Legislature(1993 - 1994)
03/08/1993 02:20 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE March 8, 1993 2:20 p.m. MEMBERS PRESENT Senator Steve Rieger, Chairman Senator Loren Leman Senator Jim Duncan Senator Johnny Ellis MEMBERS ABSENT Senator Bert Sharp, Vice Chairman Senator Mike Miller Senator Judy Salo COMMITTEE CALENDAR HOUSE BILL NO. 114 (efd add) "An Act allowing the Board of Nursing to authorize an advanced nurse practitioner to dispense medical, therapeutic, and corrective measures; and providing for an effective date." SPONSOR SUBSTITUTE FOR SENATE BILL NO. 71 "An Act relating to emergency medical services; and repealing obsolete references to the Statewide Health Coordinating Council and health systems agencies." SENATE BILL NO. 61 "An Act implementing certain recommendations of Alaska 2000 to improve the state's education system; and providing for an effective date." PREVIOUS SENATE COMMITTEE ACTION HB 114 - No previous action to record. SB 71 - No previous action to record. SB 61 - See HESS minutes dated 2/8/93, 2/10/93, 2/17/93, 2/24/93 and 3/3/93. WITNESS REGISTER Representative Cynthia Toohey Alaska State Legislature State Capitol, Room 104 Juneau, Alaska 99801-1182 POSITION STATEMENT: Sponsor of HB 114. Mary Strowing, Member Alaska State Nursing Board 1009 Wee Burn Drive Juneau, Alaska 99801 POSITION STATEMENT: Testified in support of HB 114. Mark Johnson, Chief Emergency Medical Services Section Department of Health and Social Services P.O. Box 110616 Juneau, Alaska 99811-0616 POSITION STATEMENT: Testified in support of SSSB 71. Todd Huttenlocher, Medical Director Emergency Medical Services Section Department of Health and Social Services P.O. Box 110616 Juneau, Alaska 99811-0616 POSITION STATEMENT: Testified in support of SSSB 71. Mary Gregory Mat-Su Education Association P.O. Box 3804 Palmer, Alaska 99645 POSITION STATEMENT: Testified on SB 61. Charlie Crangle Box 247 Seward, Alaska 99664 POSITION STATEMENT: Testified on SB 61. Jerry Dixon Box 1056 Seward, Alaska 99664 POSITION STATEMENT: Testified on SB 61. ACTION NARRATIVE TAPE 93-21, SIDE A Number 001 CHAIRMAN RIEGER called the Senate Health, Education, and Social Services (HESS) Committee to order at 2:20 p.m. The first order of business was HB 114 (DRUG DISPENSING:ADV. NURSE PRACTITIONERS). REPRESENTATIVE CYNTHIA TOOHEY, sponsor of the measure, said the bill clarifies the statute where it has been a common practice for nurse practitioners to dispense medication since the early 1980s. Nurse practitioners may examine and prescribe, but the statute doesn't include the word "dispense." In many rural and urban areas where there aren't pharmacies, the legislation is urgently needed. Representative Toohey said there is a zero fiscal note from the Department of Commerce and Economic Development. HB 114 passed the House HESS Committee, Labor and Commerce Committee, and the House Floor with a 39-0 vote and an immediate effective date. The bill has the support of the Board of Nursing, the Board of Pharmacy, the Alaska Nurses Association, the Alaska Association of Advanced Nurse Practitioners, advanced nurse practitioners (ANP) throughout the state, the Department of Health and Social Services, and the Department of Commerce and Economic Development. She urged support for the HB 114. SENATOR ELLIS asked if the bill would include dispensing of any kind. Representative Toohey said it would be whatever they are licensed to dispense. They must complete a certain amount of hours of pharmacology and pass some tests. They are then given licensing to prescribe specific drugs. Senator Ellis asked if they can dispense narcotics. Representative Toohey indicated that narcotics are within the license of a nurse practitioner. Number 084 MARY STROWING, Member, Alaska State Nursing Board, said the board supports HB 114. The legislation is necessary to provide legal authority for ANPs to dispense the medication that they have prescribed. Dispensing has been occurring, statewide since ANPs began practicing in Alaska under regulations established in 1980 by the Board of Nursing. She said a July 1992 attorney general opinion stated that there is no legal authority which allows ANP dispensing. A survey done by the Board of Nursing in November, 1992, with a 71 percent response rate, revealed that 55 percent of ANPs working in Alaska dispense in their practice. The survey further disclosed that 25 percent of the ANPs were in communities without pharmacies, and 22 percent were in communities without physicians. Ms. Strowing said HB 114 is needed to allow ANPs to continue to dispense in their practice so the care of the communities will not be adversely impacted. The Board of Nursing and the Board of Pharmacy have been working together on the parameters for ANP dispensing and they will be defined by the Board of Nursing's regulations. The ANP will be required to dispense in accordance with a practitioners scope of practice. She urged that HB 114 be passed into law. There being no further testimony, SENATOR LEMAN moved that HB 114, be passed out of the Senate HESS Committee with individual recommendations. Hearing no objection, the motion passed. Number 147 The next order of business was SSSB 71 (EMERGENCY MEDICAL SERVICES SYSTEM), sponsored by Senator Leman. SENATOR LEMAN said after seeing the assessment of Emergency Medical Services in Alaska completed by the National Highway Traffic Safety Administration Technical Assistance Team he concluded that there were some good recommendations on updating statutes. He said he worked with people from Emergency Medical Services as well as the Departments of Health and Social Services and Commerce and Economic Development in writing SSSB 71. He said Alaska is fortunate to have over 3,000 volunteers and paramedics who provide a valuable service, in many cases, at a reduced cost. MARK JOHNSON, Chief, Emergency Medical Services Section, Department of Health and Social Services, testified in support of SSSB 71. He informed the committee that the legislation the Emergency Medical Services Section functions under was initially passed by the legislature in 1977 and was amended in 1978. It has not been amended since. The National Highway Traffic and Safety Administration started a program a few years ago to make it possible for states to have an outside comprehensive evaluation of their systems. About 38 states have taken advantage of that process which uses federal funds. He said in September, 1992, the National Traffic Highway Safety Administration brought a team of experts to Alaska from around the U.S. Mr. Johnson said he has been working with Senator Leman's staff to identify areas that need changes and to address the various components of a comprehensive emergency medical services system. Mr. Johnson continued to review his position paper as to what the legislation would do. This legislation would: (1) Expand authority of the EMS Section, Department of Health and Social Services to set standards for Mobile Intensive Care Paramedic training programs; (2) Expand the authority of the Department of Health and Social Services to address statewide trauma care system development and to establish standards for the certification of trauma centers; (3) Require the Department of Health and Social Services to establish an EMS patient care information system and require EMS organizations and hospital to provide data; Mr. Johnson noted that currently there is a statewide trauma registry data system that every acute care hospital in Alaska is participating in on a voluntary basis. The bill would put that system in statute. He noted the department also does surveys of pre-hospital emergency medical services every year. Approximately 75 percent of the ambulance services are already providing data. (4) Change the name of the State Advisory Council on Emergency Medical Services to the Alaska Council on Emergency Medical Services, provide that the Council advise the governor and the commissioner of Health and Social Services on EMS issues, and specify the types of EMS system providers to be appointed by the governor; (5) Expand the authority of the department to adopt regulations to charge fees for certification and licensing of organizations; (6) Provide for certification of emergency medical dispatchers; (7) Provide for the disclosure of medical records information to pre-hospital EMS providers for quality of care review and education; and (8) Include state certified EMT instructors in the immunity from liability protection listed in AS 18.08.086. Other provisions of this bill would delete references to the Statewide Health Coordinating Council and health systems agencies, which no longer exist, and delete the words "physician trained" in statutory references to mobile intensive care paramedics (MICP's), to more accurately reflect that MICP's are trained by a combination of physicians, nurses and other paramedics. Number 298 CHAIRMAN RIEGER questioned whether the department is already doing the patient information system. Mr. Johnson said the answer is "yes" and it is being done under a federal grant. Chairman Rieger said the fiscal note is $200 thousand. Mr. Johnson explained that if the federal money runs out, there is no money currently to replace it. If the bill passes along with the fiscal note, that would give the department the money to continue the system. It started as a pilot program in 1988 and it is a very good data system. Chairman Rieger asked what benefits are coming from the system. Mr. Johnson said the system has two major purposes. One purpose is provide data for quality of care review so that the department can give reports back to hospitals. Very soon they will be giving reports to the pre-hospital ambulance services on trauma patients. Mr. Johnson said it is a very sophisticated piece of software that was developed by the former chairman of the American College of Emergency Physicians, Committee on Trauma. Included in the software are some parameters that came out of the Major Trauma Outcome Study, which was a nationwide study done by trauma centers throughout the U.S. in the mid 1980s. Mr. Johnson referred to the other major piece of the data the department gets information on which relates to the causes and severity of the injuries. Injuries are like diseases as they tend to show up in clusters. When those clusters can be identified, you can begin to look at ways to prevent those injuries. He said they are beginning to review the data and isolate those circumstances which resulted in injuries. TODD HUTTENLOCHER, Medical Director, Emergency Medical Services Section, Department of Health and Social Services, testified in support of SSSB 71. He said the enabling legislation for the EMS Section is 15 years old. Over that time period, the department has identified a need for the designation of paramedic training programs and certification of those programs within the state. They have identified a need for emergency medical dispatch certification standardization. Neither of those currently exist and the legislation will allow the department to do that in a formulated, well thought out pre-planned system. Number 354 There being no further testimony on the measure, SENATOR LEMAN moved to pass SSSB 71 out of the Senate HESS Committee with individual recommendations and accompanying fiscal notes. There being no objection, the motion passed. Number 362 The last measure to come before the Senate HESS Committee was SB 61 (IMPLEMENT ALASKA 2000 RECOMMENDATIONS). CHAIRMAN RIEGER indicated that Senator Salo was present via teleconference. He said at the last meeting Senator Ellis had introduced an amendment. SENATOR ELLIS explained he withdrew it to come up with a new improved version. Chairman Rieger noted that the committee was addressing the section of the bill that deals with charter schools. Senator Ellis referred to concerns raised at the previous meeting and said the original bill allows 40 charter schools. He said he reduced that to 4. Then some people thought that wasn't enough so he raised it to 10. He said the State of California, which is experimenting with a pilot project, has allowed 100 pilot schools. There was also a concern about the government of charter schools. He said in his amendment, at least 25 percent of the teachers would need to sign a petition and be in favor of the charter school concept, and 50 percent of the parents. Senator Ellis said he would personally prefer a much larger and significant buy-in by the professional staff of the school. He read a section of the Anchorage School District's summary of responses to the Alaska 2000 recommendations relating to charter schools: "We support a group of parents and teachers coming forward with a plan for a school within the policies and mission of the district but not outside the public school system." Senator Ellis gave committee members a list of all the current alternative programs that parents, teachers and students have brought forward in the past to meet specialized needs. Senator Ellis' amendment follows: Page 1, lines 1-2: Delete "implementing certain recommendations of Alaska 2000 to improve" Insert "relating to" Page 6, lines 30-31: Delete "the application of the initial board of directors of a charter school and the approval of" Insert "approval of a charter school petition by" Page 7, line 1: Delete "40" Insert "10" Page 7, lines 3-8 Delete all material. Insert new subsections to read: "(b) Each local school board shall prescribe a procedure by which an individual may submit a charter school petition for the reorganization of a school within the district as a charter school. The procedure may include a proposed form for a charter between a charter school and the local school board, setting out the charter elements. The petition for the establishment of a school in a district as a charter school may be circulated by one or more individuals seeking to establish the charter school. A charter school petition must be signed by not less than 50 percent of the parents of the school attendance area and by not less than 25 percent of the teachers employed by the school at the time the petition is circulated. (c) The charter school petition shall be submitted to the school board for review. (d) The school board shall hold public hearings on the provisions of the charter school and determine the level of parent and employee support for the charter school. Following review of the charter school petition, the board shall either grant or deny the petition (e) A charter school petition must include the following: (1) a description of the educational program of the school designed to identify those individuals that the school is attempting to educate; (2) the measurable pupil outcomes identified for use by the charter school; in the paragraph, "pupil outcomes" mean the extent to which pupils of the school demonstrate that they have attained the skills, knowledge, and attitudes specified as goals in the school's educational program; (3) the governing structure of the school, including the process to be followed by the school to ensure parental involvement; (4) a description of how new and innovative teaching methods will be encouraged; (5) a description of how professional opportunities for teachers will be created, including the opportunity to be responsible for the learning program at the school site. (f) A local school board shall forward to the state Board of Education a charter school petition that has been approved or denied." Page 7, lines 15-16: Delete "in the contract. A board of directors for the charter school shall oversee the operation of that school." Page 7, lines 17-31 Delete all material. Insert "(b) The charter school shall" Page 8, line 3 Delete "(e)" Insert "(c)" Page 8, lines 6-7 Delete "permanent charter school board" Insert "charter school" Page 8, lines 27-28 Delete "permanent charter school board" Insert "charter school" Page 9, line 8: Delete "initial and permanent board of a" Page 9, line 21, after "drawing": Insert "A school board in a district may not require a pupil to attend a charter school." Page 9, lines 22-23: Delete all material and insert: "(c) A charter school shall be nonsectarian and shall comply with the conditions of its charter school petition. A charter school may not discriminate on the basis of ethnicity, national origin, gender, or disability." Page 9, line 26, through page 10, line 2: Delete all material and insert: "(b) The provisions contained in a negotiated agreement or collective bargaining agreement applicable to teachers or other employees who transfer into a charter school may not be altered or changed as a result of the creation of a charter school. (c) A teacher in a charter school shall be evaluated in the same manner as all other teachers in the school district." Page 10, after line 9 Insert "(2) `district' has the meaning given in AS 14.17.250;" Renumber the following paragraphs accordingly. Page 10, lines 15-16: Delete all material Renumber the following paragraphs accordingly. CHAIRMAN RIEGER questioned the meaning of the amendment on Page 7, lines 17-31, Delete all material. Insert "(b) The charter school shall." Senator Ellis explained that the drafter had made a mistake on the amendment. The drafter deleted what needs to be deleted but didn't insert what should have been inserted. He said the new language is in the amendment but is placed earlier in the bill. Chairman Rieger referred to part of Senator Ellis' amendment on page 7 relating to a charter school petition that must be signed by not less than 50 percent of the parents of the school attendance area and by not less than 25 percent of the teachers employed by the school at the time the petition is circulated. He said it sounds like a major undertaking and said he thought it would be something much more experimental and a small scale effort rather then disassembling an entire school and restarting it as a different school. Senator Ellis said he thinks that is a major issue and the amendment limits the experiment or pilot project. At the last meeting, Senator Leman raised a concern about how charter schools won't cost more money. Senator Ellis said he believes that they will. New resources are needed or existing resources will be diverted from their current use. Unless there is more money, it will be a disservice to students who will be left behind. Number 514 Chairman Rieger asked Senator Ellis to comment on his amendment on page 9, line 26, relating to collective bargaining. Senator Ellis said he didn't believe that charter schools should be a way to circumvent the collective bargaining process for the certificated professionals involved in delivering education to kids. Chairman Rieger asked if the creation of a charter school would be a bargainable issue. Senator Ellis said he thinks that all terms and conditions of employment are bargainable items. He said the way he reads subsection (b) is when a the teacher transfers from a regular school to a charter school, they wouldn't lose their rights under collective bargaining. SENATOR SALO said it is important to note that all contracts between districts and employee groups have a method by which they can be changed which is called a "Memorandum of Agreement." Both parties would have to agree to any changes. TAPE 93-21, SIDE B SENATOR ELLIS moved that Amendment #10 be adopted. CHAIRMAN RIEGER objected. He said his primary objection is at the bottom of page 1 of the amendment relating to the number of charter schools to be reviewed at any time. He indicated he wants more latitude for the creation of charter schools within the existing school district and within the actual school. Number 029 SENATOR SHARP said he would like to make sure that there is an opportunity for all major school districts to have at least one charter school. He said if the policy was first come, first serve without any limits set, the larger school districts could apply for all the charter schools. There should be some control. Chairman Rieger referred to the amendment and suggested rewording page 3, lines 3-8: "(b) Each local school board shall prescribe a procedure for application to the school board for formation of a charter school. The procedure may include a proposed form for a charter between a charter school and the local school board, setting out the charter elements." He then suggested deleting the rest of the paragraph. SENATOR DUNCAN said perhaps amendments to the amendment would be appropriate. He said he willing to support Senator Ellis' amendment as written. If it is too loose, he will not support the amendment. Senator Duncan said he won't be supportive if the wording that Chairman Rieger suggested is inserted. Chairman Rieger referred to the proposed amendment on page 9, line 26, through page 10, line 2, paragraph (c) "A teacher in a charter school shall be evaluated in the same manner as all other teachers in the school district." He suggested deleting the words "the same" and inserting the words "an equivalent." Senator Ellis said he wouldn't have any problem with the new wording. He said he would consider it a friendly amendment. Senator Ellis asked that there be a vote on Amendment #10 which would include Chairman Rieger's suggestion to change "the same" to "an equivalent." There was discussion regarding whether Senator Salo could vote on the amendment via teleconference. It was determined that she may vote on amendments but could not vote to move a bill from the committee as that actually requires a signature on a bill reporting form. Number 170 CHAIRMAN RIEGER moved to amend Amendment #10. On page 7, lines 3-8, replace paragraph (b) with the following new language: "(b) Each local school board shall prescribe a procedure for application to the school board for formation of a charter school. The procedure may include a proposed form for a charter between a charter school and the local school board, setting out the charter elements." SENATOR ELLIS objected to the amendment to the amendment. A roll call vote was taken. Senators Rieger, Sharp, and Leman voted in favor of the amendment to the amendment. Senators Duncan, Ellis, Salo voted "no." So the motion failed. A roll call vote was then taken on the motion to adopt Amendment #10. Senators Duncan, Ellis, Salo voted "yes." Senators Rieger, Sharp, Leman voted "no." So the motion failed. Number 210 Chairman Rieger asked Mary Gregory, Mat-Su Education Association to give testimony on SB 61. MARY GREGORY referred to the tenure section of the bill and said she feels that there is a lot of misconception. It is something that addresses the dismissal of teachers, but it is done in a proper form. There are evaluation tools set up. The problem is that many principals don't want to do their part of the evaluations. They fail to, don't know how, or are reluctant to do it. Ms. Gregory referred to charter schools and said if there are guidelines and the same school district rulings are available and imposed in a friendly manner, she believes that the people in the state could accept that. She referred to extending the school year and said there would need to be funding as she doesn't believe people will work for nothing. Ms. Gregory said if truancy and attendance is a concern, why isn't there any state laws or regulations to address the issue. She continued to give general testimony on SB 61. CHARLIE CRANGLE informed the committee he is from Seward. He said the committee is discussing education. It seems that many times the focus is on the quantity of money rather than the end product which is quality for kids. In the long run, you either pay now or pay later. He discussed problems with overcrowded classrooms. Mr. Crangle urged that before we start engaging in new programs such as charter schools, increasing the school year, etc., we need to consider working with what we already have and doing a better job of it. He indicated concern that teachers aren't part of the process and discussed problems with truancy. JERRY DIXON, from Seward, was next to testify. He said he came to Alaska 26 years ago and has been in public education for 10 years. Mr. Dixon said he is very concerned about the direction of Alaska 2000. He indicated concern with budget cuts and laying off teachers. Mr. Dixon asked that the committee look at the entire agenda and address things like pupil/teacher ratio. He thanked the committee for listening to him. CHAIRMAN RIEGER said the bill would be back before the committee at a later date. Number 445 Chairman Rieger adjourned the Senate HESS meeting at 3:50 p.m.