved for this
purpose. Not only must a district provide parents with a choice,
it must also provide transportation.
2:03 p.m.
CHAIRWOMAN GREEN expressed concern about the size of Alaska's
districts and asked if that is a point of discussion Dr. Sclafani
will address.
DR. SCLAFANI said she plans to take that issue to the legal staff
of the U.S. Department of Education for an interpretation because
although the act says transportation must be provided within a
district, it doesn't make sense if a school is 172 miles away and
each flight costs $1,000. She confirmed that the U.S. Department
of Education would provide Alaska with some guidance on that
issue.
DR. SCLAFANI explained that if the low performing school is in
year two of school improvement, the parent who leaves the child
at that school is eligible for supplemental services for that
child, which means they receive the Title 1 funds to get tutoring
services. The tutoring services can be provided by community-
based organizations, private entities, community institutions,
on-line learning or by the school district if no other entity is
available. It is up to the parent to say, "I'm willing to keep my
child here but knowing the criticality of continuing to mount up
deficiencies if the school is not doing what it needs to do for
my child, I should have some opportunity to get my child that
additional assistance."
DR. SCLAFANI asserted that it is clear to the U.S. Department of
Education that the focus of the act is on the children. For the
first time, the nation is holding itself to the highest standard
it has ever had. In the past, some children were written off.
This time, the act requires that 95 percent of students in each
subpopulation must be assessed. Each subpopulation will have some
with cognitive disabilities that may not enable them to reach
proficiency but that should not amount to more than 5 percent of
any group. The rest have the capacity to succeed with the right
strategies. She pointed out that the new act has an interesting
mix of dollars. Some are simply categorical and will be
distributed on a formula basis; and some are categorical but will
be awarded on a competitive grant basis - states will have to
present a viable proposal before funding is awarded. It will be
up to states to distribute funds in a similar manner to
districts, recognizing that the dollars need to be targeted.
This act tries to focus the dollars on the children most in need.
CHAIRWOMAN GREEN asked about Reading First.
DR. SCLAFANI explained that Reading First is a separate component
of the act that has set aside $900 million this year and $1
billion for the next four years for the training of K-3 teachers
in scientifically based methodologies for teaching reading. The
training will be done within school districts. States can keep a
percentage of the dollars at the state level to develop a
statewide program. School districts can then use some of the
funding to pay teachers to attend the training. The bottom line
is that all teachers are trained in good practice so they can
help children succeed.
CHAIRWOMAN GREEN asked if districts with schools that need
improvement would oversee training programs.
DR. MCLAIN said that is one of the issues for which a
determination needs to be made. He and Dr. Sclafani have been
discussing that exact question and are considering the most
appropriate thing to do in that situation. Alaska could do a
statewide model with specific conditions and parameters or a
regional plan could be designed.
DR. SCLAFANI said the continuum of state intervention is another
issue that the U.S. Department of Education is looking at: where
does the state take a greater role in developing the plan and
where does it stand back? The state must establish a bar within
its accountability system to delineate at what level schools are
not performing adequately. States can choose to identify further
steps for schools that haven't made adequate progress for two
years. If after two years no progress has been made, states can
impose corrective action to develop a plan that changes practice.
Those changes could be to curriculum, staffing, and/or training.
If that is still not effective after two years, which means the
school has not been making adequate progress over six years, the
state steps in to restructure and has a much greater say in how
dollars are spent. She pointed out one question that comes up
with the 2005 requirements is that DOEED is currently using a
combination of norm referenced and criterion referenced testing.
Psychometricians say it is difficult, if not impossible, to
establish an alignment of norm-referenced tests to Alaska's state
standards. By their very nature they are a consensus document of
every states' standards so they do not measure enough of Alaska's
standards to be a good alignment nor do they do it as well as
they should. DOEED needs to decide whether to use some of the
funds for test development to develop criterion referenced tests
for those grades that are not using them.
CHAIRWOMAN GREEN noted the presence of Senator Wilken and then
asked if the testing will also help identify deficient
classrooms.
DR. SCLAFANI said they will and with a good student data
information management system, DOEED will not only have the rich
data from the assessments to look at districts, schools, and
classrooms, but also to look at the progress of the individual
child.
CHAIRWOMAN GREEN asked if areas that are not being taught could
be identified.
DR. SCLAFANI said yes - it is a good way to measure teacher
quality because if you find, longitudinally, children are missing
certain objectives each and every year, it is probably not the
children. She said the U.S. Department of Education will be
looking at whether Alaska's current criterion referenced
assessments are aligned to the curriculum. DOEED has done a
study of that question, which is under review at this time. She
added that Alaska will have to decide whether to continue with
norm-referenced tests or move into criterion referenced tests for
grades 3-8.
CHAIRWOMAN GREEN asked if the State of Alaska could use a
criterion-referenced test used in another state.
DR. SCLAFANI said the U.S. Department of Education is
recommending states look at other states' standards and find
those that are similar. The U.S. Department of Education is
concerned about the capacity of the assessment industry to come
up with 50 unique tests. Alaska might be able to use another
state's test and add a supplement.
CHAIRWOMAN GREEN asked if there is a way to evaluate a norm-
referenced test to determine which portions could be converted to
a criterion referenced test.
DR. SCLAFANI said that can but done but that would essentially be
building a criterion referenced test. She then informed members
that one of the challenges facing Alaska is the requirement for
assessment in Native languages because of the variety of
languages. It is a requirement although where it is just not
practicable, the U.S. Department of Education is asking states to
come up with a plan to address the problem. One solution might be
to start English language development earlier so that students
can reasonably demonstrate their knowledge and skills on an
assessment in English by third grade.
DR. SCLAFANI said the next issue that has already been resolved
is that many states had laws that uniformly exempted limited
English proficient (LEP) students from testing for two or three
years. This act requires a tighter reign so that no blanket
exemptions will be given. One issue with Alaska's current
program is that the U.S. Department of Education needs accurate
participation rate data for all students. If 95 percent of
students are to be assessed, the U.S. Department of Education
will need participation rates for all subpopulations. She stated
that Alaska faces a challenge when reporting its data because of
the number of small schools for two reasons: once data is
disaggregated by subpopulation, the numbers will be too small to
be statistically relevant or to meet the Family Education Privacy
Act (FERPA), which prohibits publishing information that might
identify a child or a group of children. The U.S. Department of
Education has asked Alaska to come up with a plan for holding
those schools accountable for student performance.
CHAIRWOMAN GREEN asked if the information, after it has been
disaggregated, can be re-aggregated over a larger geographical
area.
DR. SCLAFANI said the school district report does exactly that
with information from individual schools.
CHAIRWOMAN GREEN noted that DOEED was unable to get that
information from districts as well because of FERPA. She said
she is trying to figure out whether data can be released on a
regional basis because otherwise there will be no way to know
where the problems are.
DR. SCLAFANI said it would be up to the state to create an
additional intermediate level to aggregate the data. The plan
will have to show how that data will be used to determine the
quality of education.
2:25 p.m.
CHAIRWOMAN GREEN asked how legislators will realize whether or
not a particular school needs help if it cannot have the
information.
DR. SCLAFANI explained that DOEED can have the information but it
cannot be published.
CHAIRWOMAN GREEN asked if the information can be furnished to
legislators.
DR. SCLAFANI said a part of DOEED's plan will have to be how to
identify to legislators the schools that need school improvement
without publishing the data.
CHAIRWOMAN GREEN acknowledged the presence of Senator Ward.
DR. SCLAFANI indicated that Alaska did have an issue regarding
not requiring all Title 1 students to take the exit exam but she
understands that DOEED has new rules so that issue has been
resolved. She pointed out that the federal act does not require
states to have an exit exam with consequences for students; that
is a state decision. She said in her opinion, putting off the
test until 2004 to give schools more time to help students
prepare is a good idea because if children have not been prepared
with the skills they need, they will be accountable for the rest
of their lives.
TAPE 02-13, SIDE B
DR. SCLAFANI said, regarding the school designators, the state
will have to decide what the bar will be that all schools have to
meet, as well as how to define what constitutes adequate yearly
progress.
CHAIRWOMAN GREEN asked if that will also be determined through
the designator process.
DR. MCLAIN said DOEED is currently trying to address the question
of how to incorporate adequate yearly progress - whether that
will be the sole measure for designation or whether to include
other non-academic factors. He and Dr. Sclafani have been talking
about proposals to include factors such as parent and community
involvement. The question then becomes whether a high parent
involvement score could offset lower achievement. DOEED's
current proposal is to report that type of data but to keep the
adequate progress focused on student achievement.
DR. SCLAFANI said the act does, in fact, state that other factors
cannot override the academic performance factor. She then offered
to respond to any questions members might have.
SENATOR DAVIS asked, regarding the Reading First component, what
has been decided in the debate about whole language versus
phonics.
DR. SCLAFANI said that a national research panel has published
the research on what strategies are effective for student
learning. It includes phonemic awareness, alphabetic awareness,
orthographic awareness, fluency and comprehension.
SENATOR DAVIS asked for the name of the study.
DR. SCLAFANI said it was a compilation of studies edited as the
National Research Panel's Report on Reading.
SENATOR DAVIS asked about the teacher quality study she referred
to.
DR. SCLAFANI stated she was referring to "The Value Added Studies
of Teacher Performance" by William Sanders.
2:31 p.m.
SENATOR WILKEN asked if the "No Child Left Behind Act" is a major
event in K-12 education.
DR. SCLAFANI said it is; it is the first time that our nation has
said it will hold its schools responsible for the performance of
all children. That has never been the case before. For the first
time, Congress has said that in exchange for federal funds,
states are to establish an accountability system for all schools.
It is also the first time that accountability has been so clearly
laid out in terms of establishing levels of student performance
that are required for each state. The focus is, to a greater
extent, on allowing for local control and flexibility in ways to
meet them. Once those standards are set, the state is required to
do what it takes to meet those standards. In addition, this bill
contains more funds in recognition of the high costs of making
changes in public schools, particularly the cost of training
teachers. She noted the states are on a continuum from some that
had to enter compliance agreements because they had not begun to
comply with the 1994 requirements to states that have already
complied with 90 percent of the requirements of the new act.
Only six to eight states have the robust data management systems
that will enable them to use the data effectively. The U.S.
Department of Education is trying to bring them together and
elucidate what components states need. Many states are willing to
share their data management systems. She commented that it is
probably the first time that Congress and the department agree
that there can be no more time line waivers because we are losing
a generation of children.
DR. SCLAFANI said Alaska is one of the first states being visited
because DOEED requested a visit. In the past, she has met with
chief state school officers, the governors' education liaison,
and superintendents of the 100 largest districts across the
country to make clear that there will be no backing down and that
the U.S. Department of Education is here to help.
SENATOR WILKEN asked Dr. Sclafani to supply committee members
with a list of states that are doing the best job at implementing
the new law.
DR. SCLAFANI agreed.
SENATOR WILKEN asked if the act contains a time to revisit the
legislation to review the effects upon the states.
DR. SCLAFANI said a review will occur with reauthorization every
five years.
CHAIRWOMAN GREEN stated that she is impressed with the direct
language in the act.
2:36 p.m.
SENATOR LEMAN said, from his perspective, parts of the bill were
made "less good" during the congressional process, in particular
the sections that pertained to educational accountability.
DR. SCLAFANI commented that one of the challenges faced by every
state with the downturn of the economy is funding. This act does
contain significant funding. Congress and the U.S. Department of
Education have been clear that the new act supplements and does
not supplant funding requirements. States must maintain their
efforts in education and cannot look to the federal funds to
replace state funding. She applauded the Alaska legislature for
putting significant dollars into Alaska's reform efforts but
noted that continuing that effort is necessary.
There being no other questions, CHAIRWOMAN GREEN thanked Dr.
Sclafani and then announced a brief recess.
SB 283-REGULATION OF NURSING
CHAIRWOMAN GREEN asked Senator Wilken to present SB 283.
SENATOR GARY WILKEN, sponsor of SB 283, read the following
sponsor statement.
SB 283 is submitted at the request of the state board
of nursing. It will reconcile current nursing industry
standards with Alaska state law and maintain efficient
management of licensed nurses in our state.
Specifically, it does three things: 1) it codifies the
authority of licensed nurses to delegate certain basic
tasks to unlicensed assisted personnel; 2) it extends
the duration of a temporary nursing license from 4 to 6
months; and 3) it updates the statutory language
authorizing the issuance of licenses by endorsement.
These statutory adjustments are the result of a
diligent effort by the state board of nursing. They
will serve to tighten, clarify and improve their
ability to regulate and manage the delivery of safe and
effective health care to the citizens of Alaska. There
is no known opposition or negative impact of these
adjustments. Please support the state board of nursing
by enacting this beneficial legislation.
SENATOR WILKEN commented that he got involved in this issue
through a friend but he faced this issue when he worked on long
term care. He believes this bill will help to provide better
service and broaden the reach of the nurses that benefit Alaska
today.
CHAIRWOMAN GREEN acknowledged that she has one question that just
arose, that pertains to a decision by the board of nursing or one
of its subcommittees to not deliver over-the-counter supplements
that are prescribed by medical doctors. She feels it is ironic
to pass on nursing duties to other employees when nurses do not
have to adhere to a physician's decision. She said she would
like someone to provide her with the statute or regulation that
provides that written authority before passing the bill out of
committee.
SENATOR WILKEN named several people who were available to testify
and who may be able to answer that question.
MS. LYNN HARTZ, member of the Board of Nursing, stated support
for SB 283. SB 283 is essentially a "clean up" bill that brings
nursing statutes up to date with current nursing practice. It
moves the licensing by endorsement provision from one section to
another, which will correct a loophole that could allow a non-
nurse to apply for licensure. SB 283 also increases the length
of time for a temporary nursing license from four to six months
to allow extra time to get the results of a criminal background
check. It also gives licensed nurses the authority to delegate
nursing duties to other personnel and the Board of Nursing the
authority to write regulations outlining safe delegation
practices. Last year, the Board of Nursing was told that nurses
do not have statutory authority to delegate to unlicensed,
assistive personnel (UAP), therefore the board could not write
regulations about delegation. The board had always assumed that
nurses had the authority to delegate to unlicensed assistants and
even published a position statement on the subject in 1993. An
example of a duty that a nurse might delegate to a nurse's aide
is to run a urine test on a patient. Nurses' aides have no legal
scope of practice since they have no license to practice. The
legal source of the authority to do the task is the licensed
nurse. Without this legislation, UAPs would have no legal basis
to continue to perform nursing tasks for patients at hospitals.
2:55 p.m.
CHAIRWOMAN GREEN stated that about three years ago, nurses were
being required to pass on certain authorities to assistants and
some nurses chose not to. She asked if SB 283 could force a
nurse to assign a duty to an assistant that he or she would not
otherwise choose to do.
MS. HARTZ said it will not and, in fact, SB 283 will strengthen
the nurses' ability to make those judgments and not force them to
delegate an unsafe task.
CHAIRWOMAN GREEN asked what provision in SB 283 will give nurses
that protection.
MS. HARTZ said that to delegate a task that a nurse felt was
unsafe would be considered unprofessional conduct by statute.
CHAIRWOMAN GREEN said she just wanted to be sure that this bill
cannot be construed to mean that an employer could require a
nurse to delegate a task unwillingly.
MS. HARTZ said she does not believe it could. The bill also
gives the Board of Nursing the authority to write regulations,
which they want to do to prevent that from happening.
CHAIRWOMAN GREEN asked if it is an assumption that the Board of
Nursing will be writing the regulations as she saw no mention of
it in the bill.
MS. HARTZ referred Chairwoman Green to Section 5 of SB 283,
specifically the phrase, "under regulations adopted by the
board."
MS. PAT SENNER, President of the Alaska Nurses Association,
stated full support for SB 283. She noted in the past 10 years,
there has been an explosion of the types of UAPs that nurses are
being asked to delegate tasks to. Because these people are
unlicensed, no quality assurance exists to ensure that the
education UAPs received is adequate for the task they are being
asked to do. Employers often ask nurses to be the quality
assurance component and to make sure that the people they are
asked to supervise perform their tasks in an adequate manner and
have been trained properly. She pointed out that often tasks
would be assigned to UAPs on a case-by-case basis, only when the
supervising nurse is sure the UAP is able to provide adequate
care.
CHAIRWOMAN GREEN asked if a nurse might not dispense medicine
prescribed by a doctor, including non-prescription drugs.
MS. SENNER said the nurse always has the responsibility to review
medication orders given by a physician for safety reasons.
Therefore, even when a doctor prescribes medication, nurses are
responsible for making sure it is safe to give to that patient.
Court cases have occurred around the nation in which a nurse
administered an improper medication prescribed by a doctor and
nurses have been charged with murder. In one case, six different
errors were made but the nurse was held accountable for the one
improper medication error. She said the issue is not really
over-the-counter medicines, it is with medications that are not
FDA approved, usually herbal medicines. She recently attended a
urology conference where this topic and the following example
were discussed. An herbal medicine containing estrogen was given
to advanced cancer patients yet estrogen can lead to blood clots.
The problem with this and similar scenarios is that the nursing
profession is dealing with unregulated herbal medications that
often contain more ingredients than those listed on the label,
some of which could be harmful to the patient.
MS. NANCY SANDERS, a member of the Board of Nursing, agreed with
Ms. Hartz's synopsis of the bill.
CHAIRWOMAN GREEN asked where the authority to not dispense
something prescribed by a physician exists in statute or
regulation.
MS. SANDERS cited 12 AAC 44.770, which relates to unprofessional
conduct and added that some of the preparations being discussed
are not covered in nursing education programs because they are
not drugs.
MS. MARY WEYMILLER, a licensed practical nurse, said that while
SB 283 is a cleanup bill, it is an important one for the Board of
Nursing to develop regulations for state nursing practices. She
urged members to support the measure.
MS. CATHERINE REARDON, Director of the Division of Occupational
Licensing, Department of Community and Economic Development,
stated support for SB 283.
SENATOR WARD asked for more information about the 4 to 6 month
extension.
MS. REARDON said the Board has adopted regulations requiring
criminal background checks for initial licensure for a nurse or a
nurse aide. The background check includes state and FBI
fingerprint checks. The turnaround time, particularly for
fingerprint checks, is sometimes unpredictable so the Board wants
to make sure that temporary licenses do not expire while waiting
for results to come back. In about 7 percent of cases,
fingerprints are not readable and must be redone.
SENATOR WARD said he thought the could be done faster with new
technology.
MS. REARDON said it is an anticipated problem for nurses. The
division does fingerprint checks for collection agents and has
had experiences where people have had to send in fingerprints a
third time. She noted that usually the FBI turnaround time is
very quick but she suspects when they have other priorities, the
process may be slower. Sometimes it takes several months for the
FBI to send a response saying the fingerprints were unreadable.
The board's intention is to avoid a situation in which a nurse
can no longer go to work through no fault of the nurse. She
hypothesized that the technology may be better but the volume of
requests for fingerprint checks has grown.
There being no further questions or testimony, SENATOR WARD moved
SB 283 from committee with individual recommendations and its
zero fiscal note. There being no objection, the motion carried.
The committee took up SB 325.
SB 325-CIVIL LIABILITY FOR DEFIBRILLATOR USE
MS. WILDA RODMAN, staff to Senator Therriault, sponsor of SB 325,
read the following sponsor statement.
SB 325 is intended to save lives by increasing the
availability of automated external defibrillators,
devices designed to restore a normal heartbeat when a
person's heart suddenly stops.
Each year, 250,000 people die in the U.S. because of
sudden cardiac arrest. The most important treatment
for more than half of these patients is defibrillation,
an electrical shock intended to restore a more normal
cardiac rhythm. For each minute a person remains in
cardiac arrest, their chances of survival decrease by
about 7 to 10 percent. The increased availability of
automated external defibrillators, or AEDs, can help
save lives by allowing shocks to be delivered prior to
the arrival of the ambulance crew. AEDs have evolved
significantly over the past few years, and the current
generation is safer, easier to use and more maintenance
free than ever.
Businesses and municipalities are interested in making
AEDs more accessible in the workplace and where large
groups gather so that trained staff and laypersons can
access the device. Currently, AS 09.65.090 provides
immunities from civil liability to individuals who use
the device, but not to those who make the device
accessible for use. This has limited the accessibility
of AEDs because of the perception of excessive
liability due largely to an unfamiliarity with the
current ease and safety of the latest technology. It
is literally impossible to shock a person who does not
require shocking with the current device.
SB 325 extends immunity from civil liability to those
who provide AEDs with important prerequisites to ensure
their safe and effective use. It also amends the
section of statute providing immunity to those who use
AEDs in recognition of how much easier it is to safely
use the newest generation.
MS. RODMAN offered to answer questions.
CHAIRWOMAN GREEN said the committee has heard similar legislation
that pertained to emergency medical technicians. She then took
public testimony.
MS. KATHY MCLAREN, the emergency medical services training
coordinator for DHSS, stated support for SB 325 for many of the
reasons presented already. She then gave the following testimony.
67 percent of sudden cardiac deaths in Alaska occur out
of hospital or patients are pronounced dead at the
emergency room. Increased availability of the automated
external defibrillator is the only treatment for many
of those patients. The American Heart Association has
described the "chain of survival" as early access,
early CPR, early defibrillation and early advanced
care. Each link in this chain is critical to
increasing survival from sudden cardiac events. Alaska
has moved from manual defibrillation in hospital by
advanced life support personnel to automated external
defibrillation at the basic EMT level. Alaska was one
of the first states to permit AED use at a level below
that of an EMT.
Currently, lay people are trained in basic CPR and they
can be trained to apply and operate the AED. The
machine is applied - a microprocessor evaluates the
rhythm, determines whether a shock is required. The
operator can then administer the shock. This machine
is only applied to and used on patients who are not
breathing and who do not show signs of circulation. A
patient without a pulse or who is not breathing is dead
or dying. Access to AEDs may provide a chance of
increased survival. SB 325, by reducing the liability
for the people who purchase and make these devices
available, will likely increase the number of AEDs
available in this state. For that reason, the
Department of Health and Social Services supports SB
325.
CHAIRWOMAN GREEN asked Ms. McLaren if she had a proposed
amendment.
MS. MCLAREN said she did.
MS. RODMAN said she saw the proposed amendment right before the
meeting and explained that when the bill was originally drafted,
it applied to a "person or entity." The legal advisor recommended
dropping the word "entity" because the definition of a person
includes an entity. She said the intent of the amendment is to
include state agencies and municipalities and that Senator
Therriault is not opposed to the amendment.
CHAIRWOMAN GREEN asked if the DHSS legal advisor recommended the
amendment.
MS. MCLAREN said her understanding is that some of the people who
initially proposed the amendment are from municipalities and
state agencies. They were concerned that language in AS
01.10.060, which defines "person," was not sufficiently clear to
provide protections for municipalities and state agencies.
MS. RODMAN read the applicable part of the statute referred to by
Ms. McLaren as follows:
In the laws of the state, unless the context otherwise
requires, a person includes a corporation, company,
partnership, firm, association, organization, business
trust, or society, as well as a natural person.
SENATOR WARD said he believes the legislators' legal advisors
were correct.
CHAIRWOMAN GREEN said the definition does not specifically
mention a municipality and asked if it mentions a state agency.
MS. RODMAN said it does not. She pointed out that the legal
drafter advised her that a person encompasses entity, and thus
encompasses municipality or state agency.
CHAIRWOMAN GREEN suggested addressing the proposed amendment in
the Senate Judiciary Committee.
MR. TIM BEGAINE, Director of Emergency Operations for the
Fairbanks North Star Borough, stated full support of SB 325. The
borough encountered businesses and municipalities late last
summer that were interested in making automatic external
defibrillators more accessible in the workplace and in places
where recreational activities take place. The borough looked at
applicable federal and state laws, and found that the borough
would assume liability for providing public access to an AED.
Existing Alaska statute provides immunities from civil
liabilities to those who use the device, but not to those who
install the device. SB 325 will correct that deficiency and will
assist in the promotion of this life saving device in Alaska.
MS. PAM BEALE, Emergency Cardiovascular Care Manager for the
American Heart Association, expressed the following concerns with
SB 325. A provision requiring that EMS workers be notified of
the number and locations of AEDs was removed but she believes
notification would be a great service to the community. In
addition, she would like to add municipalities and state agencies
to the definition for the purpose of clarification.
MR. F.X. NOLAN, Chief of EMS Training for the Anchorage Fire
Department and the Municipality of Anchorage AED, Public Access
Defibrillation Coordinator and the Anchorage Chair of the
Northwest Region of the American Heart Association's Operation
Heartbeat Initiative, informed members that Alaska's share of the
250,000 people who succumb to sudden cardiac death every year is
slightly under 400. Some of those people die in medical
facilities, but in Anchorage every year, between 90 and 100
sudden cardiac deaths occur outside of a hospital. Last year, of
the 90+ people, 43 were defibrillated with AEDs prior to the
arrival of paramedics - by firefighters, police officers, or
others. Out of those 43, 12 went to a hospital with a pulse. He
very much supports SB 325. He sees a proliferation of AEDs in the
future; SB 325 will remove the perception of liability when used
by a member of the public. He agrees with the amendments proposed
by the previous speaker as he believes it is desirable for local
EMS agencies to know where AEDs are located.
There being no further testimony or questions, SENATOR WILKEN
moved SB 325 with its zero fiscal note and individual
recommendations. There being no objection, the motion carried.
There being no further business to come before the committee,
CHAIRWOMAN GREEN adjourned the meeting at 3:25 p.m.
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