Legislature(2003 - 2004)

04/09/2003 01:31 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
          SENATE HEALTH, EDUCATION AND SOCIAL SERVICES                                                                        
                       STANDING COMMITTEE                                                                                     
                         April 9, 2003                                                                                          
                           1:31 p.m.                                                                                            
TAPE(S) 03-18, 19                                                                                                             
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Fred Dyson, Chair                                                                                                       
Senator Lyda Green, Vice Chair                                                                                                  
Senator Gary Wilken                                                                                                             
Senator Bettye Davis                                                                                                            
Senator Gretchen Guess                                                                                                          
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
SENATE BILL NO. 121                                                                                                             
"An  Act relating  to  community schools;  and  providing for  an                                                               
effective date."                                                                                                                
                                                                                                                                
     MOVED SB 121 OUT OF COMMITTEE                                                                                              
                                                                                                                                
SENATE BILL NO. 30                                                                                                              
"An  Act  relating  to  information  and  services  available  to                                                               
pregnant women  and other persons; and  ensuring informed consent                                                               
before an abortion  may be performed, except in  cases of medical                                                               
emergency."                                                                                                                     
                                                                                                                                
     HEARD AND HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 157                                                                                                             
"An Act  relating to inpatient  psychiatric services  for persons                                                               
who  are under  21  years  of age  and  are  either eligible  for                                                               
medical assistance  or are  in the custody  of the  Department of                                                               
Health and Social Services."                                                                                                    
                                                                                                                                
     MOVED CSSB 157(HES) OUT OF COMMITTEE                                                                                       
                                                                                                                                
SENATE BILL NO. 84                                                                                                              
"An  Act   relating  to  the  Alaska   teacher  recruitment  loan                                                               
repayment program; and providing for an effective date."                                                                        
                                                                                                                                
     MOVED CSSB 84(HES) OUT OF COMMITTEE                                                                                        
                                                                                                                                
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 154                                                                                      
"An Act relating to a student loan repayment program for nurses,                                                                
and amending the duties of the Board of Nursing that relate to                                                                  
this program; and providing for an effective date."                                                                             
                                                                                                                                
     MOVED SSSB 154 OUT OF COMMITTEE                                                                                            
                                                                                                                                
PREVIOUS ACTION                                                                                                               
                                                                                                                                
SB 121 - See HESS minutes dated 4/7/03.                                                                                         
                                                                                                                                
SB 30 - See HESS minutes dated 3/17/03, 3/26/03 and 4/3/03.                                                                     
                                                                                                                                
SB 157 - No previous action to record.                                                                                          
                                                                                                                                
SB 84 - No previous action to record.                                                                                           
                                                                                                                                
SB 154 - No previous action to record.                                                                                          
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                              
Mr. Curt Ledford, Director                                                                                                      
Community Schools                                                                                                               
Sitka AK                                                                                                                        
POSITION STATEMENT: Opposed SB 121.                                                                                           
                                                                                                                                
Ms. Janice DeLand                                                                                                               
Offnet - No address provided                                                                                                    
POSITION STATEMENT: Supported SB 30.                                                                                          
                                                                                                                                
Mr. Sid Heidersdorf                                                                                                             
PO Box 658                                                                                                                      
Juneau AK                                                                                                                       
POSITION STATEMENT: Supported SB 30.                                                                                          
                                                                                                                                
Ms. Karleen Jackson, Deputy Commissioner                                                                                        
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT: Supported SB 30.                                                                                          
                                                                                                                                
Ms. Linda Bowdre                                                                                                                
PO Box 1048                                                                                                                     
Delta Junction AK 99737                                                                                                         
POSITION STATEMENT: Supported SB 30.                                                                                          
                                                                                                                                
Ms. Kari Thomas                                                                                                                 
PO Box 165                                                                                                                      
Delta Junction AK 99737                                                                                                         
POSITION STATEMENT: Supported SB 30.                                                                                          
                                                                                                                                
Ms. Roseanne Curran                                                                                                             
PO Box 42                                                                                                                       
Cordova AK 99574                                                                                                                
POSITION STATEMENT: Supported SB 30.                                                                                          
                                                                                                                                
Ms. Karen Vosburgh                                                                                                              
PO Box 1847                                                                                                                     
Palmer AK 99645                                                                                                                 
POSITION STATEMENT: Supported SB 30.                                                                                          
                                                                                                                                
Dr. Coleen Murphy                                                                                                               
No address provided                                                                                                             
POSITION STATEMENT: Opposed SB 30.                                                                                            
                                                                                                                                
Ms. Thea Pitmann                                                                                                                
No address provided                                                                                                             
POSITION STATEMENT: Opposed SB 30.                                                                                            
                                                                                                                                
Ms. Dietrick Stitler                                                                                                            
No address provided                                                                                                             
POSITION STATEMENT:  Opposed SB 30.                                                                                           
                                                                                                                                
Ms. Robin Smith                                                                                                                 
No address provided                                                                                                             
POSITION STATEMENT: Opposed SB 30.                                                                                            
                                                                                                                                
Ms. Pauline Udder                                                                                                               
No address provided                                                                                                             
POSITION STATEMENT: Opposed SB 30.                                                                                            
                                                                                                                                
Mr. Bill Hogan, Director                                                                                                        
Division of Mental Health and Developmental Disabilities                                                                        
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT: Supported the concept of SB 157.                                                                          
                                                                                                                                
Mr. John Duffy, Manager                                                                                                         
Mat-Su Borough                                                                                                                  
350 E. Dahlia                                                                                                                   
Palmer AK 99645                                                                                                                 
POSITION STATEMENT: Supported SB 157.                                                                                         
                                                                                                                                
Ms. Catherine Rapoport, Regional Vice President                                                                                 
Universal Health Services                                                                                                       
POSITION STATEMENT: Supported SB 157.                                                                                         
                                                                                                                                
Ms. Terry Keklak                                                                                                                
No address provided                                                                                                             
POSITION STATEMENT: Supported SB 157.                                                                                         
                                                                                                                                
Mr. Richard Rainery, Executive Director                                                                                         
Alaska Mental Health Board                                                                                                      
550 W 7th Ave., Suite 1820                                                                                                      
Anchorage AK 99501                                                                                                              
POSITION STATEMENT: Supported SB 157.                                                                                         
                                                                                                                                
Ms. Diane Barrans, Executive Director                                                                                           
Postsecondary Education Commission                                                                                              
Department of Education &                                                                                                       
 Early Development                                                                                                              
        th                                                                                                                      
801 W 10 St.                                                                                                                    
Juneau, AK  99801-1894                                                                                                          
POSITION STATEMENT: Supported SB 84.                                                                                          
                                                                                                                                
Ms. Mary Francis, Executive Director                                                                                            
Alaska Association of School Administrators                                                                                     
326 4th, Suite 404                                                                                                              
Juneau AK 99801                                                                                                                 
POSITION STATEMENT: Supported SB 84.                                                                                          
                                                                                                                                
Mr. John Alcantra, Government Relations Director                                                                                
National Education Association                                                                                                  
POSITION STATEMENT: Supported SB 84.                                                                                          
                                                                                                                                
Mr. Rick Urion, Director                                                                                                        
Division of Occupational Licensing                                                                                              
Department of Community & Economic Development                                                                                  
PO Box 110800                                                                                                                   
Juneau, AK 99811-0800                                                                                                           
POSITION STATEMENT:  Supported SB 154.                                                                                        
                                                                                                                                
Ms. Camille Soleil                                                                                                              
Alaska Nurses Association                                                                                                       
2207 E. Tudor Rd. Ste. 34                                                                                                       
Anchorage AK 99507                                                                                                              
POSITION STATEMENT: Supported SB 154.                                                                                         
                                                                                                                                
Ms. Catherine Geissel                                                                                                           
Alaska Nurse Practitioner's Association                                                                                         
Anchorage AK                                                                                                                    
POSITION STATEMENT: Supported SB 154.                                                                                         
                                                                                                                                
Ms. Pat Senner, President                                                                                                       
Alaska Nurses Association                                                                                                       
2207 E. Tudor Rd. Ste. 34                                                                                                       
Anchorage AK 99507                                                                                                              
POSITION STATEMENT:  Supported SB 154.                                                                                        
                                                                                                                                
Ms. Deb Erickson, Deputy Director                                                                                               
Division of Public Health                                                                                                       
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT: Supported SB 154.                                                                                         
                                                                                                                                
Ms. Angel Rick                                                                                                                  
PO Box 71727                                                                                                                    
Fairbanks AK 99707                                                                                                              
POSITION STATEMENT: Supported SB 154.                                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
TAPE 03-18, SIDE A                                                                                                            
                                                                                                                                
                    SB 121-COMMUNITY SCHOOLS                                                                                
                                                                                                                                
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services Standing  Committee meeting  to order  at 1:31  p.m. All                                                               
members  were  present.  He  announced   SB  121  to  be  up  for                                                               
consideration.                                                                                                                  
                                                                                                                                
SENATOR  GRETCHEN  GUESS  reminded  the  committee  that  Senator                                                               
Wilken  wanted her  to  find  out about  fees  for the  Anchorage                                                               
community  schools   programs.  She  said  last   year  Anchorage                                                               
collected $65,000  in fees and spent  approximately $700,000. She                                                               
stated:                                                                                                                         
                                                                                                                                
     Although there were some questions  and we did get some                                                                    
     faxes, I  do think  that Eddy  Jeans' sheet  was wrong,                                                                    
     because  in   the  accounting  of   community  schools,                                                                    
       multiple things go into community schools. This is                                                                       
     just one of, I think, of five or six. So, the sheet we                                                                     
     got was incorrect on how much money is being spent.                                                                        
                                                                                                                                
SENATOR GARY  WILKEN moved to  report SB 121 from  committee with                                                               
individual recommendations and its attached fiscal note.                                                                        
                                                                                                                                
SENATOR GUESS objected.                                                                                                         
                                                                                                                                
MR.  CURT  LEDFORD,  Director,  Community  Schools,  Sitka,  said                                                               
although the state's portion of  Sitka's overall budget is small,                                                               
it's seen by the community as state support of the program.                                                                     
                                                                                                                                
CHAIR DYSON  said he  supports community  schools and  that using                                                               
unused  community  facilities  along  with  community  talent  to                                                               
provide a multitude of services is a wonderful deal. He noted:                                                                  
                                                                                                                                
     It's one of  the ones the governor  highlighted; I wish                                                                    
     it  wasn't so.  I  am  willing to  pass  it  on to  the                                                                    
     consideration of the Finance  Committee and this is not                                                                    
     the end of the track for this.                                                                                             
                                                                                                                                
CHAIR DYSON called for a roll call vote.                                                                                        
                                                                                                                                
SENATORS GREEN, WILKEN,  and DYSON voted yea;  SENATORS GUESS and                                                               
DAVIS voted nay; and SB 121 moved from committee.                                                                               
                                                                                                                                
         SB  30-ABORTION: INFORMED CONSENT; INFORMATION                                                                     
                                                                                                                              
CHAIR FRED DYSON  announced SB 30 to be up  for consideration and                                                               
called an at-ease  from 1:36 to 1:38 p.m. He  said the Department                                                               
of Health  and Social Services  (DHSS) and the Department  of Law                                                               
(DOL) provided  conceptual notes about  the amendments to  SB 30.                                                               
The first two notes concern  typos. DHSS suggested that it create                                                               
a website  to keep the  pamphlet information updated  with access                                                               
by agencies to  update their particular information  as it became                                                               
available. That approach decreases  the fiscal note from $120,000                                                               
to $10,000 and he had not heard a good argument against it.                                                                     
                                                                                                                                
The  DOL   suggested  offering   immunity  from   prosecution  to                                                               
providers who distribute the pamphlet  or a printout as incentive                                                               
for fulfilling  the requirements  for getting information  to the                                                               
patient/client.                                                                                                                 
                                                                                                                                
MS. JANICE DELAND supported SB  30. She related her experience 27                                                               
years ago  when a  doctor told  her she had  to have  an abortion                                                               
because she was miscarrying.                                                                                                    
                                                                                                                                
MR. SID HEIDERSDORF, Juneau resident,  said, "This is much needed                                                               
legislation   to  protect   women   from  unscrupulous   abortion                                                               
practices."                                                                                                                     
                                                                                                                                
He  thought that  abortion counseling  was a  sham and  that most                                                               
women are  not adequately informed.  Many states  already require                                                               
informed consent  of this  type. He also  added that  the 24-hour                                                               
waiting period is important because  a woman needs some breathing                                                               
room from the  intimidating atmosphere of a  clinic after getting                                                               
their information.                                                                                                              
                                                                                                                                
MS. KARLEEN  JACKSON, Deputy  Commissioner, Department  of Health                                                               
and  Social  Services,  supported  SB 30.  DHSS  is  particularly                                                               
excited about  making the information  available on  its website.                                                               
That would  not only allow  physicians to download and  print out                                                               
the information, but  it would allow women who have  access to an                                                               
Internet connection to get the  information as they try to figure                                                               
out what  to do regarding a  pregnancy. The fiscal note  would be                                                               
much lower if the information was on a website.                                                                                 
                                                                                                                                
MS. LINDA  BOWDRE, Delta Junction  resident, supported SB  30 and                                                               
commented that she  can't understand why the state has  to have a                                                               
bill  to  require  doctors  to explain  a  very  serious  medical                                                               
procedure to their patients.                                                                                                    
                                                                                                                                
MS. KARI  THOMAS, Delta  Junction resident,  supported SB  30 and                                                               
thought the website was a  great idea, except that providers need                                                               
to be held accountable to make  sure they give the information to                                                               
the patient.                                                                                                                    
                                                                                                                                
MS.  ROSEANNE  CURRAN, Cordova  resident,  supported  SB 30.  She                                                               
noted, "It  just makes sense  to have  as many facts  as possible                                                               
before any type  of surgery or medical  procedure, especially one                                                               
as life changing as an abortion."                                                                                               
                                                                                                                                
MS.  KAREN VOSBURGH,  Mat-Su resident,  supported  SB 30  saying,                                                               
"It's always  a good  idea to have  more information  rather than                                                               
none or less."                                                                                                                  
                                                                                                                                
DR.  COLEEN  MURPHY, OB-GYN,  said  she  has been  practicing  in                                                               
Alaska since  1987 and  is an active  abortion provider.  She has                                                               
undergone  credentialing  and  review by  the  National  Abortion                                                               
Federation to provide such services.  She is currently undergoing                                                               
her annual  board certification for  the American College  of OB-                                                               
GYN to  provide many high quality  services, including menopausal                                                               
care, gynecologic services,  contraceptive services, abortion and                                                               
others. She  noted that she  just paid  $10,000 on a  premium for                                                               
malpractice coverage to practice here.  She is accountable to the                                                               
American  Medical  Association's  code of  ethics  for  providing                                                               
appropriate informed  consent and  she is  held to  a preexisting                                                               
statute, AS  05.09.555, which discusses informed  consent for all                                                               
surgical  and  invasive  medical  procedures.  She  concluded  by                                                               
saying  this  bill  is  unnecessary   and  meddles  with  private                                                               
discussions between a  patient and a doctor. She  said this would                                                               
place obstructions to  health care, as many women  in Alaska have                                                               
to travel from remote places  to get abortion services; requiring                                                               
a 24-hour wait only raises the cost of the care.                                                                                
                                                                                                                                
CHAIR DYSON  appreciated her mentioning  that the  Legislature is                                                               
putting the language now in  the Alaska Administrative Code about                                                               
informed consent into statute.                                                                                                  
                                                                                                                                
DR. MURPHY  interrupted to say that  she had just done  a vaginal                                                               
hysterectomy  on  a  Jehovah's  Witness  who  didn't  want  blood                                                               
products.  She   suggested  if  the   Legislature  is   going  to                                                               
specifically  include  abortion in  statute,  it  should put  all                                                               
procedures, like that one, in as well.                                                                                          
                                                                                                                                
CHAIR  DYSON replied  the  difference is  that  the human  rights                                                               
issue makes  abortion different  from other  surgical procedures.                                                               
He said  he might  agree that  the 24-hour  waiting period  is an                                                               
unfortunate  choice  and  asked   whether  doctors  still  inject                                                               
laminaria and then wait for a couple of hours as a procedure.                                                                   
                                                                                                                                
DR.  MURPHY replied  that the  National Abortion  Federation does                                                               
not  recommend the  use of  cervical dilatation.   She  explained                                                               
that the moment  a foreign body is put in  the cervix, basically,                                                               
the  abortion starts.  The informed  consent for  people who  use                                                               
laminaria actually states that the  minute laminaria is used, the                                                               
abortion starts.                                                                                                                
                                                                                                                                
CHAIR DYSON  asked the  standard length of  time a  patient stays                                                               
for observation after the procedure.                                                                                            
                                                                                                                                
DR. MURPHY replied that the  majority of patients are immediately                                                               
observed for excessive  blood loss. She explained  that there are                                                               
two  different types  of abortions  now available  - medical  and                                                               
surgical.  The  medical  procedure   involves  giving  a  patient                                                               
medicine.  The patient  can then  safely  deliver at  home as  an                                                               
abortion.  That  procedure  is growing  in  usage.  The  surgical                                                               
procedure is done  in the office and the patient  is observed for                                                               
signs  of  blood  loss  for  approximately a  half  to  one  hour                                                               
afterwards.  She also  said that  more and  more non-obstetrician                                                               
gynecologists are getting trained in  the use of medical abortion                                                               
so they  can offer it,  if they haven't been  surgically trained.                                                               
She  pointed out,  "So, more  and more  women are  actually doing                                                               
this  at  home and  it's  going  to be  really  hard  for you  to                                                               
regulate that."                                                                                                                 
                                                                                                                                
CHAIR DYSON  said he appreciated  her information. He asked  if a                                                               
patient who flies in from rural  Alaska would be able to fly home                                                               
on the same day.                                                                                                                
                                                                                                                                
DR. MURPHY  replied if  it's a  surgical procedure,  patients can                                                               
generally fly  home the same day.  If they have to  wait 24-hours                                                               
and  are using  a laminaria  procedure, they  can return  home 48                                                               
hours later. She  noted that Medicaid pays for a  minority of the                                                               
abortions done in her office because  most women pay for them out                                                               
of pocket to avoid creating a paper trail.                                                                                      
                                                                                                                                
MS. THEA PITMANN, Anchorage resident,  opposed SB 30, but was not                                                               
opposed to  trying to  reduce the number  of abortions  that take                                                               
place.  She  said the  bad  thing  about  this  bill is  that  it                                                               
addresses  the  issue  after  a woman  is  pregnant,  instead  of                                                               
providing opportunities  to prevent  unwanted pregnancies  in the                                                               
first place. She urged the committee  to do more research on this                                                               
issue.                                                                                                                          
                                                                                                                                
MS.  DIETRICH STITLER,  Anchorage  resident, opposed  SB 30.  She                                                               
related how  she was diagnosed with  hemophilia at the age  of 14                                                               
and it  is medically dangerous  for her  to carry a  pregnancy to                                                               
term because  a loss of  blood during delivery  could potentially                                                               
be fatal. She didn't think the  government should have a place in                                                               
any  pregnancy  decision she  might  have  to make.  Her  biggest                                                               
concern is with their definition  of medical necessity. She might                                                               
not fall  under that section,  because having an abortion  at the                                                               
very moment  would probably not  be a  life saving measure  or an                                                               
emergency situation. Her  doctor would probably say  that a delay                                                               
in  abortion could  create  a serious  risk or  that  there is  a                                                               
significant chance  that a delay  may create a serious  risk. She                                                               
said this bill  would add costs for additional  office visits and                                                               
create  a  waiting  period  that   could  increase  the  risk  of                                                               
complication.                                                                                                                   
                                                                                                                                
MS. ROBIN SMITH  opposed SB 30. She  said it is far  more than an                                                               
informed  consent  bill.  The 24-hour  waiting  period  makes  it                                                               
totally  biased against  rural women  by increasing  the cost  of                                                               
whatever stay they have to make  in the city. Abortions cost more                                                               
than $500 and one of  the main reasons second trimester abortions                                                               
occur is that  women are trying to get funds  together to pay for                                                               
them.  She  pointed  out the  parental  consent  requirement  has                                                               
already been struck down by Alaska  courts (although it is now in                                                               
the  Supreme Court,  but  she  thought it  would  be struck  down                                                               
again).                                                                                                                         
                                                                                                                                
MS. SMITH also  pointed out that this bill  requires the facility                                                               
to be  state and federally  approved and  at this point  the only                                                               
facility  that fits  that description  is  Valley hospital.  Most                                                               
abortions are now conducted in a doctor's office.                                                                               
                                                                                                                                
MS. PAULINE UDDER opposed SB 30  saying they should not place any                                                               
more impediments in front of  women who, according to our Supreme                                                               
Court, still  have the right to  choose. She related how  her 43-                                                               
year old  friend will have to  fly to Seattle to  get an abortion                                                               
if it turns out that she is carrying a Downs-syndrome fetus.                                                                    
                                                                                                                                
TAPE 03-18, SIDE B                                                                                                            
                                                                                                                              
CHAIR DYSON thanked all participants  for their testimony and set                                                               
SB 30 aside.                                                                                                                    
                                                                                                                                
             SB 157-INPATIENT PSYCHIATRIC SERVICES                                                                          
                                                                                                                                
CHAIR FRED DYSON announced SB 157 to be up for consideration.                                                                   
                                                                                                                                
SENATOR LYDA  GREEN, sponsor, said  SB 157 addresses  instate and                                                               
out-of-state   psychiatric   facilities,  and   is   particularly                                                               
directed  toward the  children of  the  state who  are either  on                                                               
Medicaid or  in state  custody and must  leave Alaska  to receive                                                               
services.  This  bill  requires that  those  children  be  placed                                                               
instate for psychiatric  care as long as a suitable  place can be                                                               
found.                                                                                                                          
                                                                                                                                
SENATOR  GRETCHEN   GUESS  asked  if  the   terms  "appropriately                                                               
address"  and "unavailable"  are strong  enough words  to use  to                                                               
decide if the clinical diagnosis can be addressed in the state.                                                                 
                                                                                                                                
SENATOR GREEN  replied that she  thought they provide  a moveable                                                               
target for  each individual  that would  require a  very personal                                                               
evaluation.                                                                                                                     
                                                                                                                                
CHAIR DYSON  said he supports  this bill,  but it seems  that the                                                               
department would  never send someone  out of state if  an instate                                                               
facility was  available and that  the bill might  be superfluous.                                                               
He asked what the bill changes.                                                                                                 
                                                                                                                                
SENATOR  GREEN explained  that  currently  the department  cannot                                                               
disallow a person  from choosing the facility to which  he or she                                                               
wishes  to go,  particularly if  the person  is receiving  health                                                               
care  through the  Denali Kid  Care  program. A  little over  200                                                               
individuals  have  been  placed  in outside  facilities  with  no                                                               
review by  a state entity.  This bill would require  that instate                                                               
services  be exhausted  before they  are sent  outside. It  would                                                               
also encourage  groups to  either add on  to a  current facility,                                                               
like a  juvenile psychiatric facility,  or do some other  form of                                                               
instate upgrading.                                                                                                              
                                                                                                                                
MR.  BILL   HOGAN,  Director,  Division  of   Mental  Health  and                                                               
Developmental  Disabilities, DHSS,  supported the  concept of  SB                                                               
157, which  affirms the  current process  the department  uses to                                                               
ensure  that  instate options  are  explored  before a  child  is                                                               
placed out  of state.  They feel the  bill supports  and enhances                                                               
the  monitoring of  those children  once they  are placed  out of                                                               
state to  determine if they are  ready to come back  and, if they                                                               
are, that there  is an instate option available.  It supports the                                                               
department's view  that children should  be served in  Alaska, in                                                               
their  own  community and  as  close  as  possible to  their  own                                                               
family.                                                                                                                         
                                                                                                                                
CHAIR DYSON asked why these  instate services evolved in the past                                                               
and  whether this  piece  of legislation  removed  some of  those                                                               
impediments.                                                                                                                    
                                                                                                                                
MR.  HOGAN  replied  he understands  that  on  occasion,  instate                                                               
options  are available  and for  some reason  they are  not being                                                               
taken advantage of  at the time. Another issue is  whether or not                                                               
adequate funding is available to build instate capacity.                                                                        
                                                                                                                                
MR. JOHN  DUFFY, Manager,  Mat-Su Borough,  supported SB  157 for                                                               
all the  reasons stated. He  said the state is  presently sending                                                               
350  children out  of state.  SB 157  will save  the state  large                                                               
amounts of money as instate  treatment is much less expensive and                                                               
improves  the  chances of  success  in  allowing children  to  be                                                               
closer  to their  family support  networks. In  addition, SB  157                                                               
will  bring  jobs  back  to  Alaska  and  reduces  the  risk  for                                                               
additional  private sector  investment  in residential  treatment                                                               
centers  by assuring  that the  state will  consider use  of them                                                               
before sending children out of state.                                                                                           
                                                                                                                                
CHAIR DYSON asked  if he anticipates that a  state facility might                                                               
be started or enhanced in the Mat-Su Valley.                                                                                    
                                                                                                                                
MR.  DUFFY replied  that the  borough has  been approached  by at                                                               
least  two  firms  that  are   interested  in  constructing  such                                                               
facilities out there.                                                                                                           
                                                                                                                                
MS.  KATHY CRONIN  RAPOPORT, Regional  Vice President,  Universal                                                               
Health  Services,  supported  SB  157.   She  said  she  is  also                                                               
responsible  for the  Universal Health  Care facilities  in Utah.                                                               
She concurred  that there  are over  350 children  in residential                                                               
psychiatric  treatment   centers  in  the  Lower   48.  Northstar                                                               
Hospital  is  their inpatient  acute  care  hospital and  has  58                                                               
patients.  Four of  them are  pending discharge  in the  next few                                                               
days.  All four  are children  on Alaska  State Medicaid  who are                                                               
being  referred to  treatment centers  outside the  state on  the                                                               
recommendation  of their  caseworker  and  the outside  placement                                                               
committee. This  is happening while Northstar  has nine available                                                               
residential treatment beds. She continued:                                                                                      
                                                                                                                                
     Referring these  kids to treatment centers  outside the                                                                    
     state   has  devastating   long-term  impacts   on  the                                                                    
     children, their families, and  ultimately on our state.                                                                    
     Mental  health treatment  should be  provided close  to                                                                    
     home where we can  have good coordination for follow-up                                                                    
     care with  the residential  treatment provider  and the                                                                    
     outpatient  provider who  will  see  the patient  after                                                                    
     discharge. Most  importantly, treatment  should involve                                                                    
     the family.  Family treatment is a  critical element of                                                                    
     children's mental health  treatment. Their treatment in                                                                    
     the  local community  is good  for the  children, their                                                                    
     family, and  it increases  their chances  for long-term                                                                    
     success...                                                                                                                 
                                                                                                                                
MS.  RAPOPORT agreed  that bringing  children home  for treatment                                                               
will  encourage  providers  in   the  state  to  expand  existing                                                               
residential  facilities  and  services  and  will  encourage  new                                                               
providers to enter the market.                                                                                                  
                                                                                                                                
MS. TERRY KEKLAK said she would answer questions.                                                                               
                                                                                                                                
CHAIR DYSON asked  her how much out-of-state  placement costs per                                                               
day.                                                                                                                            
                                                                                                                                
MS. KEKLAK replied  that she didn't have any  specifics, but most                                                               
out-of-state rates  are in the $325  per day or lower  range. She                                                               
knew  of one  child who  had a  rate of  $600 per  day, based  on                                                               
additional medical needs.                                                                                                       
                                                                                                                                
SENATOR DAVIS  asked her  to comment on  why children  are placed                                                               
out-of-state.                                                                                                                   
                                                                                                                                
MS. KEKLAK replied that for a  service to be paid by the Medicaid                                                               
program,  an interdisciplinary  team  is required  to review  the                                                               
placement  and make  a recommendation  regarding what  is in  the                                                               
best interest of  the child. They look at  whether existing state                                                               
services  are  appropriate for  that  child.  With Medicaid,  the                                                               
child travels to the closest  available facility that is found to                                                               
meet their medical  needs. All inpatient stays  are authorized by                                                               
an outside contractor  who is looking at all  the criteria before                                                               
an out-of-state admission would be approved for payment.                                                                        
                                                                                                                                
SENATOR  DAVIS asked  if the  available instate  facility can  be                                                               
turned down in lieu of outside placement and still be covered.                                                                  
                                                                                                                                
MS. KEKLAK replied no.                                                                                                          
                                                                                                                                
SENATOR  GUESS asked  if  they  use the  same  process for  state                                                               
custody children.                                                                                                               
                                                                                                                                
MS.  KEKLAK   replied  that  those  children   have  a  placement                                                               
committee in addition to the Medicaid requirements.                                                                             
                                                                                                                                
MR.  RICHARD RAINERY,  Executive Director,  Alaska Mental  Health                                                               
Board, stated that  the amendment is in concert  with the Board's                                                               
philosophy that the community should  be involved with the mental                                                               
health system.                                                                                                                  
                                                                                                                                
SENATOR GREEN moved to adopt Amendment 1.                                                                                       
                                                                                                                                
                                                      23-LS0179\D.1                                                             
                                                        Lauterbach                                                              
                                                           12/1/04                                                              
                                                                                                                                
                                                                                                                                
                       A M E N D M E N T                                                                                    
                                                                                                                                
                                                                                                                                
OFFERED IN THE SENATE                          BY SENATOR GREEN                                                                 
     TO:  SB 157                                                                                                                
                                                                                                                                
Page 2, following line 12:                                                                                                      
     Insert a new subsection to read:                                                                                           
          "(c) When determining whether to authorize admission                                                                  
     of a person under 21 years  of age to a psychiatric hospital                                                               
     facility  or   residential  psychiatric   treatment  center,                                                               
     either located  within the state  or outside the  state, the                                                               
     department   shall   include   in  its   consideration   the                                                               
     recommendations of a   person selected by  the Alaska Mental                                                               
     Health  Board established  by AS 47.30.661  who is  selected                                                               
     for  this  duty   by  the  board  on  the   basis  of  being                                                               
     knowledgeable about  the availability  of beds in  the state                                                               
     for  inpatient psychiatric  services  for  persons under  21                                                               
     years of age.   The board may not select  an employee of the                                                               
     department for this duty."                                                                                                 
                                                                                                                                
Page 3, following line 10:                                                                                                      
     Insert a new subsection to read:                                                                                           
          "(m) When determining whether to authorize admission                                                                  
     of a person under 21 years  of age to a psychiatric hospital                                                               
     facility  or   residential  psychiatric   treatment  center,                                                               
     either located  within the state  or outside the  state, the                                                               
     department   shall   include   in  its   consideration   the                                                               
     recommendations of a   person selected by  the Alaska Mental                                                               
     Health  Board established  by AS 47.30.661  who is  selected                                                               
     for  this  duty   by  the  board  on  the   basis  of  being                                                               
     knowledgeable about  the availability  of beds in  the state                                                               
     for  inpatient psychiatric  services  for  persons under  21                                                               
     years of age.   The board may not select  an employee of the                                                               
     department for this duty."                                                                                                 
                                                                                                                                
                                                                                                                                
There were no objections and it was adopted.                                                                                    
                                                                                                                                
MR. RAINERY pointed out that one of the reasons the state                                                                       
doesn't have facilities like this is because sending kids out-                                                                  
of-state is a relatively recent phenomenon and, also, the number                                                                
of children being sent is no longer a question.                                                                                 
                                                                                                                                
SENATOR GUESS moved to pass CSSB 157(HES) from committee with                                                                   
individual recommendations and zero fiscal note. There were no                                                                  
objections and it was so ordered.                                                                                               
                                                                                                                                
             SB  84-TEACHER LOAN REPAYMENT PROGRAM                                                                          
                                                                                                                                
CHAIR FRED DYSON announced SB 84 to be up for consideration.                                                                    
                                                                                                                                
SENATOR GARY STEVENS, sponsor, said  the teacher shortage will be                                                               
even more of a problem with  passage of the federal No Child Left                                                               
Behind laws.  SB 84  will set up  the Alaska  teacher recruitment                                                               
loan  repayment  program,  which   is  designed  to  help  school                                                               
districts recruit  and retain teachers. It  includes repayment of                                                               
education loans  when the  teachers are  hired by  Alaskan public                                                               
elementary  or   secondary  schools.   It  limits   the  lifetime                                                               
financial  award  to  $10,000  for  an  individual  teacher.  The                                                               
funding would  come from  the dividend,  which would  normally be                                                               
returned  to the  state through  the Commission  on Postsecondary                                                               
Education. The intent is that  the program would operate when the                                                               
funds  are available  and if  no funding  is appropriated  by the                                                               
Legislature,  then no  money  would be  spent.  If an  individual                                                               
leaves  a teaching  position,  they would  not  receive the  loan                                                               
repayment that would be made at the end of the school year.                                                                     
                                                                                                                                
SENATOR  STEVENS explained  that the  proposed amendment  is from                                                               
the  Alaska Postsecondary  Commission and  clarifies some  of the                                                               
language  and expands  the scope  of funding  sources to  include                                                               
federal  funds and  other receipts.  He  said he  didn't know  of                                                               
anyone who was against this bill.                                                                                               
                                                                                                                                
SENATOR GRETCHEN  GUESS asked  if this program  could be  used by                                                               
professionals in  other shortage areas, like  speech pathologists                                                               
who don't have teaching certificates.                                                                                           
                                                                                                                                
SENATOR  STEVENS   replied  that  it's  meant   for  certificated                                                               
teachers in elementary or high school.                                                                                          
                                                                                                                                
SENATOR GUESS  asked if  they are  only going  to repay  loans in                                                               
areas of shortage or is this for all teachers.                                                                                  
                                                                                                                                
SENATOR STEVENS replied that the  specifics would be developed by                                                               
the Postsecondary  Commission. His  intent is  that it's  for any                                                               
position.                                                                                                                       
                                                                                                                                
SENATOR  GARY WILKEN  said  he had  some  reservations with  this                                                               
bill, as well  as SB 154. He understands the  financial burden of                                                               
going  to school,  but he  was  concerned that  this is  slippery                                                               
slope  legislation.  He  came  to the  Legislature  just  as  the                                                               
student  loan program  was  starting  to dig  itself  out of  the                                                               
problems of the 80s and 90s  when it was a give-away program. The                                                               
program is  now robust and has  brought money back to  the state.                                                               
They have brought back about $5  million for the fourth year in a                                                               
row.                                                                                                                            
                                                                                                                                
SENATOR  STEVENS shared  his concerns,  but said  this would  not                                                               
make  the fund  any less  healthy than  it is  now, but  it would                                                               
simply reduce  the dividend that  the state receives.  Every year                                                               
the Legislature would have to fund the program.                                                                                 
                                                                                                                                
MS.  DIANE  BARRANS,  Executive Director,  Alaska  Commission  on                                                               
Postsecondary Education, explained the  amendments and noted that                                                               
the sponsor was very proactive  on getting the commission's input                                                               
on this bill. One of the  amendments insures that the criteria is                                                               
efficient  to administer  and does  not require  costly activity.                                                               
The second amendment is on page  3, line 14, after "AS 14.42.295"                                                               
to insert  "or any federal  or other funds", the  objective being                                                               
to capture  any funding that is  available for a program  of this                                                               
kind. The others are technical changes.                                                                                         
                                                                                                                                
SENATOR  WILKEN  moved  to  adopt  Amendment  1.  There  were  no                                                               
objections and it was so ordered.                                                                                               
                                                                                                                                
MS. BARRANS  responded to Senator  Wilken's concerns  saying that                                                               
this bill, rather than requiring  additional funds to be expended                                                               
from  the Student  Loan Corporation  to pay  benefits under  this                                                               
program, it  would simply be  an earmarking in statute  that when                                                               
the  dividend is  calculated  and  goes back  to  the state,  the                                                               
Legislature would  use those funds  to endow the fund  from which                                                               
benefits are paid.                                                                                                              
                                                                                                                                
SENATOR  WILKEN said  that the  fiscal note  shows 807  new hires                                                               
would participate in the program each year.                                                                                     
                                                                                                                                
MS. BARRAN  responded that  was correct and  added that  a recent                                                               
study of openings each year  showed about 1,600 teacher vacancies                                                               
and about  half of  those are  estimated to  be new  teachers who                                                               
would  still have  educational debt.  They did  not build  in any                                                               
growth estimate and the details of  the payments would have to be                                                               
worked out in regulation.                                                                                                       
                                                                                                                                
     How I  would recommend  that it  be structured  is that                                                                    
     when someone agrees to participate  in this program, we                                                                    
     identify  what their  total debt  is at  that time.  We                                                                    
     actually set  aside the amount  of funds that  we would                                                                    
     need to pay to meet  its obligation to this participant                                                                    
     so  we  would  essentially   encumber  funds  on  their                                                                    
     behalf.  What I  don't want  to be  in the  position of                                                                    
     doing  is  telling  someone  there is  going  to  be  a                                                                    
     benefit  for   them  and  then   not  have   the  funds                                                                    
     available.  I   don't'  want  to   come  back   to  the                                                                    
     legislature...One of  the things  I see  the commission                                                                    
     being  charged with  is to  monitor the  amount in  the                                                                    
     fund and  to monitor  the amount that's  been obligated                                                                    
     to   current   participants   and   only   enroll   new                                                                    
     participants when funding is available.                                                                                    
                                                                                                                                
SENATOR WILKEN said that was where  his concern lay - if one year                                                               
they needed  all of the  $5 million  of the dividend,  they would                                                               
not  fund  that particular  year.  There  would  be a  clamor  to                                                               
continue the funding  over and above the $5 million.  He asked if                                                               
they were funding  at the $500,000 level, would  she prorate that                                                               
through the debt or through the number of participants.                                                                         
                                                                                                                                
MS. BARRANS replied that she  could see either scenario occurring                                                               
depending on  a number of  variables. The amount of  controls put                                                               
in  place  will  affect  whether  or  not  that  can  occur.  Her                                                               
objective would be for it not  to occur. Since the board is given                                                               
some latitude  to set  the criteria for  the program,  they might                                                               
define  critical shortage  areas and  target the  money to  those                                                               
areas.                                                                                                                          
                                                                                                                                
SENATOR  WILKEN asked  her if  she saw  any problems  with trying                                                               
this for five years.                                                                                                            
                                                                                                                                
MS. BARRANS answered  that was more of a  political question than                                                               
a financial question  and, if it was structured  correctly at the                                                               
outset, they would  not be in a financial hole  in terms of being                                                               
obligated to pay benefits.                                                                                                      
                                                                                                                                
SENATOR WILKEN complimented Ms. Barrans on running a great show.                                                                
                                                                                                                                
MS.  MARY  FRANCIS,  Executive Director,  Alaska  Association  of                                                               
School Administrators, supported SB 84.                                                                                         
                                                                                                                                
TAPE 03-19, SIDE A                                                                                                            
                                                                                                                              
MS. FRANCIS said that last year  only about 300 educators came in                                                               
to look for Alaskan jobs.                                                                                                       
                                                                                                                                
MR.  JOHN  ALCANTRA,   Government  Relations  Director,  National                                                               
Education  Association,  supported  SB  84 for  all  the  reasons                                                               
stated previously.                                                                                                              
                                                                                                                                
SENATOR  WILKEN  moved  to  report  SB  84  from  committee  with                                                               
individual recommendations  and attached fiscal note.  There were                                                               
no objections and it was so ordered.                                                                                            
                                                                                                                                
            SB 154-NURSE EDUC LOAN REPAYMENT PROGRAM                                                                        
                                                                                                                              
CHAIR FRED DYSON announced SB 154 to be up for consideration.                                                                   
                                                                                                                                
SENATOR HOLLIS  FRENCH, sponsor,  said that  a main  question for                                                               
him was  to whom to  make the  loans available. Just  making them                                                               
available to Alaskans wouldn't produce  enough nurses to fill the                                                               
gap.                                                                                                                            
                                                                                                                                
     We're thousands  and thousands  of nurses  behind where                                                                    
     we need to  be and so we realized as  we worked our way                                                                    
     through the problem and got  familiarized with it is we                                                                    
     had to not only make  it available to Alaskans going to                                                                    
     Alaskan nursing  schools, but make it  available to any                                                                    
     person who wanted to come here and become a nurse.                                                                         
                                                                                                                                
The next thing  he thought about was the length  of the repayment                                                               
period. Part of the reason they  came up with paying someone back                                                               
for five  years is by  letting them  work in the  Alaskan economy                                                               
for that  long, they would  come to know  and love the  state and                                                               
stay. The available funding is  capped at $10,000 because that is                                                               
about what it  would cost to go to an  Alaskan nursing school. To                                                               
the slippery  slope issue  he responded  that most  programs have                                                               
those problems and you just have to draw the line somewhere.                                                                    
                                                                                                                                
SENATOR GARY WILKEN said his comments  on the prior bill apply to                                                               
this one as well.                                                                                                               
                                                                                                                                
MR.  RICK  URION,  Director,  Occupational  Licensing,  said  the                                                               
administration hadn't taken a position  on this bill, "But, it is                                                               
an exceptionally good idea."                                                                                                    
                                                                                                                                
He said  the Board of Nursing  is a good  place for it to  be and                                                               
pointed out  that the cost  of the board  is born by  the nurses.                                                               
But,  the  cost of  this  program  is  probably outside  of  that                                                               
purview and  the legislature might  want to find funding  for the                                                               
program other than from the licensees, themselves.                                                                              
                                                                                                                                
MS.  CAMILLE   SOLEIL,  Alaska  Nursing  Association,   said  she                                                               
appreciated their support of this bill.                                                                                         
                                                                                                                                
MS. CATHERINE  GEISSEL, Alaska Nurse  Practitioner's Association,                                                               
supported  SB 154.  She  said  it is  in  the  best interests  of                                                               
Alaska's  public   safety  to  increase  the   number  of  nurses                                                               
positions  that   are  currently   being  filled   by  unlicensed                                                               
personnel who make mistakes.                                                                                                    
                                                                                                                                
MS. PAT  SENNER, President, Alaska Nurses  Association, supported                                                               
SB 154. She  showed them a graph indicating that  the average age                                                               
of a  nurse in this state  is 45 to  46, with 72 percent  of them                                                               
being over the age  of 40. The graph should not  be a bell curve.                                                               
Most hospital  nurses have to  retire in their 50s,  because they                                                               
can  no  longer  do  the  heavy work  required  of  them.  It  is                                                               
estimated  that in  the next  5 to  10 years,  50 percent  of the                                                               
nursing workforce will  leave. The School of  Nursing is doubling                                                               
their number of graduates by 2006.  Part of the funding for that,                                                               
$2.25 million,  came from the  private sector and the  other part                                                               
from the university.  This bill is encouraging  the individual to                                                               
consider a nursing career and to stay in it.                                                                                    
                                                                                                                                
MS.  DEB ERICKSON,  Deputy Director,  Division of  Public Health,                                                               
supported SB  154 for all of  the stated reasons. She  added that                                                               
Alaska's senior population  is expected to triple by  2025 and an                                                               
aging population has attendant increases  in chronic diseases and                                                               
other health problems, which will add  to the demand side of this                                                               
problem. The nursing shortage affects  quality of care, access to                                                               
health care and  cost of health care. "This  program will provide                                                               
a  financial incentive  for recruitment  and retention  of nurses                                                               
that will benefit all Alaskans."                                                                                                
                                                                                                                                
MS. ANGELA RICK, nursing student,  asked if money was coming from                                                               
the federal program.                                                                                                            
                                                                                                                                
SENATOR  FRENCH explained  that they  wrote the  bill so  that it                                                               
could  some day  receive money  from  that source,  but it's  not                                                               
anticipated they would get it at this point.                                                                                    
                                                                                                                                
MS. RICK said she supported this bill.                                                                                          
                                                                                                                                
SENATOR  WILKEN  moved  to  pass   SB  154  from  committee  with                                                               
individual recommendations  and attached fiscal note.  There were                                                               
no objections and it was so ordered.                                                                                            
                                                                                                                                
CHAIR DYSON adjourned the meeting at 3:23 p.m.                                                                                  

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