Legislature(2001 - 2002)

02/28/2001 01:39 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                     ALASKA STATE LEGISLATURE                                                                                   
       SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE                                                                   
                         February 28, 2001                                                                                      
                             1:39 p.m.                                                                                          
MEMBERS PRESENT                                                                                                               
Senator Lyda Green, Chair                                                                                                       
Senator Loren Leman, Vice Chair                                                                                                 
Senator Gary Wilken                                                                                                             
Senator Jerry Ward                                                                                                              
Senator Bettye Davis                                                                                                            
MEMBERS ABSENT                                                                                                                
All Members Present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 96                                                                                                              
"An Act relating  to the issuance  of certificates of participation                                                             
to finance demolition of  all or part of the existing facility known                                                            
as  the Alaska  Psychiatric  Institute  and  construction  of a  new                                                            
facility  to be known as  the Alaska Psychiatric  Institute;  giving                                                            
notice  of  and  approving  the entry  into,  and  the  issuance  of                                                            
certificates  of participation  in, a lease-purchase  agreement  for                                                            
demolition  of all or  part of the  existing facility  known  as the                                                            
Alaska Psychiatric  Institute and construction of  a new facility to                                                            
be known as the  Alaska Psychiatric Institute; and  providing for an                                                            
effective date."                                                                                                                
     HEARD AND HELD                                                                                                             
SENATE BILL NO. 112                                                                                                             
"An Act placing certain  employees of the Alaska Mental Health Trust                                                            
Authority in the  exempt service; establishing a minimum  salary for                                                            
the long term care ombudsman;  and providing for an effective date."                                                            
     MOVED SB 112 OUT OF COMMITTEE                                                                                              
PRESENTATION  BY THE DEPARTMENTS OF  HEALTH AND SOCIAL SERVICES  AND                                                            
ENVIRONMENTAL CONSERVATION ON FISH SAFETY MONITORING                                                                            
PREVIOUS SENATE COMMITTEE ACTION                                                                                              
SB 96 - No previous action.                                                                                                     
SB 112 - No previous action.                                                                                                    
WITNESS REGISTER                                                                                                              
Commissioner Karen Perdue                                                                                                       
Department of Health and Social Services                                                                                        
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Discussed Alaska fish safety monitoring.                                                                 
Dr. John Middaugh                                                                                                               
Chief, Epidemiology Section                                                                                                     
Department of Health and Social Services                                                                                        
PO Box 240249                                                                                                                   
Anchorage, AK  99524-0249                                                                                                       
POSITION STATEMENT:  Discussed Alaska fish safety monitoring..                                                                
Ms. Barbara Belknap                                                                                                             
Alaska Seafood Marketing Institute                                                                                              
311 N Franklin, Suite 200                                                                                                       
Juneau, AK  99801-1147                                                                                                          
POSITION STATEMENT:  Discussed Alaska fish safety monitoring.                                                                 
Ms. Janice Adair                                                                                                                
Division of Environmental Health                                                                                                
Department of Environmental Conservation                                                                                        
555 Cordova St.                                                                                                                 
Anchorage, AK  99501                                                                                                            
POSITION STATEMENT:  Discussed Alaska fish safety monitoring.                                                                 
Deputy Commissioner Russ Webb                                                                                                   
Department of Health and Social Services                                                                                        
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT: Testified in favor of SB 96.                                                                              
Mr. Randall Burns                                                                                                               
Director, Alaska Psychiatric Institute                                                                                          
Department of Health and Social Services                                                                                        
2900 Providence Ave.                                                                                                            
Anchorage, AK  99508-4677                                                                                                       
POSITION STATEMENT:  Presented SB 96.                                                                                         
Mr. Scot Wheat                                                                                                                  
PO Box 2553                                                                                                                     
Homer, AK  99603                                                                                                                
POSITION STATEMENT: Testified in favor of SB 96.                                                                              
Mr. Hans Neidig                                                                                                                 
Staff to Senator Green                                                                                                          
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT:  Presented SB 112.                                                                                        
ACTION NARRATIVE                                                                                                              
TAPE 01-16, SIDE A                                                                                                            
Number 001                                                                                                                      
CHAIRWOMAN LYDA  GREEN called the Senate Health, Education  & Social                                                          
Services  Committee  meeting  to order  at  1:39 p.m.  Present  were                                                            
Senators  Leman, Ward,  Davis  and Green.   Chairwoman  Green  asked                                                            
representatives  from the Department  of Health and Social  Services                                                            
(DHSS) and  the Department  of Environmental  Conservation  (DEC) to                                                            
give their presentation.                                                                                                        
                      FISH SAFETY MONITORING                                                                                
COMMISSIONER  KAREN  PERDUE,  DHSS,  stated  that  Chairwoman  Green                                                            
offered  DHSS briefing  time  to update  the committee  on a  health                                                            
issue  that has  arisen regarding  the  safety of  consuming  Alaska                                                            
fish.  She made the following comments.                                                                                         
A lot  of information  is  becoming available  in the  media and  in                                                            
scientific  discussions about persistent  organic pollutants,  known                                                            
as POPs.    POPs are  chemicals that  are  usually not  used in  the                                                            
United  States anymore,  such  as  DDT, chlordane  and  PCBs.   POPs                                                            
travel long  distances through transboundary  transmission,  for the                                                            
most  part by  airways,  and  settle out  in  cold climates.    POPs                                                            
persist in the Arctic environment  more easily than in other places.                                                            
POPs biomagnify  in the food chain so accumulation  in lipids and of                                                            
heavy metals  in the organs  in marine mammals  is of concern.   Low                                                            
levels of POPs can cause  adverse effects.  High accumulation levels                                                            
could   potentially    affect   reproductive,   immunological    and                                                            
neurological systems,  and cause developmental problems  and cancer.                                                            
COMMISSIONER  PERDUE said fish in  Alaska are extremely healthy  and                                                            
are an extremely  important part of people's diets.   Alaska seafood                                                            
has a  very high  nutritional  value so  the risk  of eating  Alaska                                                            
seafood  is totally  outweighed  by  the benefits.    DHSS has  been                                                            
involved in discussions  with the Arctic Council and other countries                                                            
and some  international  work has been  done on  a global treaty  to                                                            
eliminate or reduce POPs.                                                                                                       
COMMISSIONER PERDUE  informed the committee that several  months ago                                                            
the  U.S.   Food  and  Drug  Administration   (FDA)  and   the  U.S.                                                            
Environmental  Protection  Agency  (EPA)  issued an  advisory  about                                                            
consuming  fish, including  Alaska fish,  that alluded  to the  fact                                                            
that Alaska fish  had higher levels of mercury than  was safe.  DHSS                                                            
and DEC  are quite  concerned  that the  public will  get the  wrong                                                            
impression,  given all of the media  attention, that Alaska  fish is                                                            
unsafe  to  eat.    She  asked  Dr.  Middaugh  to  provide  specific                                                            
information about the FDA and EPA advisories.                                                                                   
DR.  JOHN MIDDAUGH,  Chief  of the  Section of  Epidemiology,  DHSS,                                                            
informed the committee  that both he and Ms. Adair of DEC were quite                                                            
surprised  to learn that  the FDA  and EPA issued  a national  press                                                            
release for  a joint advisory, the  FDA for commercial fish  and the                                                            
EPA for non-commercial  fish, in which they specifically  targeted a                                                            
message at pregnant women,  women of childbearing age who may become                                                            
pregnant, nursing  mothers and young children to not  eat any shark,                                                            
swordfish, king mackerel  or tilefish.  Those species of seafood are                                                            
known to  have very  high average  levels of methyl  mercury  in the                                                            
flesh.    The  message  also  warned  that   group  to  limit  their                                                            
consumption  of other  fish to 12  ounces per  week of cooked  fish.                                                            
The EPA, which  has jurisdiction over recreational,  subsistence and                                                            
sports fish, issued  a joint release saying that group  should limit                                                            
its consumption  caught by family and friends to one  meal per week.                                                            
He and Ms.  Adair then heard that  both agencies have planned,  over                                                            
the next year,  a massive national campaign to educate  the American                                                            
people about the dangers of exposure to methyl mercury.                                                                         
DR. MIDDAUGH  explained that  the FDA assumed  the average  level of                                                            
methyl mercury,  the heavy metal of  concern, in fish is  0.2 to 0.5                                                            
ppm.   When he and  Ms. Adair  challenged that  assumption,  the FDA                                                            
said  it held  months of  meetings with  focus groups  comprised  of                                                            
industry and stakeholders  but, in viewing the list of participants,                                                            
all were  from locations  east of  the Mississippi  River.   The FDA                                                            
forgot  about Alaska  when issuing  the advisory  and agreed  it had                                                            
made a  mistake.   He and  Ms. Adair  were able to  provide data  on                                                            
Alaska fish  and the FDA  agreed fish from  Alaska waters are  among                                                            
the most pristine  in the world.  Some of the FDA's  own data showed                                                            
that Alaska  salmon had levels of  methyl mercury from zero  to 0.06                                                            
ppm, about 10 times lower  than the average level of fish upon which                                                            
the advisory  was issued.  According  to DHSS's calculations,  using                                                            
the most conservative  method, a person could safely  eat 1.9 pounds                                                            
of Alaska salmon per week  for a lifetime using the EPA's standards.                                                            
Using the FDA's  and World Health Organization's (WHO's)  standards,                                                            
a person  could safely consume  9 pounds of  Alaska salmon  per week                                                            
for a lifetime.                                                                                                                 
As a  result, EPA has  agreed to  add to its  national advisory  the                                                            
following two sentences.                                                                                                        
     Some kinds of fish that  are known to have much lower than                                                                 
     average levels of methyl  mercury can be safely eaten more                                                                 
     frequently  and in larger amounts.  Contact your  federal,                                                                 
        state or local health or food safety authority for                                                                      
     specific consumption recommendations about fish caught or                                                                  
     sold in your local area.                                                                                                   
DR.  MIDDAUGH  discussed some  data  collected  by DHSS  that  shows                                                            
methyl  mercury  exposure  levels  in  humans  collected  from  hair                                                            
samples in four  countries.  In the United States  the average level                                                            
is  2.0 ppm.    The worst  mercury  poisoning  episode  occurred  in                                                            
Minimata,  Japan,  where  the levels  were  100  ppm.   Two  ongoing                                                            
studies  are  underway  in  the  Seychelles  and  Faroe  Islands  to                                                            
determine  a safe level  of exposure  to methyl  mercury related  to                                                            
potential  adverse  effects  on  the development   of the  brain  of                                                            
fetuses, who are born and  followed for seven years.  The mean level                                                            
in maternal  hair samples  in the Seychelles  is 6.8 ppm and  in the                                                            
Faroe Islands, 4.8 ppm.   In both locations, most children are doing                                                            
very  well  regarding   neuro-developmental  parameters,   but  some                                                            
abnormalities  have  been  found in  the  Faroe  Islands.   The  WHO                                                            
advisory maximum tolerable level is set at 6.0 ppm.                                                                             
DR. MIDDAUGH  provided  data  from five  studies done  from 1972  to                                                            
1991, on human hair mercury  concentrations in Alaska.  The 1990 and                                                            
1991 study  of Nome  women showed a  mean level  of 1.0 to 1.4  ppm.                                                            
That  is very  good news  because  all of  those women  were  eating                                                            
subsistence foods.                                                                                                              
DR.  MIDDAUGH discussed  statistics  from  several  studies: an  FDA                                                            
study in December  of 2000 on mercury  levels in commercial  seafood                                                            
species;  a study  done by the FDA on mercury concentrations  in the                                                            
top 10 types of  fish consumed by the U.S. population;  a study done                                                            
on mercury  in Alaska  by the University  of Alaska  in 2000;  and a                                                            
study done by  the DEC lab in 1999 on methyl mercury  levels in fish                                                            
tissue  from samples  taken around  Alaska.   All studies  concluded                                                            
that the levels  in Alaska salmon  are very low.  He noted  that the                                                            
DEC study determined  some areas of  concern, for example  levels in                                                            
cod from Cook  Inlet were of concern,  as were levels in  very large                                                            
halibut in Frederick Sound.                                                                                                     
DR. MIDDAUGH said  Alaska must have an the ability  to monitor these                                                            
levels on an ongoing  basis to fend off the EPA and  FDA and also to                                                            
answer concerns  of American  consumers with  confidence.   He asked                                                            
the committee  to consider  the request for  funds for both  DEC and                                                            
DHSS to  continue  monitoring so  that they  can provide  scientific                                                            
evidence to respond to national advisories.                                                                                     
Number 1095                                                                                                                     
SENATOR WARD said  he heard from a fisherman in Nikiski  that farmed                                                            
salmon from Chile  contains a lot of antibiotics.   He asked if that                                                            
is true.  He noted that  when he was in Palm Springs, California, he                                                            
learned  that no restaurant  sells  Alaska salmon,  even though  the                                                            
salmon on every  menu is marketed  as such. He also asked  if any of                                                            
the studies show what is in farmed salmon.                                                                                      
COMMISSIONER  PERDUE  deferred  to  Barbara Belknap  of  the  Alaska                                                            
Seafood Marketing Institute (ASMI).                                                                                             
Number 1197                                                                                                                     
MS. BARBARA BELKNAP, Director  of ASMI, explained that farmed salmon                                                            
contains  antibiotics, but  much less so than  the amount ten  years                                                            
ago.  Because of the density  in the pens, the potential for disease                                                            
in farmed salmon  is tremendous.  If one fish becomes  diseased, all                                                            
do.  Farmed  salmon are treated to  prevent diseases, in  particular                                                            
infectious  salmon anemia.   That  disease is present  in some  wild                                                            
salmon but, because  wild salmon are not in high densities,  it does                                                            
not cause any harm.                                                                                                             
SENATOR  WARD noted  the market  for organically  grown chicken  has                                                            
grown to 18 percent because  consumers have become aware of the feed                                                            
supplements used by large  commercial operations.  He asked if there                                                            
are any  requirements  in federal  or state laws  for disclosure  of                                                            
feed supplements used in farmed salmon.                                                                                         
MS. BELKNAP said there are none.                                                                                                
SENATOR WARD asked if farmed  salmon are measured for methyl mercury                                                            
MS. BELKNAP  said they are  not.  She noted  that she does  not know                                                            
that farmed salmon would  have a particular problem with mercury but                                                            
they do have antibiotics  in them. Farmed salmon are fed other fish.                                                            
The interesting  fact is that they  are the only predator  grown for                                                            
food.   Farmed  salmon  operators  were looking  at  feeding  farmed                                                            
salmon the same sort of  feed that is fed to cattle but with the mad                                                            
cow disease  scare, the  operators are still  feeding farmed  salmon                                                            
with pellets made  from other fish caught off of the  coast of South                                                            
SENATOR  WARD said he  spent an  entire day, when  in Palm  Springs,                                                            
trying to find a restaurant  that served Alaska salmon.  Four of the                                                            
restaurants billed  their meals as "the Alaskan plate"  but the fish                                                            
was not from Alaska.   At the time he was unaware  of the antibiotic                                                            
and mercury  problems in  fish but since,  he learned some  of those                                                            
fish are being  fed byproducts of the livestock industry.   He asked                                                            
if Alaska has to identify what is being fed to farmed salmon.                                                                   
MS. BELKNAP  said salmon  are farmed in Canada,  the United  States,                                                            
Chile, Norway,  Ireland and  Scotland.  It  is a huge business.   At                                                            
present, nothing  requires the labelling  of the ingredients  in the                                                            
salmon.   They are  labelled Atlantic  salmon, for  example,  in the                                                            
grocer's  case, but nothing  is available  to tell  you what  it was                                                            
fed.   Farmed salmon  has no natural  coloring  because it does  not                                                            
feed on  the types  of ocean feed  that give salmon  its color  so a                                                            
coloring agent is used.                                                                                                         
SENATOR  WARD commented  that  the federal  government  is about  to                                                            
caution the world  about eating fish that is caught  in the wild but                                                            
it is completely silent about what is fed to farmed salmon.                                                                     
MS. BELKNAP said  this is déjà vu because, first of  all, Alaska had                                                            
the  problem of  people believing  that  all salmon  are  endangered                                                            
because Pacific  Northwest salmon are endangered.   Now, the FDA and                                                            
EPA have made a blanket  announcement about fish.  ASMI is trying to                                                            
differentiate  Alaska's fish.   ASMI believes  that its partnership                                                             
with DHSS and  DEC is a great way  to bring the marketers  into this                                                            
equation  so that  Alaska can  bring its  knowledge  to the  foreign                                                            
market, where food safety  is a huge issue, and to work with DEC and                                                            
DHSS to market  Alaska fish as safe.   ASMI has just added  the word                                                            
"safe" to its  ads.  It also uses  the words "pristine environment,                                                             
pure, natural"  and it wants  to be able to  show the world  that is                                                            
SENATOR WARD said  his concern is in the labeling  as other foods in                                                            
grocery stores contain a label if they are grown organically.                                                                   
CHAIRWOMAN  GREEN asked that  Senator Ward  and Ms. Belknap  discuss                                                            
this problem and report  back to the committee.  She noted that when                                                            
Commissioner Perdue  brought this information to her  attention, the                                                            
Commissioner  was  very  troubled  by  what  Alaska  had  run  into.                                                            
Chairwoman  Green  said she  was extraordinarily  pleased  that  the                                                            
state agencies  took quick,  direct action  and got the language  in                                                            
the message softened.   Chairwoman Green said she believes the state                                                            
needs  to go further  and asked  if the  EPA and  FDA were asked  to                                                            
specifically mention Alaska fish.                                                                                               
MS. JANICE ADAIR, Director  of the Division of Environmental Health,                                                            
DEC, said  she and Dr.  Middaugh had that  discussion with  the FDA.                                                            
They talked not only about  specific states, but also about specific                                                            
species of  fish.  The FDA  was not inclined  to do that because  it                                                            
felt that  questions  would arise  about specific  information  from                                                            
CHAIRWOMAN  GREEN noted that  brings into  question the accuracy  of                                                            
their advisory.   She said  the committee  was trying to figure  out                                                            
what direction,  on a practical level,  it could take to  underscore                                                            
the work done  by the state agencies.   She expressed concern  about                                                            
the alarm the advisory  could cause and that people who saw it might                                                            
never eat fish again.  She offered to entertain any suggestions.                                                                
COMMISSIONER  PERDUE felt it was gratuitous  that they were  able to                                                            
get the wording  changed.  She said  they have been concerned  about                                                            
making a  very big issue  about this because  the more it is  talked                                                            
about,  if information  is inaccurate,  the  more it  gets into  the                                                            
psyche of people.  She  said she honestly believes that Alaska based                                                            
data needs to be collected on both humans and fish.                                                                             
CHAIRWOMAN  GREEN said this  issue should be  brought to the  Alaska                                                            
congressional  delegation.    She  noted  that Gavel  to  Gavel  was                                                            
invited  today because  she wanted  to  minimize the  alarm and  let                                                            
people know  that state agencies can  be contacted for information,                                                             
but Gavel to Gavel did not come.                                                                                                
Number 1754                                                                                                                     
SENATOR LEMAN  asked if different  fish processing methods,  such as                                                            
smoking fish, has any impact on contamination levels.                                                                           
CHAIRWOMAN  GREEN asked that a representative  from DEC get  back to                                                            
the  committee   with  that  information.   She  then  thanked   the                                                            
participants for their  presentation and announced that SB 96 was up                                                            
for consideration.                                                                                                              
          SB  96-C.O.P.S FOR API DEMOLITION/CONSTRUCTION                                                                    
DEPUTY  COMMISSIONER  RUSS  WEBB, DHSS,  introduced  Randall  Burns,                                                            
Director  of the Alaska  Psychiatric Institute  (API), and  informed                                                            
the committee  that SB 96 will make  a capital investment  needed to                                                            
replace an old facility  and provide an efficient place to perform a                                                            
core function of government far into the future.                                                                                
MR.  RANDALL  BURNS,  API,  said he  asked  the  committee  for  the                                                            
opportunity  to make the case for  passage of SB 96, the  Governor's                                                            
bill regarding  certificates  of participation  to  finance the  API                                                            
2000 project.   He is also here to represent the staff  and managers                                                            
of  the hospital  and,  most importantly,  the  API  patients.   The                                                            
existing API facility does  not meet current therapeutic environment                                                            
standards  for  patient  care,   which  impacts  the  care  that  is                                                            
provided.   From his perspective,  that is the most important  issue                                                            
behind SB 96.   However, from a practical  standpoint, the  facility                                                            
needs to be replaced.                                                                                                           
API has reached  the end of its useful life.  The  facility contains                                                            
sprayed-on  asbestos material, which  is falling off.  In  addition,                                                            
asbestos-based  adhesive  was used  on tile  in the  building.   The                                                            
fire-life-safety  and mechanical  support systems  are worn  out and                                                            
expensive to maintain.   The roof repair will cost  in excess of $.5                                                            
million.  The  sprinkler system piping is not seismically  braced so                                                            
that its fire  suppression equipment is vulnerable  if an earthquake                                                            
were to occur.                                                                                                                  
API was  not designed as  a psychiatric hospital.   In 1962,  it was                                                            
paid  for by the  federal  government as  a facility  that could  be                                                            
converted into a medical/surgical  hospital within 24 hours to treat                                                            
military  casualties in  case of war.   The lifespan  of most  major                                                            
facilities  is 40 years.  Because  it is a hospital, it is  open 365                                                            
days per year,  24 hours per day.   The state has recognized,  since                                                            
1988, that API needs to  be replaced.  A study was done to determine                                                            
whether it made sense to  renovate the existing facility; the answer                                                            
was no.                                                                                                                         
The decision to  replace API was first supported by  the legislature                                                            
in the early 1990s  when it appropriated $6.1 million  over a 3-year                                                            
period for design work.   After about five years, API went to bid on                                                            
a hospital  but came up short of funds  with which to build  because                                                            
the facility  had been  designed and  redesigned.   The only  reason                                                            
DHSS did  not go forward  at that time was  the lack of funds.  Once                                                            
those  bids  were  withdrawn,  DHSS  embarked   on  some  additional                                                            
planning  processes: building  a replacement  API; purchasing  a new                                                            
facility; or  partnering with Providence  Hospital to build  a joint                                                            
facility.  The plan to  partner with Providence Hospital relied upon                                                            
a land swap between  the University of Alaska and  the Alaska Mental                                                            
Health  Trust  Authority  (AMHTA).    That  was too  complex  to  be                                                            
accomplished  so  Providence  withdrew from  that  consideration  in                                                            
1998.   DHSS then looked  at purchasing a  replacement hospital  and                                                            
put out a response  for bids, which  Charter Hospital responded  to.                                                            
API spent two years trying  to purchase Charter Hospital, but strong                                                            
local opposition  to planning  and zoning  considerations made  that                                                            
option impossible.                                                                                                              
DHSS decided that it needs  to build the facility that it planned to                                                            
build sometime  ago.  The  AMHTA recently  announced it will  convey                                                            
the 80 acre  parcel on which API is  located to DHSS.  This  80 acre                                                            
parcel was granted to AMHTA in the land settlement in 1993.                                                                     
Number 2300                                                                                                                     
SENATOR WILKEN  asked where the University of Alaska  is in relation                                                            
to the 80 acre parcel.                                                                                                          
MR. BURNS said  it is across the street  to the north.  He  said the                                                            
parcel is already zoned  appropriately for a hospital.  API has been                                                            
located in  the area and other hospitals  grew up around  it, so API                                                            
would not  be moving  into a new  neighborhood.   API is a  teaching                                                            
hospital so  it will remain convenient  to the University  and other                                                            
hospitals.   API  is  a  specialty   hospital  so  being   close  to                                                            
medical/surgical  hospitals will allow  API patients to get  medical                                                            
care quickly, when necessary.   The University Community Council and                                                            
residents  are very  supportive of  the location  and the  Anchorage                                                            
Planning and  Zoning Commission recommended  that API remain  at its                                                            
present site.                                                                                                                   
MR. BURNS  said DHSS  cannot build  a replacement  hospital  without                                                            
additional  funding.  SB 96 will provide  the financing to  demolish                                                            
the old facility  and build a new  one.  DHSS would build  a 54 bed,                                                            
expandable  to 72 bed,  hospital, giving  the state the flexibility                                                             
necessary to serve the  inpatient psychiatric needs that are not met                                                            
by  local communities.    A portion  of the  old building  would  be                                                            
reused  as storage  space  and  a gym.   The  existing  facility  is                                                            
considered to  be a hazardous waste site; SB 96 will  cover the cost                                                            
of cleaning that parcel.                                                                                                        
SENATOR WILKEN  asked why it is considered  to be a hazardous  waste                                                            
MR. BURNS said it is because  of the asbestos only.  The asbestos is                                                            
friable  and has  fallen off  of all  of the  beams  and is  sitting                                                            
throughout  the structure.  SB 96  will approve $58,750,000  for the                                                            
construction.   DHSS  has $22.2 million,  made up  of $19.2  million                                                            
from the  original API 2000  project and $3  million from the  AMHTA                                                            
for demolition  work.  The remaining  $36.5 million would  be raised                                                            
through   certificates  of   participation   in  a  lease   purchase                                                            
TAPE 01-16, SIDE B                                                                                                              
MR. BURNS  said the  state's obligation  would be  $3.7 million  per                                                            
year for  15 years, after  which the state  would own the  building.                                                            
The  total  cost  of constructing   a new  building  will  be  $48.2                                                            
million, demolishment costs  will be $9.7 million, phasing will cost                                                            
$.5 million and financing  will cost $250,000. He discussed the cost                                                            
per bed comparison with three other hospitals in Alaska.                                                                        
SENATOR WARD asked how  the API per bed cost compares to the per bed                                                            
cost of Providence Hospital's new addition.                                                                                     
MR. BURNS  said he did not  know the answer  to that but DHSS  might                                                            
have that information.                                                                                                          
SENATOR  WARD asked  if anything  would  stop DHSS  from  requesting                                                            
proposals for design, build, and operation of this facility.                                                                    
MR.  BURNS  said he  believes  that  would  require  some  statutory                                                            
changes and would get back to Senator Ward with an answer.                                                                      
COMMISSIONER  PERDUE reminded  the committee  that  API is the  only                                                            
state psychiatric hospital  and she believes no state has privatized                                                            
its entire  state psychiatric  services.   DHSS has outsourced  some                                                            
work to private hospitals in Anchorage and Fairbanks.                                                                           
SENATOR WARD said  he appreciates that, however there  are companies                                                            
with the ability to operate  a facility with fewer than 60 beds.  He                                                            
pointed  out he  was  contacted  as Co-Chair  of  the Privatization                                                             
Commission by some of these companies.                                                                                          
Number 2171                                                                                                                     
MR. BURNS  said replacing  API is  one aspect  of an ongoing  three-                                                            
pronged effort between  DHSS, the AMHTA and the Mental Health Board.                                                            
The  second   prong  is   to  privatize   a  variety  of   treatment                                                            
alternatives  to  hospitalization  at  API.   Statutorily,  DHSS  is                                                            
mandated  to work on making  sure that patients  are treated  in the                                                            
least  restrictive environment  and  as close to  home as  possible.                                                            
DHSS provides  services locally,  instead  of through API,  whenever                                                            
possible.  The third prong  is quality of care.  API recently scored                                                            
98 out of 100 by the Joint Commission in December of last year.                                                                 
MR. BURNS explained  that in Anchorage,  API will be using  a single                                                            
point of  entry service,  the idea  being that  any law enforcement                                                             
official or family  member will know where to bring  a person who is                                                            
experiencing a  mental health crisis.  When the person  is admitted,                                                            
the staff will determine  what type of services to refer that person                                                            
for.  In   many  parts   of  the  state,   inpatient  services   are                                                            
nonexistent.  API is  the safety  net when  other  services are  not                                                            
available.  In  addition, API houses forensic patients  and patients                                                            
who are not guilty by reason  of insanity and it provides competency                                                            
evaluations to the courts.                                                                                                      
MR. BURNS  explained that  the new facility  will be constructed  to                                                            
hold  72  beds because  until  communities   have a  full  range  of                                                            
services  necessary, API will  not be able  to function at  54 beds.                                                            
The current  patient capacity fluctuates.   API must admit  patients                                                            
who need services, no matter  what other service providers will not.                                                            
Number 1955                                                                                                                     
SENATOR WILKEN asked why  they are not planning a facility with more                                                            
than 54 beds.                                                                                                                   
MR. BURNS said  in 1994, after three years of planning,  DHSS sought                                                            
funding  from the legislature  to plan  for a  114 bed, $65  million                                                            
facility.  DHSS  was appropriated $22.8 million and  told to build a                                                            
72 bed  facility.   Therefore,  DHSS has  been working  within  that                                                            
guideline and a 54 bed  facility is the long term goal of the mental                                                            
health system.  The goal  is to offer enough services in communities                                                            
so that API will be more of a tertiary care facility.                                                                           
SENATOR WILKEN  expressed concern  that if the legislature  approves                                                            
this plan, DHSS will be  back before the legislature, just about the                                                            
time API opens  its doors, asking for another building  unless there                                                            
is some way to restrain the growth.                                                                                             
MR. BURNS  said, regarding  the  single point  of entry,  Providence                                                            
Hospital   is  in  the   business  of  receiving   people   who  are                                                            
experiencing  a mental  health crisis  in Anchorage;  68 percent  of                                                            
patients are from  the Anchorage area.  They are referred  for other                                                            
services from  there so, on its face,  that will stop some  of those                                                            
people  from coming  to API.   An  important  part of  this plan  is                                                            
designated evaluation and  treatment, which will reduce API's intake                                                            
considerably.   He believes that over  time, the plan that  is being                                                            
implemented should result in a reduction in the bed need at API.                                                                
SENATOR WILKEN  asked if this plan was designed in  the early 1990s.                                                            
MR. BURNS said the plan was finalized in 1996.                                                                                  
SENATOR WILKEN  asked if  any redesign of  the plan was considered,                                                             
given fiscal constraints.                                                                                                       
MR. BURNS said  it was discussed but the issue is  the $19.2 million                                                            
in the  bank right  now.   DHSS has  worked hard  to maintain  those                                                            
funds and it would be costly to do another redesign.                                                                            
CHAIRWOMAN GREEN thought  DHSS has been constrained by the framework                                                            
placed on it by the legislature.                                                                                                
SENATOR WILKEN  repeated that it seems strange to  build a four-lane                                                            
highway that will be full when the ribbon is cut.                                                                               
MR. BURNS said that is why it will be expandable to 72 beds.                                                                    
SENATOR WILKEN noted that 72 beds will not be sufficient.                                                                       
MR. BURNS repeated  that DHSS hopes other programs  will be on line.                                                            
The crisis  treatment  capacity has  been expanded  in Anchorage  as                                                            
well as the  de-tox capacity.  The  hope is that more people  can be                                                            
kept out of the hospital by referring them to other services.                                                                   
SENATOR WARD  asked if a wing for  youth has been incorporated  into                                                            
the new design for API                                                                                                          
MR. BURNS  said currently  API has  12 beds, the  new facility  will                                                            
have nine.                                                                                                                      
Number 1723                                                                                                                     
SENATOR WARD  asked if the  Alaska Native  Hospital is charged  when                                                            
IHS-eligible patients stay at API.                                                                                              
MR. BURNS said  28 percent of API's residents are  Alaska Native and                                                            
the cost  of their  treatment is  primarily borne  by the state  and                                                            
with federal Medicaid funds.                                                                                                    
SENATOR WARD asked what that percentage is.                                                                                     
MR.  BURNS  explained  that  API  gets  a  form  of  Medicaid  named                                                            
Disproportionate  Share Hospital (DSH) because many  of its patients                                                            
are indigent.   Those  funds used  to comprise  46 percent of  API's                                                            
budget.  This is the first  year the federal government, in the 1997                                                            
Budget  Reconciliation  Act,  cut  DSH  funds  to  public  hospitals                                                            
beginning in  the federal fiscal year  01.  Over three years,  those                                                            
funds will have been cut by 66 percent.                                                                                         
Number 1648                                                                                                                     
SENATOR  LEMAN said  he would  like a  reconfirmation  that the  new                                                            
facility  is not too elaborate  for the state's  revised vision  for                                                            
institutional treatment.   He also asked whether all options for the                                                            
existing building have  been explored, such as University ownership.                                                            
MR. BURNS  said at one  point, the University  considered using  the                                                            
facility as a repository  for books and storage.  The engineers felt                                                            
the building  wouldn't bear  the weight so  the University  withdrew                                                            
its  consideration.   API  is  using  that facility  because  it  is                                                            
grandfathered  into it; he does not believe any other  public entity                                                            
could move into that facility  without a substantial clean up of the                                                            
SENATOR  LEMAN asked  if that  clean up  could cost  as much as  the                                                            
MR.  BURNS  said  that is  correct.  He  noted  that  regarding  the                                                            
appropriateness  of the  design to  the state's  vision, DHSS  spent                                                            
four  years discussing  the  appropriateness  of  the  design.   The                                                            
building will be a single  story, which is controversial, but it was                                                            
designed that  way for patient care  issues.  It is very  attractive                                                            
and will be very functional.                                                                                                    
SENATOR WILKEN expressed  concern that DHSS is taking an old effort,                                                            
and given some  fiscal constraints,  and saying that effort  will be                                                            
adequate for the  next 50 years.  He asked if it is  time to look at                                                            
alternatives and,  if more money is needed, come up  with a proposal                                                            
that will not  require a revision in five years.   He noted the next                                                            
committee of referral will  be the place to talk about the financial                                                            
aspect of this plan.                                                                                                            
COMMISSIONER  PERDUE said,  regarding  the question  of whether  the                                                            
facility is large  enough, the 1990 census at API  was 200 patients.                                                            
Psychotropic drugs  and other community services have  really driven                                                            
that number  down.  DHSS feels confident  that it can work  with the                                                            
bed capacity  in the new plan as long  as it remains flexible  up to                                                            
72.  Regarding  the design,  Commissioner  Perdue said the  facility                                                            
will be 98,000  square feet.  It has  been controversial  because it                                                            
takes up the entire  site.  If DHSS could get the  assurance that it                                                            
will have the  money to build, it  may be able to take an  objective                                                            
look at whether  it can be built cheaper  if redesigned.   DHSS does                                                            
not  want to  continue to  use the  seed money  it  has for  another                                                            
redesign.    DHSS could  look  at  partnering,  if the  building  is                                                            
designed as a multi-story facility.                                                                                             
Number 1366                                                                                                                     
SENATOR WARD said  that he sat in on some of the citizens  committee                                                            
meetings and pointed  out that one of the reasons  for designing the                                                            
building  with  a  single  story   is that   it  provides  the  best                                                            
therapeutic atmosphere for patients.                                                                                            
CHAIRWOMAN GREEN  announced the committee would take  teleconference                                                            
MR.SCOTT  WHEAT, informed the  committee that  he has served  on the                                                            
API  governing  body for  a  number  of years.    Over 10  years  of                                                            
following this  issue, the certificate of participation  idea is the                                                            
best he has  heard for funding.  Providing  a single point  of entry                                                            
will  allow  people  to get  the  proper  support  they need.    The                                                            
question of  moving the hospital has  caused a lot of anxiety  among                                                            
patients,  families and  staff.  He  noted the  quality of care  and                                                            
operations  of the  hospital are  very good.   The  use of a  single                                                            
story with a courtyard  will provide the most attractive environment                                                            
for patient care.                                                                                                               
DEPUTY COMMISSIONER  WEBB said this is a long standing  problem that                                                            
needs a solution.                                                                                                               
There  being  no  further  questions   or  testimony  on  the  bill,                                                            
CHAIRWOMAN GREEN announced  she would set the bill aside for now and                                                            
the committee would take up SB 112.                                                                                             
         SB 112-LONG-TERM CARE OMBUDSMAN;MENTAL HLTH AUTH                                                                   
MR. HANS NEIDIG, staff  to Senator Lyda Green, explained that SB 112                                                            
would place the  employees of the AMHTA in the exempt  service while                                                            
establishing  a minimum  salary for  the long  term care  ombudsman.                                                            
Currently, The executive  director position is partially exempt, the                                                            
financial  officer is  fully exempt,  and four  other employees  are                                                            
partially exempt.  SB 112  would make all partially exempt positions                                                            
fully exempt.  SB 112 was  introduced at the request of the AMHTA to                                                            
address concerns  about its  ability to run  efficiently as  a state                                                            
corporation.   In addition, this legislation  establishes  a minimum                                                            
salary  for the  long  term care  ombudsman  at a  range  21.   That                                                            
position is currently a range 20.                                                                                               
MR. JEFF  JESSE, Executive  Director of the  AMHTA, stated  the bill                                                            
contains two  parts.  The first part  pertains to the exempt  status                                                            
of the  current  AMHTA employees.   The  AMHTA outfit  is small;  it                                                            
needs to be able  to retain the employees who are  doing a good job.                                                            
On the other  hand, it cannot  afford to hold  on to people  who are                                                            
not able to meet  its level of fiduciary responsibility  so it needs                                                            
more flexibility  to manage.  He looked at other state  corporations                                                            
with  a similar  structure and  their employees  are  in the  exempt                                                            
service.  Regarding the  long term care ombudsman, the Governor, via                                                            
an   executive   order,    transferred   the   responsibility    for                                                            
administering  the office of the long term care ombudsman  to AMHTA.                                                            
The trustees  were willing  to take  on that  responsibility  on the                                                            
condition that  they could look at  how the office was functioning.                                                             
The ombudsman was paid  at a range 20, which is a lower to mid-level                                                            
manager  range, yet  this  person is  responsible  for wielding  the                                                            
power of subpoena  over confidential  records and to bring  lawsuits                                                            
if  necessary.    AMHTA wants  some  flexibility  to  look  for  the                                                            
qualifications   needed  to  make  that  office  successful   so  it                                                            
suggested  a minimum salary  of a  range 21.   Any additional  costs                                                            
will be absorbed by reorganizing AMHTA's existing budget.                                                                       
There being  no further questions  or testimony, SENATOR  WARD moved                                                            
SB 112  out of  committee with  individual recommendations  and  its                                                            
zero fiscal note.  There being no objection, the motion carried.                                                                
SENATOR WILKEN  asked Mr. Jesse to what extent he  has been involved                                                            
in the API facility.                                                                                                            
MR. JESSE said probably more than he could have ever imagined.                                                                  
CHAIRWOMAN GREEN informed  the committee that she will be looking at                                                            
all proposals  for exit exam legislation  over the weekend  and will                                                            
draft a bill to  work from.  She asked committee members  to let her                                                            
know of any ideas or new thoughts on the issue.                                                                                 
Number 636                                                                                                                      
SENATOR  LEMAN  said he  took  the  ideas in  the  memo he  sent  to                                                            
Chairwoman Green and had it drafted into a bill.                                                                                
SENATOR WILKEN noted that  the school organizations have visited the                                                            
Capitol and  are all over  the map on the  issue but all agree  that                                                            
Chairwoman Green has done a good job on this issue.                                                                             
SENATOR WARD  noted, for  the record, that  Lisa Caress has  been on                                                            
line to testify  on SB 112, if necessary, and that  her letter is in                                                            
committee  members' file.   He thanked her  for her efforts  on this                                                            
CHAIRWOMAN GREEN then adjourned the meeting at 3:05 p.m.                                                                        

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