Legislature(1997 - 1998)
04/16/1997 09:07 AM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE April 16, 1997 9:07 a.m. MEMBERS PRESENT Senator Gary Wilken, Chairman Senator Loren Leman, Vice Chairman Senator Lyda Green Senator Jerry Ward Senator Johnny Ellis MEMBERS ABSENT All members present. COMMITTEE CALENDAR SENATE BILL NO. 164 "An Act relating to the authority of an emergency medical technician at the scene of an accident or emergency." - HEARD AND HELD SENATE BILL NO. 122 "An Act relating to unfair discrimination under a group health insurance policy for services provided by marital and family therapists; and providing for an effective date." - MOVED CSSB 122(L&C) OUT OF COMMITTEE SENATE BILL NO. 132 "An Act relating to registration of sex offenders and central registry of sex offenders; relating to access to, release of, and use of criminal justice information and systems; relating to notices concerning sex offender registrants; and providing for an effective date." - MOVED SB 132 OUT OF COMMITTEE PREVIOUS SENATE COMMITTEE ACTION SB 164 - No previous Senate action to record. SB 122 - See Labor and Commerce Committee minutes dated 4/8/97. SB 132 - See Senate Health, Education & Social Services Committee minutes dated 3/24/97. WITNESS REGISTER Beth Hagevig, Staff Senator Wilken State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Read the Sponsor Statement. Craig Lewis Alaska EMS Association Interior Region Emergency Medical Services Council 3522 Industrial Avenue Fairbanks, Alaska 99701 POSITION STATEMENT: Urged support of SB 164. Ellen Wofford, EMT-III Delta Rescue Squad PO Box 52 Delta Junction, Alaska 99737 POSITION STATEMENT: Supported SB 164. Tom Dean, Chief Tok EMS PO Box 811 Tok, Alaska 99780 POSITION STATEMENT: Encouraged passage of SB 164. Mark Johnson, Chief Section of Community Health & Emergency Medical Services Department of Health & Social Services PO Box 110616 Juneau, Alaska 99811-0616 POSITION STATEMENT: Supported SB 164. Rachael Moreland, Staff Senator Leman State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Read the Sponsor Statement. Catherine Reardon, Director Division of Occupational Licensing Department of Commerce & Economic Development PO Box 110806 Juneau, Alaska 99811-0806 POSITION STATEMENT: Supported SB 122. Beverly Lindell, President Alaska Association of Marriage & Family Therapists PO Box 32481 Juneau, Alaska 99803 POSITION STATEMENT: Supported SB 122. Marianne Burke, Director Division of Insurance Department of Commerce & Economic Development PO Box 110805 Juneau, Alaska 99811-0805 POSITION STATEMENT: Discussed SB 122. ACTION NARRATIVE TAPE 97-40, SIDE A SB 164 AUTHORITY OF EMERGENCY MED TECHS Number 001 CHAIRMAN WILKEN called the Senate Health, Education & Social Services Committee (HES) to order at 9:07 a.m. and introduced SB 164 as the first order of business before the committee. BETH HAGEVIG , Staff to Senator Wilken, read the following Sponsor Statement into the record: Senate Bill 164 repairs a long overdue shortcoming in our public safety network. Specifically, it provides EMTs with appropriate and relevant authority at the scene of an accident as well as during responses to medical emergencies in homes, without creating potential conflict between emergency personnel. SB 164 is intended to protect EMTs who arrive first on the scene of an accident or medical emergency, or who are the only emergency responders to arrive for some time, as is the case in many rural areas. Currently, we ask emergency medical technicians to perform actions necessary to their duties such as: *controlling and directing activities at the scene of an accident; *temporarily blocking or redirecting traffic to avoid the scene of an accident; *trespassing upon property in order to respond to an emergency call; *entering a building, including a private residence, or premises where report of an injury or illness has taken place; and *directing the removal or destruction of a motor vehicle or other thing in order to prevent further harm to injured or ill individuals; without giving them the proper legal authority to do so. By taking for granted that EMTs are expected to perform these duties in the absence of any legal authority, we leave hundreds of men and women vulnerable to the lack of cooperation on the part of the public and potential liable suits. Alaska relies heavily on its emergency medical personnel, especially in rural areas where law enforcement and fire personnel are relatively few in numbers. Just as we expect EMTs to protect our safety in an emergency situation, we should reciprocate this service, and give EMTs the proper legal authority to do their jobs without compromising their personal safety. CHAIRMAN WILKEN referred the committee to the information in the packet which detailed the levels of EMTs in Alaska. BETH HAGEVIG noted that ETTs although listed with the levels of EMTs, are not technically EMTs. Number 094 CRAIG LEWIS , Alaska EMS Association and Interior Region Emergency Medical Services Council Inc., urged the support of SB 164. Mr. Lewis believed that the committee packet included documents regarding cases in other states where EMTs without this authority were injured and held liable after the fact. The EMTs in rural settings perform those duties listed. Mr. Lewis noted that customarily there is a responsible person in charge, sometimes called the Chief Medic. SB 164 does not compromise nor conflict with any existing law enforcement or fire fighting authority. SB 164 provides legal protection for EMTs responding in locations where the trooper response is delayed or there are no volunteer fire fighters to assume the role. SENATOR GREEN referred to line 14 on page 1 when noting that during the Millers Reach fire lots of people began directing traffic without consistent identification that resulted in fist to cuffs and later arrests. In SB 164, what provides consistent identification of those in authority? CRAIG LEWIS pointed out that SB 164 is not designed to deal with a wild land fire circumstance as in Millers Reach. Mr. Lewis believed the bill to address motor vehicle accidents or illnesses in homes. The majority of EMTs are in uniform or wear some sort of patch. CHAIRMAN WILKEN did not want just anyone to claim to be an EMT and end up directing traffic. Should SB 164 contain language indicating the need for EMTs to carry identification or wear a uniform in order to know that the person is truly an EMT if challenged? CRAIG LEWIS acknowledged that the involvement of bystanders and the question of challenging of the EMTs is complicated. The EMTs have credentials and cards which explain the certification as well as uniforms. EMTs are trained in dealing with the public. The definitions and standards defining an EMT seem to already address the issue of identification. Number 213 ELLEN WOFFORD , EMT-III with Delta Rescue Squad, supported SB 164. Many EMTs are volunteers and therefore may come upon a scene and not be in the uniform, but do carry badges and perhaps have a hat indicating the person's EMT status. TOM DEAN , Chief of the Tok EMS, believed he was sort of responsible for this legislation because he questioned whether Alaskan EMTs had authority after reading an article discussing a similar situation in another state. SB 164 addresses what is done on a regular basis by EMTs. Mr. Dean noted that in his area, EMTs often arrive 30 minutes to an hour before troopers at motor vehicle accidents. SB 164 merely gives authority to EMTs to do what they are already doing. Mr. Dean encouraged the passage of SB 164. MARK JOHNSON , Chief of the Section of Community Health & Emergency Medical Services in DHSS, informed the committee that the Section of Community Health & Emergency Medical Services was responsible for planning, coordinating, and implementing a statewide emergency medical services system which includes the certification of all EMTs and ambulance services. With regard to ETTs, those persons are not equivalent to EMTs. ETTs, first responders, would not be covered under this statute. Mr. Johnson explained that if someone is certified by his section then, that person would receive a certificate, a wallet card, and patches. Mr. Johnson supported SB 164. CHAIRMAN WILKEN inquired as to the number of people involved from the EMT-I level to MICP. MARK JOHNSON stated that approximately 4,000 people are certified statewide. Number 295 SENATOR WARD asked if SB 164 was enacted, would Martin Buser be sent to jail if during an emergency situation an EMT told him not to go home and he did. BETH HAGEVIG said that she would have to confer with legal on that issue. Placing EMTs as enforcers was not the intent of this legislation; the intent was to give EMTs the authority to do what they are already doing. In general when EMTs arrive on the scene, the EMTs rely on law enforcement to perform enforcement duties. SENATOR WARD restated his question. BETH HAGEVIG noted that SB 16 was modeled after the fire fighter authority legislation in which there is a penalty if a fire fighter's instructions are disobeyed. Ms. Hagevig reiterated that she would need to confer with an attorney on this matter. MARK JOHNSON believed that there was no enforcement authority with SB 164. The reason for SB 164 is to protect EMTs; most EMTs do not want enforcement authority. Mr. Johnson also deferred to legal advice. SENATOR GREEN believed Mr. Johnson, but noted that during an ongoing emergency the functions between the various responding groups can become blurred. This legislation may not be the proper place to address this issue, the ability to deputize. Senator Green referred to lines 3 and 4 on page 2; is that a typical standard? MARK JOHNSON believed that if EMS receives a call then that gives EMS reasonable authority to enter on the basis of that call. This simply clarifies that. BETH HAGEVIG reiterated that SB 164 was drafted almost verbatim from the fire fighter authority legislation. In response to Senator Ward, CRAIG LEWIS reiterated that the intent of SB 164 was to provide authority not enforcement. In general, persons who violate statutes are penalized and if SB 164 becomes law then the penalties relevant to that would apply. There is a $1,000 fine for failing to comply with a fire fighter's instructions which is specifically stated in that legislation. That is not stated in SB 164. Number 383 SENATOR WARD asked if all persons covered under SB 164 were required to carry photo identification. CRAIG LEWIS said no, although most have a card issued by the state which identifies the person and level of skill. MARK JOHNSON also replied no to Senator Ward's inquiry. SENATOR WARD noted that police officers are not always in uniform, but do have identification beyond a badge, a cap, or a patch. TOM DEAN reiterated that in the Millers Reach fire, EMTs would not be in control in such a major fire. SENATOR WARD informed everyone of another situation in which a person with identification took control of an emergency situation and instructed those present to move away from the victim. Unbeknownst to the EMT person, one of the bystanders was a relative. Without the proper identification, the situation could have been very difficult. TOM DEAN assumed that there was a reason that there were instructions to separate the people from the victim. CHAIRMAN WILKEN redirected the conversation to the question of identification. MARK JOHNSON reiterated that all the certified EMTs are issued a wallet card, patches and a certificate. CHAIRMAN WILKEN asked if adding language requiring that the EMT certification card be carried, which is not a photo identification, would address the identification concerns. SENATOR WARD suggested that a specific background or designation on the person's drivers license could be utilized to signify their EMT status. MARK JOHNSON deferred to the DMV, but did note that SB 38 would require, in addition to the organ donor specification, a Do Not Resuscitate order as well. If SB 38 passes, that is a lot of information on the drivers license. CHAIRMAN WILKEN suggested that SB 164 be held to work on this matter. SB 164 was held to Friday's agenda. SB 122 INS.COVERAGE:MARRIAGE & FAMILY THERAPIST Number 459 CHAIRMAN WILKEN introduced SB 122 as the next order of business. He noted that there was a CS from the Labor & Commerce Committee, when saying that he would entertain a motion to place it before the committee. SENATOR WARD moved to adopt CSSB 122(L&C) for discussion purposes. Without objection, CSSB 122(L&C) was adopted. RACHEAL MORELAND , Staff to Senator Leman, read the following Sponsor statement into the record: Senate Bill 122 was introduced by the Labor and Commerce Committee at the request of the Alaska Association for Marriage and Family Therapy (AAMFT). SB 122 will add marital and family therapists to the list of providers against whom insurers may not discriminate. This bill does not require insurers to add coverage of marital and family therapists where the coverage currently is not provided. It merely requires that insurers treat marital and family therapists on equal footing with other licensed providers and extend the same opportunities for coverage that the insurer offers others providing the same services. The definition of unfair discrimination is clarified by this bill and codifies existing practice. Section 1, paragraph 1 adds marital and family therapists to the unfair discrimination list under group health insurance policies with an effective date of July 1, 1997. Paragraph 2 defines unfair discrimination. Legislation (Section 4, ch. 39, SLA 1993) affecting the unfair discrimination clause was passed in 1993 with an effective date of 1998. Section 2 repeals and reenacts this section to reflect the addition of marital and family therapists and the definition of unfair discrimination. Currently, health insurers offering mental health services may not discriminate against licensed psychologists, psychological associates or clinical social workers. SB 122 would allow those insured with mental health coverage to choose treatment from a licensed marital and family therapist. AAMFT is a division of the American Association for Marriage and Family Therapy, Inc. Marriage and family therapists (MFTs) are a group of mental health professionals with background in a variety of disciplines, including psychology, social work, and family social science. MFTs are licensed or certified in 37 states and are recognized by the U.S. Department of Health and Human Services as one of the five core mental health disciplines in the U.S. CATHERINE REARDON , Director of the Division of Occupational Licensing in the Department of Commerce & Economic Development, informed the committee that the Board of Marital and Family Therapists works in association with this division. The board supports the inclusion of MFTs in this nondiscrimination clause. SENATOR LEMAN inquired as to how many people are licensed by the board in this category. CATHERINE REARDON said that at the beginning of this fiscal year, there were 181 persons licensed in this category. Number 515 BEVERLY LINDELL , President of AAMFT, requested the committee's support for SB 122. Ms. Lindell noted that SB 122 does not mandate coverage nor increase the scope of service nor does the bill include any willing provider language. This legislation is important for fairness. Ms. Lindell noted that MFTs have been licensed in this state since 1992 and pay fees to provide that service. MFTs are also one of the five core mental health groups identified by the National Institute of Mental Health. With regard to the concern of cost, Ms. Lindell informed the committee that the Division of Insurance reported that there is no evidence that costs would increase due to the increase in the pool of providers. In fact, the effect of competition may actually decrease the costs. Ms. Lindell explained that MFTs tend to be solution focused which results in achieving a job efficiently and quickly which could result in reduced costs to insurers. Ms. Lindell also noted that a survey in the American Psychologist reported that consumers refer to MFTs more often than other mental health professionals. Further there has been much information about family problems across the nation and in Alaska which has the highest rate of teen suicide and sexual abuse. MFTs are the groups that have expertise in that area and would like to practice that with reimbursement. CHAIRMAN WILKEN asked Ms. Burke to explain the term "unfair discrimination" to the committee. MARIANNE BURKE , Director of the Division of Insurance for DCED, explained that "unfair discrimination" does not include the purpose of utilization review for standards of clinical appropriate health care which Ms. Burke could support. With regard to cost containment, Ms. Burke was a bit concerned that it could be used to force an individual to seek the cheapest service available. Ms. Burke pointed out that the process of utilization review is a cost containment measure. Clinically appropriate health care services have elements of cost containment. Ms. Burke believed that the amendment helps clarify this section of Title 21. SENATOR LEMAN did not intend for "cost containment" to mean that the lowest cost provider must be utilized, but rather that the appropriate provider be utilized. Senator Leman pointed out that there may be appropriate measures to contain cost which would not be an unfair discrimination practice. CHAIRMAN WILKEN asked if Ms. Burke had heard from insurance companies in Alaska with regard to the amendment. MARIANNE BURKE had only heard from one writer of health insurance in the state who favored the amendment. SENATOR LEMAN moved to report CSSB 122(L&C) out of committee with individual recommendations and the accompanying zero fiscal note. Without objection, it was so ordered. SB 132 CRIMINAL JUSTICE INFO, INCL. SEX OFFENDER Number 581 CHAIRMAN WILKEN announced SB 132 as the final order of business before the committee. SENATOR WARD moved to report SB 132 out of committee with individual recommendations and accompanying fiscal notes. CHAIRMAN WILKEN asked if there was anyone to testify or any questions on SB 132. Hearing none, Chairman Wilken asked if there was any objection to the motion. Hearing no objection, SB 132 was reported out of committee. There being no further business before the committee, the meeting was adjourned at 9:55 a.m.