04/07/2004 05:45 PM Senate HES
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+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 7, 2004
5:45 p.m.
TAPE (S) 04 - 20
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Gary Wilken
Senator Bettye Davis
Senator Gretchen Guess
MEMBERS ABSENT
Senator Lyda Green, Vice Chair
COMMITTEE CALENDAR
SENATE BILL NO. 385
"An Act relating to homeland security, to civil defense, to
emergencies and to disasters, including disasters in the event
of attacks, outbreaks of disease, or threats of attack or
outbreak of disease; establishing the Alaska division of
homeland security and emergency management in the Department of
Military and Veterans' Affairs and relating to the functions of
that division and that department; and providing for an
effective date."
MOVED CSSB 385(HES) OUT OF COMMITTEE
CS FOR HOUSE CONCURRENT RESOLUTION NO. 31(HES)
Proclaiming April 2004 as Traumatic Brain Injury Awareness
Month.
MOVED SCS CSHCR 31(HES) OUT OF COMMITTEE
CS FOR HOUSE BILL NO. 25(JUD)
"An Act relating to health care decisions, including do not
resuscitate orders, anatomical gifts, and mental health
treatment decisions, and to powers of attorney relating to
health care, including anatomical gifts and mental health
treatment decisions; and providing for an effective date."
HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 385
SHORT TITLE: SECURITY;DIV. HOMELAND SECURITY/EMER. MGT
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES
04/05/04 (S) READ THE FIRST TIME - REFERRALS
04/05/04 (S) HES, FIN
04/05/04 (S) HES AT 1:30 PM BUTROVICH 205
04/05/04 (S) Heard & Held
04/05/04 (S) MINUTE(HES)
04/07/04 (S) -- Rescheduled to 5:30 pm 4/7/04 --
04/07/04 (S) HES AT 5:30 PM BUTROVICH 205
BILL: HCR 31
SHORT TITLE: TRAUMATIC BRAIN INJURY AWARENESS MONTH
SPONSOR(s): REPRESENTATIVE(s) MCGUIRE
02/16/04 (H) READ THE FIRST TIME - REFERRALS
02/16/04 (H) HES
02/26/04 (H) HES AT 3:00 PM CAPITOL 106
02/26/04 (H) Moved CSHCR 31(HES) Out of Committee
02/26/04 (H) MINUTE(HES)
03/01/04 (H) HES RPT CS(HES) NT 6DP
03/01/04 (H) DP: GATTO, WOLF, COGHILL, SEATON,
03/01/04 (H) CISSNA, WILSON
03/24/04 (H) TRANSMITTED TO (S)
03/24/04 (H) VERSION: CSHCR 31(HES)
03/26/04 (S) READ THE FIRST TIME - REFERRALS
03/26/04 (S) HES
04/07/04 (S) -- Rescheduled to 5:30 pm 4/7/04 --
04/07/04 (S) HES AT 5:30 PM BUTROVICH 205
BILL: HB 25
SHORT TITLE: HEALTHCARE SERVICES DIRECTIVES
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH
01/21/03 (H) PREFILE RELEASED (1/10/03)
01/21/03 (H) READ THE FIRST TIME - REFERRALS
01/21/03 (H) HES, JUD, FIN
02/13/03 (H) HES AT 3:00 PM CAPITOL 106
02/13/03 (H) Heard & Held
02/13/03 (H) MINUTE(HES)
02/27/03 (H) HES AT 3:00 PM CAPITOL 106
02/27/03 (H) Heard & Held
02/27/03 (H) MINUTE(HES)
03/06/03 (H) HES AT 3:00 PM CAPITOL 106
03/06/03 (H) Moved CSHB 25(HES) Out of Committee
03/06/03 (H) MINUTE(HES)
03/10/03 (H) HES RPT CS(HES) NT 7DP
03/10/03 (H) DP: GATTO, WOLF, HEINZE, SEATON,
03/10/03 (H) CISSNA, KAPSNER, WILSON
03/26/03 (H) JUD AT 1:00 PM CAPITOL 120
03/26/03 (H) -- Meeting Canceled --
03/28/03 (H) JUD AT 1:00 PM CAPITOL 120
03/28/03 (H) Heard & Held
03/28/03 (H) MINUTE(JUD)
03/31/03 (H) JUD AT 1:00 PM CAPITOL 120
03/31/03 (H) Moved CSHB 25(JUD) Out of Committee
03/31/03 (H) MINUTE(JUD)
04/07/03 (H) JUD RPT CS(JUD) NT 5DP
04/07/03 (H) DP: SAMUELS, HOLM, GARA, OGG, MCGUIRE
04/07/03 (H) FIN REFERRAL WAIVED
05/06/03 (H) TRANSMITTED TO (S)
05/06/03 (H) VERSION: CSHB 25(JUD)
05/07/03 (S) READ THE FIRST TIME - REFERRALS
05/07/03 (S) HES, JUD
05/16/03 (S) HES AT 1:30 PM BUTROVICH 205
05/16/03 (S) Heard & Held
05/16/03 (S) MINUTE(HES)
03/08/04 (S) HES AT 1:30 PM BUTROVICH 205
03/08/04 (S) Heard & Held
03/08/04 (S) MINUTE(HES)
03/24/04 (S) HES AT 1:30 PM BUTROVICH 205
03/24/04 (S) Heard & Held
03/24/04 (S) MINUTE(HES)
04/02/04 (S) HES AT 1:30 PM BUTROVICH 205
04/02/04 (S) Bill Postponed to 04/07/04
04/07/04 (S) -- Rescheduled to 5:30 pm 4/7/04 --
04/07/04 (S) HES AT 5:30 PM BUTROVICH 205
WITNESS REGISTER
BRIG. GEN. CRAIG CAMPBELL
Adjutant General for National Guard of Alaska
Commissioner, Department of Military & Veterans Affairs
PO Box 5800
Ft. Richardson, AK 99505-0800
POSITION STATEMENT: Presented SB 385.
MR. DAVE LIEBERSBACH
Acting Assistant Commissioner
Office of Homeland Security & Emergency Services
POSITION STATEMENT: Presented Amendment 1 to SB 385.
MR. RYAN MAKINSTER
Staff to Representative Lesil McGuire
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Presented HCR 31 on behalf of the bill's
sponsor.
DR. MARIA WALLINGTON
Medical Ethicist
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Answered questions pertaining to HB 25.
MS. LINDA SYLVESTER
Staff to Representative Weyhrauch
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Explained changes to HB 25.
MR. JASON HOOLEY
Staff to Chair Dyson
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Regarding HB 25, confirmed that version V
was previously adopted.
MS. CAROLE EDWARDS
Alaska Nurses Association (ANA)
Juneau, Alaska
POSITION STATEMENT: Provided further input to the current
version of HB 25.
MS. LOIS HILDENBRAND
American Cancer Society (ACS)
Fairbanks, Alaska
POSITION STATEMENT: Supports HB 25.
MS. CONNIE JONES
Anchorage, Alaska
POSITION STATEMENT: Suggested that the section on pregnancy be
removed from HB 25.
MR. BRUCE ZALNERAITIS
Life Alaska Donor Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions on HB 25 relating to
anatomical gifts and consent.
MR. CHIP WAGONER
Alaska Catholic Conference (ACC)
Juneau, Alaska
POSITION STATEMENT: Provided recommendations to the current
version of HB 25.
MS. MARIE HELM
Christian Sciences Churches of Alaska
Juneau, Alaska
POSITION STATEMENT: Testified on HB 25, suggesting the
inclusion of a patient's right to be transferred home.
ACTION NARRATIVE
TAPE 04-20, SIDE A
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 5:45 p.m.
Present at the call to order were Senators Wilken, Davis, Guess,
and Chair Dyson.
SB 385-SECURITY;DIV. HOMELAND SECURITY/EMER. MGT
The committee took up SB 385.
CHAIR DYSON said his understanding from the commissioners of
DPS, DOT and DEC is there are no problems with this, and he
hopes to pass the bill out of committee.
BRIG. GEN. CRAIG CAMPBELL, Adjutant General for National Guard
of Alaska, and Commissioner for Department of Military &
Veterans Affairs, began his testimony by apologizing for not
being at Monday's meeting [4/5/04] due to scheduling conflicts.
SB 385 refers to the emergency services and civil defense code
in statute and makes the necessary adjustments to actively and
correctly handle the homeland security mandate that's upon
Alaska and every other state. He clarified that the old law
refers to districts, and "we're taking all that out." In 1951,
when the original code was passed, it was under the civil
defense authority that the Senate and the House allowed for
establishing districts for civil defense; Alaska never opted to
do that, so the decision was made to eliminate that unnecessary
reference. Another issue from Monday's meeting was property.
It is referenced to be able to confiscate and use property, and
the question was, "Is it real or personal property or both?"
That has been reviewed with the attorney, and the way it's
written is passive, so it can be either personal or real
property. Not just land or structures, but it could include
other things necessary to conduct business in Homeland Security.
CHAIR DYSON asked if this included airplanes or boats.
COMMISSIONER CAMPBELL confirmed this was part of the real
property and would be covered.
CHAIR DYSON asked, "But only when the governor declares an
impending or actual emergency?"
COMMISSIONER CAMPBELL said, "That's the big issue of this whole
statute, and that's the important part, is setting up the
authority to do this." He said it wouldn't be given to his
department or DPS unless the governor declares a higher state of
threat and publicly declares it in the state. A disaster policy
cabinet then meets and recommends actions that need to be taken
to the governor, who in turn has to make the declaration to do
that. There's a multi-step process whereby the governor
declares the authority to implement that, which would not be
allowed in a day-to-day routine operation.
CHAIR DYSON said that under the governor's emergency powers, he
"has much of that already" and what's being done here is
integrating existing concepts into the new organization and the
re-distribution of these responsibilities.
COMMISSIONER CAMPBELL confirmed that was correct. He outlined
emergency management today as meeting to declare an emergency,
and taking it to the governor who would review and approve it as
appropriate. He pointed out the questions for Homeland Security
as, "When do you go to a level orange? When do you go to a
level red? What do you do at level orange? What do you do at
level red?" This establishes a statute allowing for replication
of the emergency services process in Homeland Security; that is
the intention.
COMMISSIONER CAMPBELL addressed the question, "Do we have any
ability to have agreements with Canada, with Canadians?" In
this statute, there are several references to having agreements
with other jurisdictions, and it specifically mentions
"provinces" in two separate places. That was deliberately done
to recognize an agreement with Canada and to establish those
types of relationships.
CHAIR DYSON said he saw this reference but "provinces" or "other
countries" wasn't included in all the sections that refer to
coordination. He asked if the inclusion was a logical and legal
inference, if it carries through.
COMMISSIONER CAMPBELL said yes, and explained that page 8, lines
14-16 establishes the right for reciprocal aid agreements with
other governments, but it doesn't go into details on what those
are. This grants the ability to negotiate those agreements with
other jurisdictions, including provinces of Canada, to
established needs. He referred to the issue of authority,
noting that Chair Dyson had not received objection from DPS or
DOT on the issue of authority. He explained that currently,
when it comes to setting up a checkpoint or a roadblock on a
roadway, it's designed to be done - as state troopers and police
will do - in response to criminal activity. "We're in a
different world in Homeland Security." Establishing a
checkpoint on a road where one can't demonstrate there's already
been something criminal that's happened is difficult to do
without statutory authority. SB 385 absolutely establishes
that right and the ability for DMVA, in coordination with DPS to
set up those checkpoints.
COMMISSIONER CAMPBELL referred to the checkpoints established at
the Dalton Highway in Valdez over the holidays. State defense
forces and the National Guard were manning those checkpoints and
worked with the state troopers. Although this was executed
correctly, lawyers said, "We can't find the authority to execute
it." Today at 11:00 a.m., a cabinet meeting with Commissioner
Tandeske, Commissioner Barton, and lawyers from those
departments reviewed SB 385 and the proposed amendments,
ensuring concurrence that the authority was written properly.
He said he was satisfied that, as written, SB 385 allows for
manning the checkpoints. Commissioner Tandeske is satisfied
that it keeps public safety's control of checkpoints, blockages,
and rights-of-way.
MR. DAVE LIEBERSBACH, Acting Assistant Commissioner for the
Office of Homeland Security and Emergency Services, and the
Director of Division of Emergency Services within DMVA,
presented Amendment 1.
SENATOR GRETCHEN GUESS moved Amendment 1.
CHAIR DYSON objected for purposes of discussion.
MR. LIEBERSBACH reviewed the following changes incorporated in
Amendment 1 [made available from DMVA]:
Page 3, line 18
Following "coordinate"
Insert "with"
Page 6, lines 6-10:
Delete "(14) when the governor orders state action in
response to a high or severe threat of attack, at the direction
of the governor and in coordination with the Department of
Public Safety, establish and operate checkpoints for the
reasonable inspection of persons and vehicles for weapons or
explosives, using state roads, state property, or state
facilities"
Page 10, line 19:
Following "designee"
Insert "of the adjutant general, in consultation with
the commissioner of public safety or a designee of the
commissioner of public safety,"
Page 10, following line 19:
Insert a new bill section to read:
*Sec. 9. AS 26.20.100 is amended to read:
Sec. 26.20.100. Traffic control. In coordination
with the department of public safety and the department of
transportation and public facilities, the [THE] department
may
(1) formulate and execute plans and regulations for
the control of traffic for the rapid and safe movement of
evacuation over public highways and streets of people,
troops, or vehicles and materials for homeland security and
civil defense [NATIONAL DEFENSE OR FOR USE IN A DEFENSE
INDUSTRY, AND MAY COORDINATE THE ACTIVITIES OR AGENCIES OF
THE STATE AND OF THE DISTRICTS CONCERNED WITH PUBLIC
HIGHWAYS AND STREETS, IN A MANNER THAT WILL BEST CARRY OUT
THOSE PLANS]; and
(2) establish and operate checkpoints along private or
public roadways serving critical property or facilities in
the state, at the direction of the governor when the
governor determines that a sufficiently high threat of
attack exists to warrant such action. The checkpoints
established under this subsection may be in conjunction
with closure of the roadway under AS 19.10.100. Operation
of a checkpoint shall be limited to enforcement of the
roadway closure or reasonable inspection of persons and
vehicles for weapons, explosives, chemicals, biological or
biochemical agents, or other instruments capable of causing
widespread of severe injury to persons or property.
Renumber the following bill sections accordingly.
Page 14, line 5:
Delete "firearms,"
Insert "[FIREARMS,]
Page 15, line 26
Delete "26.20.100,"
MR. LIEBERSBACH explained that "firearms" was deleted because it
nd
might raise concerns related to the 2 Amendment of the U.S.
Constitution, the right to bear arms. The limit of sale and
dispensing was as much a concern as was limiting the
transportation of firearms, i.e. not being able to carry hunting
rifles in vehicles.
CHAIR DYSON asked if this change would reduce the department's
authority to take away an illegal firearm if, for example a
felon had a firearm.
MR. LIEBERSBACH said it does not reduce that capacity, and the
authority lies with the troopers; they still have all of their
authority.
CHAIR DYSON asked if National Guard forces, under a declaration
of emergency, have similar police powers to troopers, even
though this is structured so that they will be working under the
supervision of a trooper.
MR. LIEBERSBACH stated that the last change should not read as
the deletion of "26.26.100" but rather, as follows:
Page 15, line 26
Delete "26.20.100"
This would not repeal "26.20.100."
CHAIR DYSON moved to amend Amendment 1 to make the above noted
change. He asked if there was any objection. There being none,
Amendment 1 was amended.
CHAIR DYSON removed his prior objection to Amendment 1 and asked
if there were further objections. Seeing none, Amendment 1 was
adopted.
CHAIR DYSON told Senators Davis and Guess that if they came up
with anything bothersome regarding the bill, he would make sure
there would be an opportunity to address those concerns in the
Finance Committee. He confirmed, with Senator Wilken, the co-
chair of Finance, that this would be acceptable.
CHAIR DYSON asked for the wish of the committee.
SENATOR WILKEN moved to report SB 385 as amended [CSSB 385(HES)]
from committee with individual recommendations and accompanying
fiscal note.
CHAIR DYSON asked if there were any objections. Seeing and
hearing none, it was so ordered.
6:05 p.m.
HCR 31-TRAUMATIC BRAIN INJURY AWARENESS MONTH
MR. RYAN MAKINSTER, staff to Representative Lesil McGuire,
presented CSHCR 31(HES) on behalf of the sponsor. He began by
telling members that there was a request for an amendment that
would proclaim May rather than April as Traumatic Brain Injury
Awareness Month. He explained that every 21 seconds someone in
the U.S. sustains a traumatic brain injury (TBI), which equals
more than 4,000 people daily. Of the approximately 1,500,000
people who suffer these injuries annually, 50,000 die while
another 80,000 sustain life-changing injuries. In Alaska alone
at least 600 people receive acute care for brain injuries, 150
Alaskans die, and another 190 experience the onset of lifelong
disabilities because of traumatic brain injuries. TBI is not
something that one can find a cure for and it is not a disease.
They are the result of accidents. The only way to lower these
numbers is to increase awareness. Males below the age of 30
have a higher risk of TBIs. A lot of professional skaters,
skiers, and snowboarders wear helmets now; people should wear
helmets and seatbelts to lower the incidence of injury.
MR. MAKINSTER offered the background information that
Representative McGuire's younger brother - who is his same age -
experienced a head-on collision during his senior year and was
in a coma for three months. He came out of the coma, graduated
from high school, went to college and is a productive citizen in
society but, he has lifelong disabilities including a speech
impediment. The jobs that were available to him are no longer
available. Mr. Makinster told members that one of his close
friends was involved in a jet-ski accident in Idaho and was in a
coma for six months. He had been a straight-A student, all-star
athlete, had a full scholarship to Washington State University
to play football. Subsequently he had to drop out of school for
two years for rehabilitation. He did eventually graduate from
college with a 4.0; however, he has to take expensive medication
for the rest of his life.
MR. MAKINSTER respectfully requested that three changes be made
to HCR 31. The first change would be on page 1, line 1,
changing "April" to "May" of 2004. Also, an associated change
would be to change the language to "May" on page 2, line 6. The
reason for this change is because today's date is already
partially through April, 2004. Also this would then be in
concert with the Kenai Peninsula's TBI Awareness Week. The
third change would be to insert "Alaska Traumatic Brain Injury
Advisory Board" after the word "the" on page 1, line 14.
CHAIR DYSON moved to amend CSHCR 31(HES) to change the date to
reflect May instead of April of 2004, and to include the "Alaska
Traumatic Brain Advisory Board" and asked if there was any
objection. Seeing and hearing none, those amendments were
adopted.
CHAIR DYSON thanked Mr. Makinster, noting that perhaps someone
would be saved or would receive support as a result of increased
awareness.
SENATOR GRETCHEN GUESS moved to report CSHCR 31 as amended [SCS
CSHCR 31(HES)] out of committee with individual recommendations
and the accompanying zero fiscal note.
CHAIR DYSON asked if there was any objection. There being none,
it was so ordered.
6:10 p.m.
The committee took an at-ease from 6:10 - 6:15 p.m.
HB 25-HEALTHCARE SERVICES DIRECTIVES
The committee took up CSHB 25(JUD).
DR. MARIA WALLINGTON, medical ethicist at Providence Alaska
Medical Center in Anchorage, acknowledged that a great deal of
work has been done on the bill since it passed the House, and
that she was looking forward to enactment of the bill. She
indicated that she needed to catch a plane, but could answer
questions for several minutes.
CHAIR DYSON said HB 25 would be heard on Wednesday [April 14]
and confirmed that she would be available by telephone. He then
asked Dr. Wallington if a person has an advance directive and an
agent, if that agent can make the health care decisions.
DR. WALLINGTON said that is correct.
CHAIR DYSON asked if the agent could over-ride what the person
included in the advance care directive.
DR. WALLINGTON responded, "No, they can't. They are instructed
to make decisions that support and work for the health care
directives that the patient has given in their directive." If
the particular issue is not addressed in the directive then it
would follow what the agent knows of the person's wishes or
values. If those are not pertinent or unknown, the agent is
instructed to work according to the best interest of the
principal.
CHAIR DYSON asked if the agent was the only one to define those
best interests or if there was a medical team involved in that
decision.
DR. WALLINGTON said the decisions were generally shared. The
medical personnel have a great deal of input because of knowing
the medical issues and the benefits/risks of treatment.
CHAIR DYSON asked about the meaning of the phrase "inhumane
burden."
DR. WALLINGTON said to her it means that what this person is
going through seems pretty awful.
CHAIR DYSON asked if this were something other than pain and
suffering.
DR. WALLINGTON answered it seems an inhumane burden would lead
to suffering. She noted that she didn't pick that terminology
and had a similar question about the meaning. She explained
that people can experience physical pain and suffering; there
can be emotional suffering from not being able to speak and
knowing it; there can be spiritual suffering also. She said she
wasn't sure what amounts to an inhumane burden, but that she
hopes the medical people and the agent would recognize a
situation as being too much.
CHAIR DYSON asked about someone other than the patient making
that decision when the patient is incompetent or unconscious.
DR. WALLINGTON interjected, a person not capable of expressing
his/her opinion.
CHAIR DYSON continued that a conscious and competent patient
makes his/her own decisions, no matter what the agent or the
directive says. However, if a non-terminal patient (someone who
is not going to die really soon) is unconscious, and is
experiencing pain and suffering, then the directive, the agent,
and the best interest would indicate the use of pain medications
to deal with the suffering.
DR. WALLINGTON confirmed, "If the suffering is from the pain."
CHAIR DYSON asked at what point - under what circumstances -
regarding an incompetent or unconscious person who is not
terminal, ought the decision be made to withdraw hydration and
food to let the person die.
DR. WALLINGTON said one has to go back to the word "terminal"
and ask if the only reason a person is still living is because
of being provided with some kind of medical care, is that person
terminal if you can force him/her to keep on living? That is,
if someone would die without medical care, is that person
terminal? Or, if you can keep them alive with medical care, are
they not terminal? It's a grey area because obviously, a
diabetic without insulin will die, but that person wouldn't be
referred to as terminal. She said that for her personally, it
hinges on whether what is needed to keep the person alive
actually allows him/her to go on with life, or if there is hope
for that person to become healthy again and not depend on that
medical care. She said so much depends on the particular
situation, giving absolute criteria is very difficult.
CHAIR DYSON said he doesn't think of someone on a ventilator or
an oxygen bottle as being terminal. If a person has a
degenerative condition that's going to terminate his/her life,
and medical attention is supporting them, but can't reverse
them...
Dr. WALLINGTON interjected, "It's irreversible and progressive."
CHAIR DYSON continued by asking, "If the best knowledge is that
the person is not going to return to consciousness, what
criteria should be used to decide whether that person - who is
heading downhill in a reasonable period of time, with no good
chance of returning to consciousness - decide whether or not to
stop the support that's keeping that person alive?"
DR. WALLINGTON asked, "Thinking of yourself as the deciding
agent, and the physician?"
CHAIR DYSON replied, "No, you as the ethical guru on this who
helped to guide us all with your training and experience."
DR. WALLINGTON recalled that previous discussion regarding best
interest was "how we're trying to capture this decision-making
process, is [through] the patient's values." As an example she
mentioned that in Orthodox Judaism there is a belief that the
life of the body is an absolute good and therefore what is
required to keep the body functioning would be aligned with that
value. She said her personal value system is that if she wasn't
conscious of her interactions with others and God, then she
wouldn't want her body kept alive. She emphasized that personal
values should be weighed in the balance and need to be a part of
the decision. The value of having a surrogate who knows you is
that he/she can express what you have expressed to him/her. Dr.
Wallington informed members she had to leave the meeting to
catch a plane.
SENATOR GUESS stated that she was working from version B and she
wondered whether the rest of the committee was also working from
version B.
CHAIR DYSON said no, "We're still working off of the last
version that we had."
MS. LINDA SYLVESTER, staff to Representative Weyhrauch,
clarified that version B was from "Legislative Legal" and it
contained a correction that was mission from version V. She
said, "'V' is the operative, 'W'; and 'B' has ... two changes."
A definition of "enucleator" was taken out, as it doesn't exist
in the state and is pretty irrelevant to the discussion. The
only substantive change is the first statement in the form, a
caution or a warning about Alaska, it does not honor suicide -
assisted suicide, euthanasia - and since it is repeated in the
form, it was taken out of the introduction to the Optional form.
That is the difference between versions B and W. There are
substantial changes from versions V to W, but version B is
essentially the same as 'V.'
CHAIR DYSON asked if the last committee action taken was to
adopt version V.
MR. JASON HOOLEY, staff to Chair Dyson, confirmed that was
correct, version V was adopted during the 3/24/04 meeting.
MS. SYLVESTER continued that at the last hearing, her
instructions were to accumulate comments and amendments, and the
results of that are dramatic improvements to 'V'....
CHAIR DYSON clarified that version V was before the committee.
MS. CAROLE EDWARDS, a board member of the Alaska Nurses
Association (ANA), and an oncology nurse for over 20 years,
testified that she has given direct care to many patients at the
end of life. She referred to a phrase, "even if it should
hasten my death" from one of the versions pertaining to pain
medication. She asked Ms. Sylvester for the page number of this
reference.
MS. SYLVESTER said in the form there is an option for an
individual filling out the advance health care directive to
choose "Relief from Pain." The preferred language is, "I direct
that treatment for the alleviation of pain or discomfort be
provided at all times." It has been proposed to continue that
statement by stating, "even if it kills me, even if it hastens
my death, even if it causes my death." She said "the sponsor
resists that and our position is encouraged by the medical
field." Ms. Sylvester said this was what Ms. Edwards was
referring to.
CHAIR DYSON questioned whether she said the sponsor resists
this.
MS. SYLVESTER confirmed this was so. She said it was preferable
that "it should be neutral" about causing or hastening death.
MS. EDWARDS said ANA would like the language in version Q, pages
21-22, under "(8) Relief from Pain: If I mark this box, I
direct that treatment to alleviate pain or discomfort should be
provided" to be included, but to eliminate "even if it hastens
my death." She explained that ANA's view is that most
individuals don't have significant background regarding pain
medication at the end of life. People reading this phrase might
not understand the need for large doses of pain medication and
might be tempted to not check this box for fear that someone
might intentionally kill them or hasten their death. These same
people might find that in facing a very painful death, the wish
is to reverse this decision, but they are unable to do so, not
being competent or conscious at that time. Family members not
wanting to lose their loved one or not wanting to change the
written wishes, might hesitate to allow adequate amounts of pain
medication to be given at that point. If this phrase were
eliminated it would cause less confusion.
MS. EDWARDS continued that health care providers don't give pain
medication to hasten death; it is given to relieve pain. That
is the goal. The bottom line for a lot of health care providers
is that they don't want to lose their licenses. She said that
regarding the entire bill, no matter what one's beliefs are,
everyone has the right to make these important decisions for
his/her end of life, with the surrogate being aware of those
wishes. She said she wants her wishes honored at the end of her
life. She wants her parents' wishes honored, and as an only
child, she knows exactly what they want and she plans to follow
their wishes. She hopes that they're in New Jersey, because
that state will allow her to follow their wishes. She hopes
that Alaska will allow for her wishes and her patients' wishes
to be followed, and for people to make their own decisions.
CHAIR DYSON asked what New Jersey does that other states don't
do.
MS. EDWARDS said that her parents' advance directives are filled
out, indicating "nothing at the end of life." They don't want
CPR, artificial fluid and nutrition, or life support. They want
I-V fluids only if it's to deliver pain medication so they are
comfortable at the end of life.
CHAIR DYSON asked if New Jersey allows a person to make the
choice for virtually no life support at the end of life.
MS. EDWARDS said yes. She added that she has the durable power
of attorney for health care to make those decisions for her
parents.
Tape 04-20, SIDE B
MS. LOIS HILDENBRAND, a volunteer with the American Cancer
Society (ACS), testified from Fairbanks that ACS supports
provisions of the current version of the bill. The society
supports the rights of patients and their loved ones to make
informed decisions about their health care, and it should be
clear and uniform so patients' wishes may be respected and
suffering may be diminished. She then told members that she
practiced as a nurse in Alaska from 1982 until 1998 and is
currently a pastor at the University Community Presbyterian
Church. She offered an anecdote about her uncle who was in
nursing care after a life-threatening event. She was a witness
to his "do not resuscitate (DNR)" order in Anchorage. He was
then transferred to Fairbanks where his family is located. A
year after he was transferred he noticed a little blue dot on
the plate card in the dining room at the Denali Center. When he
found out that this blue dot was for people who had DNR orders
he said that he had such an order, but the nurse taking care of
him said that he didn't. The one he had signed in Anchorage did
not transfer to Fairbanks. Fortunately this wasn't an issue;
however, had an event occurred, he would have been resuscitated
which would have been against his will. She commended this
attempt to make things uniform throughout the state so that
situations like this would not be faced in the future.
6:40 p.m.
MS. CONNIE JONES, a reverend and associate rector at St. Mary's
Episcopal Church, said she wasn't speaking on behalf of the
church, but was speaking for herself. She said she is very
supportive of the bill, and expressed her strong concern that on
page 8, regarding a section on pregnancy, there is language that
takes away some freedom from the physician, patient, and
surrogate. It says that certain health care decisions may not
be given effect under certain circumstances dealing with
pregnancy. She suggested this subject was for some other bill
rather than for this one, and that there would be more
widespread support of the bill if that section were removed.
CHAIR DYSON said he thought that he and the sponsor were in
agreement, but it was his assumption that a woman who is
comatose and unable to make decisions - the fact that she is
carrying an unborn child - is evidence that she wants that child
to survive unless there is information to the contrary. He said
he believed the sponsor was interested in the implied, if not
expressed, wish for this to be carried forward and asked Ms.
Jones what the problem was with that.
SENATOR GUESS asked for clarification of the version being
addressed.
CHAIR DYSON responded this was on page 8 in version V.
MS. JONES wondered if she had the correct version, as she had
version V. [It was clarified that this also referred to page 8,
line 16, version B.] Ms. Jones continued that she didn't see
any definition relating to this section, in the back. She was
looking, in particular for a definition of "fetus" as she didn't
know what stage was being referred to.
CHAIR DYSON said he thought he was speaking for the sponsor, but
the assumption was that if a woman was pregnant and hadn't
already made the choice to, or wasn't already in the process of
getting an abortion, then this was a wanted child, so the
default choice would be to preserve that woman's life as long as
possible to enhance the child's chances of surviving her.
MS. JONES suggested that this kind of detail does not belong in
the bill and her hope was that the physicians dealing with this
person and the surrogate, if the woman was comatose, would use
judgment and not have to be given an instruction indicating that
these health care decisions "may not be given effect." She
reiterated that the bill doesn't suffer by having this language
removed, and said it sounds a little dictatorial. Ms. Jones
asked about obtaining updated versions of the bill.
CHAIR DYSON pointed out that the language she had referred to
had not changed [between versions] and said she could contact
either his office or Senator Guess's for updated versions.
MR. BRUCE ZALNERAITIS, with Life Alaska Donor Services in
Anchorage, the state's organ and tissue donor program, testified
that he was available to answer questions relating to anatomical
gifts and consent, particularly to what is called "first person
consent or donor designation."
CHAIR DYSON asked if Life Alaska Donor Services is a program or
a commercial enterprise.
MR. ZALNERAITIS replied this is a non-profit organization
responsible for organ and tissue donations in the state. He
mentioned that he has made recommendations to the bill.
CHAIR DYSON asked if he was uncomfortable about the direction
the sponsor was going with the bill.
MR. ZALNERAITIS said no. He referred to the question of opting
out as opposed to opting in. Life Alaska supports the system
now in place in which a person chooses to be a donor, and until
he/she does so, is not a donor. That could be described as an
opt-in system. A person needs to indicate, through a donor
registry or the completion of a donor card, that he/she wishes
to be a donor. In the absence of that, he/she is not a donor
unless upon his/her death, the family chooses to grant
permission for him/her to be a donor.
CHAIR DYSON asked if the current donor law is opt-in.
MR. ZALNERAITIS said yes, and that means that based on the
Uniform Anatomical Gifts Act that Alaska has adopted, Life
Alaska is not able to proceed with a donation unless either the
person has granted permission in advance, or his/her relatives -
upon that person's death, in the order described - granted
permission for donation. It does not take place without such
permission.
CHAIR DYSON asked if it is correct that the agent, surrogate, or
guardian could not overrule a person who gave an advance
directive indicating they did not want to be a donor.
MR. ZALNERAITIS said correct. In accordance with the Uniform
Anatomical Gifts Act, if a "known prior objection" exists from
the person, or in the case of after death, the deceased,
donations shall not take place.
CHAIR DYSON questioned whether the family could make those
decisions after death if the person didn't write it down.
MR. ZALNERAITIS said correct. This would be considered as "no
known objection."
CHAIR DYSON asked for clarification about a situation in which a
person has flat-line brainwaves, and the current practice to
keep the heart and lungs going, while the team gets ready and/or
prepares the recipients and whether it is within the realm of
commonly defined ethics.
MR. ZALNERAITIS said the first step is to consult with the next-
of-kin to determine whether, in the absence of advance notation
to be a donor, the family would grant permission to consider
their loved one as being a donor. Only then would organ
function get assessed and teams be brought in to do the
transplants.
CHAIR DYSON asked if there were any states that had opted-out.
MR. ZALNERAITIS said there are no opt-out systems in the United
States that he knows of.
MR. CHIP WAGONER, representing the Alaska Catholic Conference
(ACC), testified that ACC is the official voice of the church in
Alaska regarding public policy matters. He emphasized the
significance of the bill, with its goal to enable individuals to
have their wishes implemented. He stated that ACC has the goal
of wanting to prohibit and prevent euthanasia; euthanasia is
defined as "an action or an admission which of itself or by
intention causes death in order that all suffering may in this
way be eliminated." He said this was a balance of two very
important public policies, and Chair Dyson's version X comes
closest to meeting that balance. He referred to version X,
saying that of the 14 amendments ACC submitted, 3 were accepted,
4 were compromised, and 7 were rejected. Regarding version B,
12 were rejected, 1 was compromised, and 1 was accepted. He
mentioned a change in ACC's recommendation regarding two
situations in which life-sustaining procedures could be withheld
or withdrawn from a patient, when it was determined by the
surrogate, agent, or guardian. One situation was when the
person was terminally ill, and the other was when a person was
permanently unconscious. Since those amendments were submitted,
there was a conference held in Europe sponsored by the
Pontifical Academy for Life and the International Federation of
Catholic Medical Associations, the International Congress of
Life Sustaining Treatments and Vegetative State Scientific
Advances and Ethical Dilemmas. Pope John Paul II issued a
statement at that conference relating to the issue of when
artificial nutrition and hydration could be withheld or
withdrawn, and ACC is backing off from that amendment somewhat,
although it may not change ACC's support for the bill.
CHAIR DYSON asked what position the group came to that was
authenticated by The Pope.
MR. WAGONER read the following: "I should like particularly to
underline how the administration of water and food, even when
provided by artificial means, always represents a natural means
of preserving life, not a medical act. It's use, furthermore,
should be considered in principle ordinary and proportionate and
as such, morally obligatory insofar as and until it is seen to
have attained its proper finality, which in the present case,
consists in providing nourishment to the patient and alleviation
of his suffering." Mr. Wagoner stated that this was a stronger
position and that regarding version X ...
CHAIR DYSON interrupted, saying that this was a bit of a problem
because [version X] had not been distributed yet, and he hadn't
had a chance to look at it; it was not yet a part of the active
discussion.
SENATOR GUESS reiterated that it was disturbing that she had
received version B from the sponsor, "which is after X, and a W,
and that there's an X floating around" and that she wasn't being
provided with the version Mr. Wagoner was speaking to.
MR. WAGONER apologized and said, "I think we're very, very
close, Mr. Chairman."
CHAIR DYSON agreed, stating that the sponsor and his staff have
done immense and valuable work.
MR. WAGONER confirmed, "Without a doubt, I think you've brought
two of the ends kind of in the middle, and if the middle
survives that would be great."
CHAIR DYSON encouraged members to bring any specifics on the
bill to his staff in order to achieve the very best product
because "this is such a laborious effort that I doubt if we'll
be back visiting it for a long time, and we're setting a course
here that makes a huge difference for a small but significantly
impacted group of people."
SENATOR GUESS said it was difficult to provide comments when the
version being worked from is unspecified and there are two
different versions being drafted by Legislative Legal. She said
she provided comments to the sponsor and his staff, and she
spent time with Dr. Wallington as well.
CHAIR DYSON responded that there would only be three, four, or
five places with changes. He added, "We'll try to highlight
those for you."
MR. WAGONER asked to speak to the pain management issue. He
said there are two reasons why ACC advocated for having
something that the patient could put on his/her form regarding
pain management to alleviate discomfort and pain. ACC wants
something included to the effect that "it's not being done with
the intention of causing their death." The language may need to
be re-worded, but it's included to alleviate the fear that
doctors may have of prescribing pain medication, and secondly to
clarify that euthanasia or assisted suicide is not being
authorized.
CHAIR DYSON asked if there was any further testimony.
7:03 p.m.
MS. MARIE HELM, representative of the committee on publication
for the Christian Sciences Churches of Alaska, expressed support
for HB 25 and commended Representative Weyhrauch, his staff and
the HES committee for their work. She referred to language in
version V on page 10 that talks about allowing a patient to
transfer from a facility. She stated that she hopes that it
could be spelled out that a patient could choose to go home
where there might be hospice care or other alternative
treatments because there might be times that this would be the
right choice for an individual.
CHAIR DYSON asked where that was on page 10.
MS. HELM replied that the language was on line 12, page 10 of
version B. She suggested adding language such as, "a location
of the patient's choice or the patient's home" saying it would
be nice to include that so it would be understood that it's the
patient's right to choose to go home.
CHAIR DYSON said that is a good point and thanked her for her
contribution.
CHAIR DYSON held CSHB 25(JUD) in committee.
There being no further business before the Senate Health,
Education and Social Services Standing Committee, CHAIR DYSON
adjourned the meeting at 7:05 p.m.
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