Legislature(2003 - 2004)

05/16/2003 01:51 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                                                               
                          May 16, 2003                                                                                          
                           1:51 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Fred Dyson, Chair                                                                                                       
Senator Lyda Green, Vice Chair                                                                                                  
Senator Bettye Davis                                                                                                            
Senator Gretchen Guess                                                                                                          
MEMBERS ABSENT                                                                                                                
Senator Gary Wilken                                                                                                             
COMMITTEE CALENDAR                                                                                                            
HOUSE BILL NO. 270                                                                                                              
"An Act relating to the licensure of pharmacists; and providing                                                                 
for an effective date."                                                                                                         
     MOVED HB 270 OUT OF COMMITTEE                                                                                              
CS FOR HOUSE BILL NO. 18(JUD) am                                                                                                
"An Act relating to the liability of parents and legal guardians                                                                
of minors who destroy property."                                                                                                
     MOVED SCS CSHB 18(HES) OUT OF COMMITTEE                                                                                    
CS FOR HOUSE BILL NO. 25(JUD)                                                                                                   
"An  Act relating  to  health care  decisions,  including do  not                                                               
resuscitate   orders,  anatomical   gifts,   and  mental   health                                                               
treatment  decisions,  and  to powers  of  attorney  relating  to                                                               
health  care,  including  anatomical   gifts  and  mental  health                                                               
treatment decisions; and providing for an effective date."                                                                      
     HEARD AND HELD                                                                                                             
PREVIOUS ACTION                                                                                                               
HB 270 - No previous action to consider.                                                                                        
HB 18 - No previous action to consider.                                                                                         
HB 25 - No previous action to consider.                                                                                         
WITNESS REGISTER                                                                                                              
Representative Nancy Dahlstrom                                                                                                  
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT: Sponsor of HB 270.                                                                                        
Ms. Margaret Soden, President                                                                                                   
Board of Pharmacy                                                                                                               
PO Box 61328                                                                                                                    
Fairbanks AK 99706                                                                                                              
POSITION STATEMENT: Supported HB 270.                                                                                         
Ms. Linda Sylvester                                                                                                             
Staff to Representative Weyrauch                                                                                                
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT: Commented on HB 25 for the sponsor.                                                                       
Mr. Ron Cowan                                                                                                                   
Long Term Care Ombudsman                                                                                                        
POSITION STATEMENT: Supported HB 25.                                                                                          
Ms. Marie Darlin                                                                                                                
POSITION STATEMENT: Supported HB 25.                                                                                          
Ms. Sioux Plummer Douglas                                                                                                       
Juneau Hospice Foundation                                                                                                       
5050 Thane Road                                                                                                                 
Juneau AK 99801                                                                                                                 
POSITION STATEMENT: Supported HB 25.                                                                                          
Dr. Maria Wallington                                                                                                            
POSITION STATEMENT: Supported HB 25.                                                                                          
ACTION NARRATIVE                                                                                                              
TAPE 03-28, SIDE A                                                                                                            
                  HB 270-PHARMACIST LICENSING                                                                               
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services  Standing  Committee  meeting  to  order  at  1:51  p.m.                                                               
Present were  SENATORS DAVIS  AND GREEN.  The Chair  announced HB
270 to be up for consideration.                                                                                                 
REPRESENTATIVE  NANCY DAHLSTROM,  sponsor  of  HB 270,  explained                                                               
that currently the Board of Pharmacy  cannot deny a license to an                                                               
applicant  who may  have had  a questioned  background, a  felony                                                               
drug conviction  or a drug  abuse problem. The public  safety and                                                               
the  pharmacy profession  are both  compromised  because of  this                                                               
situation and  the right  to deny  a license  was unintentionally                                                               
left out of the statute when it was originally drafted.                                                                         
HB 270 gives  the authority to deny a license  to a new applicant                                                               
if  they find  that they  have committed  fraud, deceit,  falsely                                                               
advertised  or  been  convicted  of  a felony  as  listed  in  AS                                                               
08.80.261. Everyone involved agrees with  the changes and she has                                                               
support  letters  from  the  Board of  Pharmacy  and  the  Alaska                                                               
Pharmaceutical Association.                                                                                                     
CHAIR DYSON asked who initiated this issue.                                                                                     
REPRESENTATIVE DAHLSTROM replied the State Board of Pharmacy.                                                                   
CHAIR DYSON  asked if  there had been  any negative  testimony in                                                               
the other two hearings.                                                                                                         
REPRESENTATIVE DAHLSTROM  replied that there wasn't  any negative                                                               
testimony from anyone.                                                                                                          
SENATOR GUESS arrived at 1:54 p.m.                                                                                              
SENATOR DAVIS commented that this is a good bill.                                                                               
MS.  MARGARET   SODEN,  President,  Alaska  Board   of  Pharmacy,                                                               
strongly supported HB  270, because as the  law currently stands,                                                               
they  would   have  to  grant   a  license  to  someone   with  a                                                               
questionable  background,  who would  then  be  able to  practice                                                               
pharmacy.  Their license  would  have to  be sanctioned  somehow.                                                               
This is not good for the health and safety of Alaskans.                                                                         
CHAIR DYSON asked if this had  been a noticeable problem with any                                                               
practitioners in the state.                                                                                                     
MS.  SODEN replied  that  a  couple of  years  ago, an  applicant                                                               
sought licensure  and the board  wanted to deny the  license. The                                                               
applicant  had falsified  their  application, as  well, and  they                                                               
didn't grant  a licensed based  on that. They realized  then that                                                               
they needed this authority.                                                                                                     
CHAIR DYSON asked when the board meets next.                                                                                    
MS. SODEN replied that they meet on July 25 in Anchorage.                                                                       
CHAIR  DYSON  said he  looked  forward  to  working with  her  on                                                               
collaborative agreements.                                                                                                       
SENATOR  GREEN  moved   to  pass  HB  270   from  committee  with                                                               
individual recommendations.  There were no objections  and it was                                                               
so ordered.                                                                                                                     
          HB  18-PARENTAL LIABILITY FOR CHILD'S DAMAGE                                                                      
CHAIR  DYSON announced  HB  18 [CSHB  18(JUD) AM]  to  be up  for                                                               
consideration and  that it is  similar to SB  2. He asked  if the                                                               
Senate  committee  substitute,  version  \I, brings  HB  18  into                                                               
conformity with the  Senate bill except that it  doesn't have the                                                               
effective date.                                                                                                                 
MS. SUSAN  CUNNINGHAM, staff to Representative  Meyer, sponsor of                                                               
HB 18, said that is correct.                                                                                                    
SENATOR GREEN  moved to  adopt SCSHB  18(HES), version  \I. There                                                               
were no objections and it was so ordered.                                                                                       
MS. CUNNINGHAM  said the committee  substitute provides  that the                                                               
intent of  the legislation is  to promote responsibility  as well                                                               
as the  recovery of damages  and requires the involvement  of the                                                               
minor  who  caused the  damages  to  participate in  the  justice                                                               
process.  It raises  the  limit  on the  recovery  of damages  to                                                               
$25,000   and  provides   consistency  between   two  conflicting                                                               
statutes,  AS 13.26.070  (powers and  duties of  a guardian  of a                                                               
minor) and  AS 34.50.020 (liability  for destruction  of property                                                               
by minors).                                                                                                                     
She  explained  that  currently   under  AS  13.26.070,  a  legal                                                               
guardian  is not  liable to  third  persons. The  CS removes  the                                                               
legal  guardian from  all subsections  of AS  34.50.020. It  also                                                               
provides that the adoptive parents  of hard to place children are                                                               
not liable. The  reasoning is that the amount  an adoptive parent                                                               
could  be  liable  for  would  actually be  a  deterrent  in  the                                                               
adoption of children, which is  not the sponsor's intent. Lastly,                                                               
the   CS  involves   the  unemancipated   minor   in  the   court                                                               
proceedings, so if  damages are recovered under  the statute, the                                                               
court will  require the minor  to produce a report  that includes                                                               
the   financial  resources   he   may  have   available  to   pay                                                               
restitution,  what  restitution  has  already been  made  to  the                                                               
claimant and  what, if  anything, he has  learned from  the civil                                                               
justice process.                                                                                                                
CHAIR DYSON said  when SB 2 passed from this  committee there was                                                               
no limit to liability, but  the Judiciary Committee established a                                                               
$25,000 limit.                                                                                                                  
SENATOR  GUESS  asked  them  to  comment  on  holding  the  minor                                                               
accountable, aside  from the written  report. She wanted  to know                                                               
if  the  court, regardless  of  whether  the  minor has  a  legal                                                               
guardian, or  is hard  to adopt  or is  living with  his parents,                                                               
could  make   the  child  responsible   and  can  they   be  held                                                               
responsible after they turn 18 years of age.                                                                                    
MS. CUNNINGHAM replied that she did  not think the child could be                                                               
held responsible  when he turns 18  as the parent is  sued if the                                                               
child  is  a   minor.  As  for  holding   the  minor  financially                                                               
responsible,  under the  Juvenile  Justice restitution  statutes,                                                               
the court can order restitution to be paid by the minor.                                                                        
SENATOR GREEN  asked if the  restitution could extend  past their                                                               
gaining the age of majority.                                                                                                    
MS. CUNNINGHAM replied yes.                                                                                                     
CHAIR DYSON said this issue was  discussed a lot in the Judiciary                                                               
Committee where Senator French researched  it and found that this                                                               
was about as good as they could do, given existing law.                                                                         
SENATOR GUESS followed  up that in the  Juvenile Justice statute,                                                               
it doesn't  matter if it's a  legal guardian or parent.  It's the                                                               
same statute for all kids.                                                                                                      
SENATOR GREEN moved  to pass SCSHB 18(HES) out  of committee with                                                               
individual recommendations  and zero fiscal notes.  There were no                                                               
objections and it was so ordered.                                                                                               
2:07 - 2:10 p.m.                                                                                                                
             HB  25-HEALTH CARE SERVICES DIRECTIVES                                                                         
CHAIR DYSON announced CSHB 25(JUD) to be up for consideration.                                                                  
MS. LINDA SYLVESTER, Staff to  Representative Weyrauch, said that                                                               
this bill had previously passed  the House unanimously as HB 197.                                                               
It deals  with the  end of  life health  care directives  and was                                                               
inspired  by a  concept called  the five  wishes. The  issue this                                                               
bill  addresses is  that  the  process of  dying  in American  is                                                               
overly complicated.  For example,  identifying an  individual for                                                               
power  of attorney  is  in a  completely  different section  than                                                               
other end  of life issues  like decisions of  how you want  to be                                                               
treated, cremated, die at home,  etc. Organ donations are another                                                               
issue. This  bill follows  37 states  in taking  end of  life and                                                               
health  care  decision issues,  as  well  as mental  health  care                                                               
directives, and repealing them from  all of the statutes. It then                                                               
reimplements them  in one section  of the statute. HB  25 repeals                                                               
the  organ  donation  statute,  the   living  will,  the  do  not                                                               
resuscitate orders,  the power  of attorney  for health  care and                                                               
Alaska's mental health directives.                                                                                              
The new concepts in the  bill are entirely logical. She explained                                                               
that currently  in Alaska if  you are injured  and incapacitated,                                                               
you're unable to  make decisions yourself and you  presented to a                                                               
hospital, they  would turn to someone  who is with you  to act as                                                               
your  surrogate. But,  statutes  don't support  the hospitals  in                                                               
that  practice.  It's  further complicated  if  you're  an  older                                                               
person  and have  two adult  children.  The question  is who  has                                                               
precedence  and what  standard of  care you  will have  when they                                                               
make decisions for you.                                                                                                         
HB  25  sets  out  the  hierarchy  for  surrogates  who  are  not                                                               
nominated  by executing  a legal  form; they  have a  standing in                                                               
statute - like a  spouse, an adult child and on  down the line to                                                               
a  very  close friend.  The  surrogate  makes decisions  for  you                                                               
considering your values, intentions,  beliefs and expressions you                                                               
have  made about  how  you want  to be  treated.  There are  also                                                               
discussions about if there is  disagreement in the group covering                                                               
issues  like how  much pain  medication or  where someone  should                                                               
live after they are stabilized. HB  25 brings these issues to the                                                               
forefront so families  can discuss them in  advance and broadcast                                                               
them so there is no confusion.                                                                                                  
She said  that every interested  group has reviewed the  bill and                                                               
an  incredible amount  of work  has  gone into  making sure  that                                                               
nothing has been left out and  they are not seeking to make major                                                               
changes, but are  simply combining some sections  and inserting a                                                               
new section on surrogates.                                                                                                      
CHAIR  DYSON  said  with  today's  blended  families  and  serial                                                               
marriages he  could see where  certain family members  would have                                                               
vested interest  in who  is making these  decisions. He  asked if                                                               
hospitals and other caregivers have  been subject to lawsuits for                                                               
not having  done end of  life decisions the way  inheritors might                                                               
have wanted.                                                                                                                    
MS. SYLVESTER replied  that currently there is  always the option                                                               
of judicial relief if there is  a dispute. The primary concern is                                                               
if there  is a dispute over  someone, for instance, a  mother who                                                               
is  in a  vegetative state  and will  not recover,  they can  die                                                               
naturally  or   linger  "as  little   balls  of   pain."  Medical                                                               
facilities are in the state of helplessness.                                                                                    
CHAIR DYSON  said he understood that,  but his question was  if a                                                               
hospital had been sued after the fact.                                                                                          
MS. SYLVESTER asked  if he meant if someone has  made decision to                                                               
terminate life support and a family member disagreed with that.                                                                 
CHAIR  DYSON replied  it could  be one  person whose  inheritance                                                               
would change radically depending on  who dies first. He suspected                                                               
there  were  cases like  that  and  he  wanted  to know  if  this                                                               
legislation gave  the hospital some clear  guidelines and perhaps                                                               
some protection if they follow the procedure.                                                                                   
MS.  SYLVESTER responded  that there  is an  immunity section  on                                                               
page 9, line 30.                                                                                                                
MR.  RON COWEN,  Long Term  Care Ombudsman,  said they  have been                                                               
involved in  the evolution  of this  legislation and  support the                                                               
current language. It  is an important law and this  makes it more                                                               
understandable  to  both  consumers   and  providers.  In  recent                                                               
scoring  of our  state  in  the area  of  advance directives  and                                                               
health care decisions, we didn't do  very well and this is a good                                                               
step in the right direction.                                                                                                    
CHAIR  DYSON asked  what  happens if,  for  instance, an  elderly                                                               
tourist  off  a  boat  collapses  in  the  street  and  emergency                                                               
personnel transports  them. He  wanted to  know what  procedure a                                                               
hospital had to go through to  find out if there are any existing                                                               
end-of-life or care provisions for that person.                                                                                 
MR.  COWEN  replied if  someone  came  in completely  alone,  the                                                               
hospital  would  see if  there  was  any documentation  on  their                                                               
person that speaks to their  advanced directives, which is rarely                                                               
found.  If  someone  is  with  them, the  hospital  is  bound  to                                                               
determine  what authority,  if any,  that person  has, in  making                                                               
decisions on that  person's behalf, especially if  the patient is                                                               
unable to speak  for himself. Short of  that, hospitals typically                                                               
defer to  attending physicians  in terms  of their  estimation of                                                               
the  likelihood   or  potential  for  that   person  to  survive.                                                               
Sometimes  a person  is  put on  life  sustaining measures  until                                                               
advanced directives can be sought.                                                                                              
MS.  SHELLEY  OWENS,  Community   Health  and  Emergency  Medical                                                               
Services,   said  she   administers  the   Comfort  One   Do  Not                                                               
Resuscitate  Program for  the state.  The department  supports HB
25,  which consolidates  existing provisions  in law  and expands                                                               
the content of  the previous living will  provisions. The Comfort                                                               
One  program is  the pre  hospital  program that  provides for  a                                                               
terminally ill person to have a  do not resuscitate order that is                                                               
very  simple  and  easily  identified  by  pre  hospital  medical                                                               
personnel. She asked them to  think of the pre hospital providers                                                               
as they consider sections in this  bill. The Comfort One bill was                                                               
established in 1996  and their two goals are to  honor the wishes                                                               
of  a terminally  ill patient  not  to be  resuscitated when  his                                                               
heart or breathing  stops and to help develop a  system where the                                                               
patients' wishes  can be  clearly and  unambiguously communicated                                                               
to health care providers.                                                                                                       
MS.  OWENS  explained  when  a person's  heart  stops,  they  are                                                               
clinically dead and  the issue is do they  attempt to resuscitate                                                               
him. Regarding their  question about when a  tourist arrives, the                                                               
EMT  would  look  to  see  if there  is  an  I.D.  bracelet  with                                                               
instructions and make sure it matches the patient.                                                                              
CHAIR DYSON  asked if the  state was  well equipped to  deal with                                                               
organ donations.                                                                                                                
MS. OWENS  replied that  she couldn't  really answer  that. Under                                                               
current  law, a  person is  resuscitated until  their organs  are                                                               
harvested, if that's their primary wish.                                                                                        
MS. MARIE DARLIN, AARP, supported HB  25; it is one of the issues                                                               
they  have  been  involved  in  for many  years.  In  regards  to                                                               
reciprocity among  states, one of  the big problems  is educating                                                               
people who have all their information  to carry it with them when                                                               
they travel.  Another recommendation is  that the hospital  has a                                                               
copy of it.                                                                                                                     
MS. SIOUX  PLUMMER DOUGLAS,  Juneau Hospice  Foundation, formerly                                                               
the  Juneau  End   of  Life  Task  Force,   originally  got  this                                                               
legislation moving.  This legislation has passed  the House twice                                                               
and is a better bill than  before. It's intended to be useful and                                                               
helpful  and was  originally based  on  the concept  of the  five                                                               
wishes: 1. The kind of person  you want to make decisions for you                                                               
when you  can't, 2.  The kind  of medical  treatment you  want or                                                               
don't want,  3. How comfortable you  want to be, 4.  How you want                                                               
people to  treat you,  and 5.  What you want  your loved  ones to                                                               
She is  a passionate  supporter of end  of life  planning, having                                                               
lost six  of her closest family  members in four years.  There is                                                               
no  question  that  people  knowing what  your  wishes  are  will                                                               
improve your last  moments. She pointed out that it  isn't only a                                                               
senior issue, but an issue for Alaskans of all ages.                                                                            
CHAIR DYSON thanked her for her work.                                                                                           
DR. MARIA WALLINGTON said she has  been working with the group on                                                               
this bill  and it handles so  many problems that she  has to deal                                                               
with  daily  at  Providence  Hospital. She  asked  if  there  was                                                               
anything in particular that they wanted her to address.                                                                         
CHAIR DYSON said they are pretty well up to speed.                                                                              
DR.  WALLINGTON  encouraged  them  to  pass  the  legislation  so                                                               
patients and hospitals don't have to wait another year.                                                                         
SENATOR GUESS said  she is also passionate about  this issue, but                                                               
she thought  there might be  some inconsistencies  in definitions                                                               
like adult child and adult  brother or sister. She was interested                                                               
on  page 5,  line  25, and  addressing  domestic partners.  Often                                                               
people decide not  to go through the marriage  process again, but                                                               
have partners  for life  and those  aren't addressed.  She didn't                                                               
see any definitions  of an adult parent or adult  sibling and she                                                               
thought that needed to be clarified.                                                                                            
MS.  SYLVESTER  said  it  would  be fine  to  include  the  extra                                                               
definitions.  Although  the  basic  five  wishes  come  from  the                                                               
Uniform  Health Care  Decisions  Act, there  are variations.  The                                                               
main  consideration with  a spouse  is that  they would  have the                                                               
utmost priority and inheritance issues must be delineated.                                                                      
TAPE 03-28, SIDE B                                                                                                            
SENATOR  GUESS suggested  having  a work  session  on this  issue                                                               
during the interim to work on technical issues.                                                                                 
CHAIR DYSON said he would be delighted to do that.                                                                              
MS. SYLVESTER noted that they also  need to address women who are                                                               
pregnant  and  how  this  will impact  them,  because  there  are                                                               
circumstances where suddenly there is not one patient, but two.                                                                 
CHAIR DYSON thanked everyone for the work they had done and held                                                                
CSHB 25(JUD) in committee.                                                                                                      
CHAIR DYSON adjourned the meeting at 2:46 p.m.                                                                                  

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