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