Legislature(2003 - 2004)
04/14/2003 01:35 PM Senate HES
| Audio | Topic |
|---|
* 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 AND SOCIAL SERVICES
STANDING COMMITTEE
April 14, 2003
1:35 p.m.
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Lyda Green, Vice Chair
Senator Gary Wilken
Senator Bettye Davis
MEMBERS ABSENT
Senator Gretchen Guess
COMMITTEE CALENDAR
Overview: Division of Public Health - Douglas Bruce, Director,
and John Middaugh, Chief, Epidemiology
CS FOR HOUSE JOINT RESOLUTION NO. 13(HES)
Urging adoption of the Alaska recommendations for implementing
the No Child Left Behind Act of 2001.
MOVED SCS CSHJR 13(HES) OUT OF COMMITTEE
SENATE BILL NO. 30
"An Act relating to information and services available to
pregnant women and other persons; and ensuring informed consent
before an abortion may be performed, except in cases of medical
emergency."
MOVED CSSB 30(HES) OUT OF COMMITTEE
PREVIOUS ACTION
HJR 13 - No previous action to record.
SB 30 - See HESS minutes dated 3/17/03, 3/26/03, 4/3/03 and
4/9/03.
WITNESS REGISTER
Representative Carl Gatto
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Sponsor of HJR 13.
Mr. Cody Rice
Staff to Representative Gatto
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Commented on HJR 13.
Dr. Bob Johnson
PO Box 945
Kodiak AK 99615
POSITION STATEMENT: Opposed SB 30.
Ms. Frances Cater
PO Box 1472
Kodiak AK 99615
POSITION STATEMENT: Opposed SB 30.
Ms. Pauline Utter
13820 Jarvi Dr.
Anchorage AK 99503
POSITION STATEMENT: Opposed SB 30.
Ms. Robin Smith
14400 Jarvi Dr.
Anchorage AK 99503
POSITION STATEMENT: Opposed SB 30.
Ms. Katie Bryson
7911 Hazel Ct.
Anchorage AK 99524
POSITION STATEMENT: Opposed SB 30.
Ms. Sophie Butigan
PO Box 242134
Anchorage AK 99524
POSITION STATEMENT: Opposed SB 30.
ACTION NARRATIVE
TAPE 03-21, SIDE A
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 1:35 p.m.
Present were Senators Wilken, Davis and Chair Dyson. The first
order of business to come before the committee was an overview
from the Division of Public Health on Severe Acute Respiratory
Syndrome (SARS).
MR. DOUGLAS BRUCE, Director, Division of Public Health, said
that Dr. John Middaugh would give the background and overview of
SARS.
DR. JOHN MIDDAUGH, Chief of Epidemiology, Department of Health
and Social Services (DHSS), said in late 2002, cases of life
threatening respiratory disease with no identifiable cause began
to be reported from the Quang Dong province in China, followed
by similar reports of illness from Viet Nam, Canada and Hong
Kong. On February 26, the first person who was officially
identified with a case of SARS came to the attention of Carlo
Urbani, World Health Organization (WHO). The patient he saw was
a 48-year old businessman from the U.S. who had stayed in a
hotel in Hong Kong before traveling to Hanoi on February 24. He
became ill shortly after he arrived in Hanoi and was
hospitalized on February 26. His health declined until he died
on March 12.
On March 12, the World Health Organization issued a global
alert, which resulted in worldwide surveillance for persons with
SARS. By April 1, 2003 there were over 1,800 reports of SARS
from over 15 countries; 62 of those cases resulted in death. Dr.
Urbani, himself, died from SARS during that period.
On March 12, following the WHO global alert, the United States
Centers for Disease Control and Prevention in Atlanta issued a
health alert to all public health officials in all 50 states.
Immediately, Alaska began enhanced surveillance. As of today,
3,169 cases have been reported worldwide, with 144 deaths -
about 4.5% of the cases. Twenty-one countries have had cases of
SARS; Toronto, Canada has reported 100 cases with 13 deaths. In
the United States as of April 10, there were 166 SARS cases
reported in 31 states with no deaths. No health workers have
been infected in the United States and there has been no
evidence of person-to-person transmission within communities.
California has reported 35 cases among its 34 million people, 4
million of whom are Asians.
The disease has an incubation period of 2 to 10 days with a
median of around 5 days. The virus has been isolated, but until
a definitive epidemiologic agent is identified, the virus has a
syndrome and case definition. A SARS victim has a fever of
greater than 100.4 degrees, headache, discomfort, body aches,
muscle stiffness, loss of appetite, malaise, rash and diarrhea;
and after 2 to 7 days, the person develops a dry cough and
trouble breathing. The definition also includes exposure to
Southeast Asian countries or to cases exposed to them.
The concern about bio-terrorism has attracted government
resources for public health surveillance, communication links to
hospitals and hospital administrators, and emergency first
responders to physicians in emergency rooms. Health care
providers are continually being updated. The agent might have
been identified as a corona virus, which is a family of viruses
that heretofore was known to cause the common cold. Until this
outbreak, this virus family was not known to cause severe
illness in humans. The corona virus family does cause severe
illness in certain animals' feces, like swine, birds and other
ruminants. This virus was isolated from patients who had SARS
and was identified under a microscope, which identified its
characteristic appearance. Nucleotide sequence tests identified
400 base pairs in the virus isolates from patients in eight
separate countries. In control patients who are healthy, the
virus has not been found at all. Evidence suggests that this
virus is a new member of the corona virus family and shares new
characteristics of being able to cause severe illness and even
death among humans.
At this point, China has allowed teams of epidemiologists in to
do much more research and define more information about the
characteristics of SARS and SARS infection. When Dr. Middaugh's
department got the alert, he immediately contacted public health
experts, such as the Alaska Native Medial Center, the
Southcentral Foundation, the Municipality of Anchorage
Department of Health and Human Services, experts at Providence
Hospital and the Alaska Regional Hospital and the Arctic
Investigations Program, a unit of the Centers for Disease
Control (CDC) run by Dr. Jay Butler in Anchorage. Physicians
throughout the state have been receiving the CDC health alerts
and updates by email, fax, and first class mail.
DR. MIDDAUGH explained that links are posted on DHSS's Internet
site so that individuals could immediately access direct
information from the CDC and WHO computer sites. This
continually updated information is interfaced with the Meet and
Greet program for the international passenger flights coming in
from Hong Kong or Korea. Information about the symptoms of SARS
and a contact number in case a passenger develops any symptoms
in the next 10 days is provided. The CDC and WHO are also
working to provide information to the crews of cargo vessels and
planes. He has collaborated with the Municipality of Anchorage
health department, Providence and Alaska Regional Hospitals and
the Alaska Native Medical Center to develop a plan to transport,
evaluate, and appropriately monitor an ill crew or passengers
who could be possible SARS cases from an international flight.
His department has worked with all three of the civilian
hospitals in Anchorage to develop a plan to accept, isolate and
treat an ill crew member, passenger or any other patient who
presents with an illness that meets the SARS case definition.
The department has prepared collection kits to obtain
appropriate diagnostic specimens as recommended by the CDC and
worked with the state lab on handling and shipping procedures to
the CDC. DHSS staff has been trained on how to follow up an
investigation of a potential case.
DR. MIDDAUGH said that finally, state laws on procedures were
reviewed for isolating and quarantining individuals. They have
given numerous media interviews to reporters around the state
about SARS and have also had follow up meetings with their team
of experts and other physicians around the state. One possible
case had been detected of an airline pilot who developed
symptoms and that allowed them to have a test run of procedures.
The pilot had the flu, but it showed that their system worked
very well.
DR. MIDDAUGH said DHSS still needs to provide more and more
information to the public and statewide medical care providers
and is planned to have teleconference meetings with colleagues
in Washington, British Columbia and the Yukon Territory in
anticipation of the tourist season. The cruise ship industry, in
particular, is working with the CDC and it's anticipated that
the CDC will come out with formal written guidelines regarding
handling SARS within the week. AS of this morning, the CDC
thought it would have the entire genome of this virus sequenced
out and it is working on a rapid laboratory test kit, which it
expects to be operational at the end of the week. The CDC will
send out materials as soon as they are developed to the
different states to enable the labs to effectively use them.
He is working with the CDC to develop specific guidelines for
rural clinics in remote areas as the major initial focus was on
the large hospitals related to handling patients and appropriate
respiratory isolation. Those physical facilities are not
available in smaller areas.
SENATOR WILKEN asked if passengers can disembark when a jumbo
jet lands at the Anchorage International Airport.
DR. MIDDAUGH answered that passengers are allowed to disembark
within the international component of the terminal. Those who
are not ending their journey go back on the aircraft. All of the
international flights fall under federal quarantine authority.
The minute a person clears U.S. Customs that person falls under
state authority.
SENATOR WILKEN remarked that Alaska is just as vulnerable as any
other large transportation center because of its proximity to
the Asian countries.
DR. MIDDAUGH agreed and said the WHO suggested that all non-
essential travel to Hong Kong, China and North Viet Nam be
suspended and yet the virus has been identified in eight
countries and patients from 21 countries meet the case
definition. China wasn't providing information to the rest of
the world about the extent of the illness and it appears to be
more widespread. Having a rapid reliable laboratory test will
really help in containment efforts. Experts are looking at how
quickly a vaccine for this virus could be developed.
SENATOR WILKEN asked if they are working on a vaccination or a
pill.
DR. MIDDAUGH replied that neither effective pills nor anti-viral
agents are available for any viral infection. There is a great
deal to be learned about the clinical risk factors whereby one
person gets a very mild infection and another person dies from
it. Most of the people who have died are elderly or have had
severe underlying diseases, such as diabetes. The experts also
know that tobacco use in China and Viet Nam is horrific and that
tobacco may well prove to be a risk factor for someone exposed
to this virus. They have to wait and see if that pans out with
the epidemiologic research.
He suspects that the experts will look at whether our technology
can develop an effective vaccine and how would it be tested and
approved. If the vaccine is safe and effective he thought there
might be a global vaccination program.
SENATOR WILKEN asked how the virus is transmitted.
DR. MIDDAUGH replied that SARS is definitely transmitted through
an airborne route, as are all the corona family viruses. It's
possible that infected sputum droplets could be potentially
passed through other objects and the virus has been identified
in feces. One of the symptoms associated with SARS is diarrhea,
but the level of virus in that is low. The primary risk factor
is very close contact and there has been no evidence of casual
transmission as in a hotel or large settings. In addition, no
community transmission has occurred.
SENATOR DAVIS asked how long it will take to get something to
help a patient.
DR. MIDDAUGH replied that it would take many months to a year,
depending on the characteristics of the virus and their ability
to engineer a vaccine. It might be possible to get expedited
review for use by people who meet the SARS case definition.
SENATOR DAVIS asked how long it took to establish that the one
case in Alaska was not SARS, but the flu.
DR. MIDDAUGH replied that it took a matter of hours for the
positive flu identification to come back. The system worked very
well.
CHAIR DYSON asked if the disease has attacked anyone other than
the ones mentioned.
DR. MIDDAUGH said those are possibly the only group of factors,
but data hadn't been made widely available.
CHAIR DYSON asked how to protect people against airborne
transmission.
DR. MIDDAUGH replied that standard respiratory isolation
procedures used for suspected cases of TB or other respiratory
illnesses work very well for SARS - face masks with a certain
level of HEPA filter individually fitted. Hand washing helps as
the virus doesn't live in the environment for more than 3 or 4
hours. So far, there has been no transmission of SARS to a
health care worker in the United States.
CHAIR DYSON asked if there is any evidence that it can be
sexually transmitted.
DR. MIDDAUGH replied no.
CHAIR DYSON asked what level this type of problem would get to
before quarantine is authorized.
DR. MIDDAUGH replied that probably has a very limited role here.
President Bush added SARS to the list of internationally
quarantinable diseases as a precaution. For international
travel, all countries have agreed to adopt a uniform list of
diseases for denial of entry, quarantine or isolation. The list
is very short. There are no recommendations to implement
quarantine because of the wide spread of the virus and the very
likely probability that there are individuals infected who have
mild illness and don't meet the case definition. It's
conceivable that would change with a definitive test that would
immediately enable the medical community to determine if someone
has the disease. Voluntary isolation by those who have been in
contact has been very effective.
CHAIR DYSON asked if the disease can be transmitted by people
who are asymtomatic.
DR. MIDDAUGH said that is one of the major focuses of the teams
that are now in China.
CHAIR DYSON asked if the symptoms are posted on a website.
DR. MIDDAUGH said they are and added that he would provide the
committee any information it might need. He said the website is
updated constantly. He added that DHSS's capabilities have been
expanded with support for the bio-terrorism money and the
building of infrastructure here, but he didn't know what the
demands might be if SARS were to break out on a cruise ship or
in a village.
HJR 13-FEDERAL EDUCATION LAW OF 2001
CHAIR DYSON announced HJR 13 to be up for consideration.
REPRESENTATIVE CARL GATTO, sponsor, said the state needs some
considerations in implementing the No Child Left Behind (NCLB)
mandate. A federal government official said there would be no
waivers, but Alaska has situations that do not exist in any
other place in the nation. Alaska has one-room school houses
that are not on a road system and if the NCLB were applied to
the strictest limit, low-performing students would have to be
moved to the next available school, a plane ride away. That
would take those students out of their homes. This resolution
asks for the widest possible consideration for Alaska only
because it is truly unique.
SENATOR WILKEN asked for a description of the Alaska
consolidated state application accountability workbook,
mentioned on page 2, line 16.
MR. CODY RICE, staff to Representative Gatto, explained that the
state consolidated workbook is the state's application to the
federal officials for how we are planning on meeting the NCLB
requirements.
SENATOR WILKEN asked if every state has a workbook like that.
MR. RICE answered yes.
SENATOR GREEN arrived at 2:20 p.m.
SENATOR WILKEN asked if endorsing this resolution means they are
condoning the fact that some school districts don't teach
English as a first language.
REPRESENTATIVE GATTO responded that Anchorage has immersion
programs, but unfortunately some children from villages will be
taught by a Yupik teacher and won't know English. Those students
would be tested in their native language through the third grade
and then the requirement would shift to English.
SENATOR WILKEN asked who would test them.
REPRESENTATIVE GATTO said he thought the schoolteacher would
prepare the test. Some accommodations would be made so that the
teacher would read the questions and have the student write the
answers down, until the student reaches the fourth grade. That
is required in the standards and to meet the NCLB.
SENATOR WILKEN said he wanted it on the record that he is
troubled that we endorse it in some school districts.
REPRESENTATIVE GATTO responded that philosophically, when
dealing with rural communities, if there are children who have
no intention of ever leaving their villages, that's an issue;
but most of those children will some day want to move to another
city, get a job, make a change, understand English, etc. They
need to be prepared long before they graduate. And, if they
don't want to move, having the knowledge base to be able to move
will not hurt them. He doesn't want to condemn them to be in
that village forever, like it or not.
CHAIR DYSON referred to the language on page 1, line 14, and
asked what he meant by "39 school districts each enroll less
than 1 percent of the student body."
REPRESENTATIVE GATTO replied if you take the student body of the
state as whole, the schools are so small that only 1 percent of
the student body is spread over 39 districts.
CHAIR DYSON said that could be stated clearer.
SENATOR WILKEN moved to adopt a conceptual amendment to page 1,
line 13, to delete "the" and on line 14 to delete "student body"
and insert "Alaska's students." There were no objections and
Amendment 1 was adopted.
TAPE 03-21, SIDE B
SENATOR WILKEN moved to pass SCSHJR 13(HES) from committee with
individual recommendations. There were no objections and it was
so ordered.
SB 30-ABORTION: INFORMED CONSENT; INFORMATION
CHAIR FRED DYSON announced SB 30 to be up for consideration.
SENATOR LYDA GREEN moved to adopt the committee substitute (CS)
to SB 30, version LS0193\S, Lauterbach, 4/11/03. There were no
objections and it was so ordered.
CHAIR DYSON explained that the CS adopts the Division of Public
Health's suggestion to put updated information on informed
consent on a website where it can be easily downloaded. That
will make it easier for the department to keep up current
addresses of support groups and providers and greatly reduce the
cost. That is the main change. The bill puts in statute that
which is already in regulation requiring informed consent and
gives the option, but does not demand, that the provider put the
website information in his own pamphlet.
DR. BOB JOHNSON, Kodiak, said he is a retired physician who in
his last 10 years of practice performed an average of 70
abortions per year. He explained that he scheduled five visits
for each patient. During the first visit, he determined if the
patient had really investigated other options and felt
comfortable with the decision; the second visit was to inform
the patient about the procedure and possible problems that could
arise and to answer questions. He found that patients expressed
many varying needs and that each one needed to be treated as an
individual. He didn't have a set list of information he felt
required to give to them, because some of them couldn't tolerate
it, some would have been angered by it, some didn't need it and
others had questions that probably wouldn't have been included
in his list. Dictating the requirements of what a person should
be told is a mistake. The deputy commissioner pointed out that
the department doesn't regulate, monitor or license clinics or
doctors offices and that this might produce a situation where
monitoring is necessary.
CHAIR DYSON said that some testifiers indicated that having a
24-hour waiting period would be a great inconvenience. He asked
if he considered it good practice to have first contact with a
client, perform the procedure and put the client back on an
airplane in one day.
DR. JOHNSON replied that he was never faced with that situation,
because Kodiak is the end of the line and they were all there to
begin with. He thought most doctors would like to have a couple
of days with the patient to explore the decision and answer
questions about the procedure.
CHAIR DYSON asked if he thought it is wise to observe the
patient for some period after the procedure to make sure there
aren't complications.
DR. JOHNSON replied about a half hour is all that is necessary
if the patient is in the same community.
CHAIR DYSON asked about patients who fly out to a rural
community.
DR. JOHNSON said the complication rate is extremely low, but he
wouldn't want anyone flying on the same day.
MS. FRANCES CATER, Kodiak, said that SB 30 is unnecessary and
that any ethical doctor would do all those things anyway. It
would be very expensive for DHSS to monitor this program instead
of doing more important things.
MS. PAULINE UTTER, Anchorage resident, opposed SB 30, but said
if it passes, she thinks it should also include information
about how hard it is for the mother to get child support.
MS. ROBIN SMITH, Anchorage resident, said she wants to reduce
the number of abortions, but thought the best way to do that is
to reduce the number of unintended pregnancies. She is
disappointed that the governor's budget reduced all state money
for family planning. Alaska has the highest rate of teen
pregnancies and rape in the country.
MS. KATIE BRYSON, Anchorage resident, also opposed SB 30 for all
the aforementioned reasons and added while the intent of the
legislation is to empower women by mandating choice through
information, the language of this bill would make the pamphlet
heavily biased rather than objective. She opined, "It would
serve to intimidate rather than inform."
MS. SOPHIE BUTIGAN, Anchorage resident, opposed SB 30. She
personally finds the 24-hour waiting period biased against lower
income women and women without access to affordable health care.
SENATOR GREEN moved to pass CSSB 30(HES) from committee with
individual recommendations and the accompanying fiscal note.
SENATOR DAVIS objected.
A roll call vote was taken. SENATORS GREEN, WILKEN, and DYSON
voted yea; SENATOR DAVIS voted nay; and CSSB 30(HES) moved from
committee.
CHAIR DYSON adjourned the meeting at approximately 3:20 p.m.
| Document Name | Date/Time | Subjects |
|---|