Legislature(1997 - 1998)
04/07/1997 09:09 AM Senate HES
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* first hearing in first committee of referral
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SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE
April 7, 1997
9:09 a.m.
MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice Chairman
Senator Lyda Green
Senator Jerry Ward
Senator Johnny Ellis
MEMBERS ABSENT
All members present.
COMMITTEE CALENDAR
CONFIRMATIONS
Board of Clinical Social Work Examiners - Diane DiSanto
Board of Dispensing Opticians - Mary Seutter
Board of Education - Roy Nageak, Marilyn Webb
State Medical Board - Beverly Fletcher, Donald Hudson, Sarah Isto,
Suzanne Lombardi, Donald Olson
Board of Professional Teaching Practices Commission - Mary Lou
Madden, Thomas Matheson, Christine Miller
SENATE BILL NO. 96
"An Act regulating hospice care."
PREVIOUS SENATE COMMITTEE ACTION
SB 96 - See Senate Health, Education & Social Services Committee
minutes dated 2/24/97 and 3/21/97.
WITNESS REGISTER
Ritchie Sonner
Hospice & Home Care of Juneau
3200 Hospital Drive, #100
Juneau, Alaska
POSITION STATEMENT: Supported SB 96.
Charles Quarre, President
Central Peninsula Hospice
HC1 Box 3336
Sterling, Alaska 99672
POSITION STATEMENT: Expressed concerns with SB 96.
Barbara Rich
Hospice of the Tanana Valley
PO Box 80482
Fairbanks, Alaska 99708
POSITION STATEMENT: Indicated support for SB 96.
Joy Janssen
Petersburg Hospice
Petersburg, Alaska
POSITION STATEMENT: Discussed how this would apply to neighbor to
neighbor care.
Maxine Worhatch
Petersburg Hospice
Petersburg, Alaska
POSITION STATEMENT: Discussed the need for insurance for volunteer
hospices.
Erica Worhatch
Petersburg Hospice
Petersburg, Alaska
POSITION STATEMENT: Discussed liability for volunteer hospices.
Shelbert Larsen, Administrator
Health Facilities Licensing & Certification
Department of Health & Social Services
4730 Business Park Boulevard, Suite 18
Anchorage, Alaska 99503-7117
POSITION STATEMENT: Stated that SB 96 was a good bill.
ACTION NARRATIVE
TAPE 97-36, SIDE A
Number 001
CHAIRMAN WILKEN called the Senate Health, Education & Social
Services Committee (HES) to order at 9:09 a.m. and announced that
the committee would hear from appointees to the Board of Clinical
Social Work Examiners, the Board of Dispensing Opticians, the Board
of Education, the State Medical Board, and the Board of
Professional Teaching Practices Commission. Chairman Wilken
invited the State Board of Education appointees to begin.
MARILYN WEBB , State Board of Education appointee, informed the
committee that she currently resides in Juneau. Ms. Webb has two
children who graduated from the Anchorage School District. Ms.
Webb and her husband arrived in Alaska many years ago to work in a
BIA school in Savoonga where Ms. Webb coordinated the bilingual
program and worked with the kindergarten, first and second grade
programs. Ms. Webb, a certified teacher, noted that she currently
works in the Head Start program in Alaska. Ms. Webb felt that it
is a privilege to work on the State Board of Education.
SENATOR GREEN noted that in Alaska, Head Start goes through a
department other than the Department of Education. Is Head Start
located in the Department of Education in other states? MARILYN
WEBB said that it depended on the state. Head Start is a federal
program and the funding goes directly to the grantee.
Number 102
SENATOR GREEN asked Ms. Webb if she had an opinion on child
care/daycare grants. There is more than one type of assistance;
one type of assistance goes to the licensed care provider and the
other goes to the user. Therefore an individual could choose
his/her own provider. Senator Green noted the debate revolving
around whether the assistance should only be used for licensed
providers. MARILYN WEBB said that quality of care is of concern.
There is much research about the importance of what occurs with
home care. Ms. Webb expressed the need to ensure that funding
supports quality care for children whether in licensed or exempt
homes.
SENATOR LEMAN inquired as to Ms. Webb's possible role in
encouraging local school districts to cooperate with home school
and private school students who want to participate in school
district activities. Senator Leman acknowledged that some school
districts have been cooperative in this area and others have not.
MARILYN WEBB noted that she had just had a presentation from
Representative Dyson and the board voted to unanimously support his
bill. SENATOR LEMAN noted that the Anchorage School District has
been reluctant in this matter.
CHAIRMAN WILKEN noted that Ms. Fletcher had a time constraint and
her testimony would be taken next.
Number 180
BEVERLY FLETCHER , appointee to the State Medical Board, pointed out
that most of her work in Alaska has been in the arena of domestic
violence and sexual assault. She began in that field in Dillingham
in 1982. Ms. Fletcher has been in Juneau since early 1991 to the
present and has been working for the Coast Guard as Family Programs
Administrator. As a Family Programs Administrator, Ms. Fletcher
primarily works in the domestic violence and sexual assault field
as well as the Special Needs Program. Ms. Fletcher felt that her
experience afforded her the understanding of rural health care
issues as well as issues effecting urban Alaska.
ROY NAGEAK , appointee to the State Board of Education, informed the
committee that he had four children in the North Slope Borough
School District. Mr. Nageak began in the school district when the
state took over the BIA schools. When Mr. Nageak began with the
school district the Iowa Test of Basic Skills (ITBS) scores were in
the lower end of the national curve, below 10 percent. In the last
10 years, those scores in the North Slope have moved into the 40
and 50 percentiles which Mr. Nageak attributed to the involvement
in hiring the teachers and the increased parental involvement. The
North Slope has a belief that all children can learn. Mr. Nageak
noted his involvement with the Alaska Association of School Boards
which has provided him with a good state perspective.
Mr. Nageak informed the committee that he was a whaling captain.
He learned a value lesson from his father and uncle who were strict
with him due to the dangers involved. Mr. Nageak emphasized the
need to do the same with today's children; children need to realize
that what they learn or do not learn early on effects them later.
Number 260
SENATOR LEMAN noted that Mr. Nageak had attended a boarding school.
There have been results from schools, such as Mt. Edgecombe, that
are better than results in rural school districts. What can be
taken from the boarding school experience that could be applied to
other schools to better the results? ROY NAGEAK recalled his
parents commitment to education; his parents sent him to boarding
school about the time, age 14 or so, when the return from
subsistence education would surface. Many people in leadership
positions today attended boarding schools. No matter where
students attend school, parental involvement is very important.
Mr. Nageak said that a learning curve of the transition from a BIA
operated system to a locally operated system is occurring, but that
has not yet occurred in some of the more isolated areas. Mr.
Nageak believed that educational scores would be higher once the
problem areas in Alaska are identified and a training process
begins. With regards to boarding schools, Mr. Nageak pointed out
that he missed the support of his parents during his time in an
Oregon boarding school.
SENATOR LEMAN clarified that he was not suggesting that all
children attend boarding schools rather what successes from
boarding schools can be utilized in local schools in order to
improve performance. ROY NAGEAK said that it was a matter of
communication, sharing successes between school districts.
SENATOR GREEN inquired as to Mr. Nageak's opinion on charter
schools. ROY NAGEAK informed the committee that the North Slope
Borough School District just reviewed a charter school proposal.
There were many unanswered questions during the application
process. Mr Nageak emphasized the need for a process to review
charter school proposals. SENATOR GREEN was not sure that statute
clearly specifies the role of the local school district versus that
of the State Board of Education. Senator Green asked if anything
was necessary at the state level to ensure that the review
processes were not duplicated. ROY NAGEAK noted that it takes time
to determine the responsibilities of a new law. If local school
districts have an intensive process for a charter school, the state
board should reflect that process.
Number 319
DIANE DISANTO , appointee for the Board of Clinical Social Work
Examiners, informed the committee that she was a licensed clinical
social worker professionally trained in the bachelor and masters
level of social work. Ms. DiSanto was the statewide Social Worker
of the Year. Ms. DiSanto has worked in the direct practice and
with advocacy in the management of social work. Ms. DiSanto is an
Anchorage resident.
SENATOR LEMAN commented that Ms. DiSanto had given him a tour of
the South Central Foundation which is quite impressive. Senator
Leman thanked Ms. DiSanto for those services and, in many cases,
for less money than under traditional models.
DIANE DISANTO noted that an addendum had been sent which specified
that she had left the South Central Foundation last January.
MARY CATHY SEUTTER , appointee for the Board of Dispensing
Opticians, informed the committee that she was licensed as an
optician in Virginia in 1978. Ms. Seutter moved to Alaska in 1983
and received her license in Alaska. She reviewed her employment
history since moving to Alaska. Ms. Seutter believed in continuing
education for all professionals and informed the committee of her
efforts in that vein.
CHAIRMAN WILKEN then moved to the Professional Teaching Practices
Commission appointees.
Number 428
CHRISTINE MILLER , appointee to the Professional Teaching Practices
Commission, informed the committee that she was born, raised and
graduated from high school in Fairbanks. Ms. Miller has a
Bachelors degree from Western Washington State College in Speech
Pathology & Audiology and a Masters degree in Speech Pathology from
the University of Washington. She also holds a Type A certificate
in Alaska with a K-12 special education, speech and hearing
endorsement. Ms. Miller specified that she had taught 18 years in
the Fairbanks schools, eight years as a classroom teacher and 10 as
support to the class in the area of speech and language. Ms.
Miller believed that Alaska has a highly educated and dedicated
teaching staff and in order to maintain that level, as
professionals, teachers should police themselves. In response to
Chairman Wilken, Ms. Miller said she had taught at North Pole
Elementary for 12 years and Ticasuk Brown Elementary for six years.
SUZANNE LOMBARDI , appointee to the State Medical Board, noted that
she was the current chair of the State Medical Board. Ms. Lombardi
informed the committee that she was instrumental in forming the
shelter in the Mat-Su Valley. At that time, Ms. Lombardi worked
with the legislative delegation in order to obtain funding for the
shelter. Ms. Lombardi then went to Law School and upon her return
to Alaska Ms. Lombardi was a clerk for the Honorable James K.
Singleton, Jr. Then Ms. Lombardi was appointed by Governor Hickel
to the Prosecutor's Office. Currently, Ms. Lombardi is in private
practice with Faulkner, Banfield.
Last session a sexual misconduct statute was passed which left the
promulgation of regulations regarding the definition of sexual
misconduct to the State Medical Board. The board accomplished that
and hoped that by the next meeting the Department of Law would have
passed those regulations. The board has also passed regulations
regarding record keeping and prescriptions.
SENATOR LEMAN said that the Legislature is poised to pass SB 24
which creates a judicial by-pass for a minor seeking an abortion,
enabling the parental consent provision to be enforced. Senator
Leman asked if Ms. Lombardi would, as a member of the State Medical
Board, enforce that law. SUZANNE LOMBARDI stated that the board is
obligated to enforce any statute passed by the Legislature.
SENATOR LEMAN noted the unfortunate dismissal of some qualified
people from the State Medical Board. Senator Leman asked if the
board was in a position so as not to suffer such a blow again?
Senator Leman said that he would take this matter up in a later
conversation. Senator Leman understood that the previous board did
not have all the information on James McGuire which lead to the
dismissal of the previous board. That action indicated that the
Governor was held responsible for information that the board did
not have. Senator Leman wanted to ensure that the board was not
placed in that position again, that there is a provision in place
to obtain such information.
SUZANNE LOMBARDI did not believe it unusual for a governor to
change boards. Ms. Lombardi did not know the reasons why the
former board is not in tact. Ms. Lombardi believed that the
Legislature would be proud of the work of those on this board.
SENATOR GREEN indicated that she needed to converse with Ms.
Lombardi about a complaint the Senator had received regarding a
matter before the board. Senator Green expressed concern with the
style of the board. SUZANNE LOMBARDI noted that she had been in
frequent contact with Senator Green's staff and would be happy to
discuss any matter with Senator Green.
Number 522
DON HUDSON , appointee to the State Medical Board, informed the
committee that he was board certified in Emergency Medicine and
specialized in Emergency Medicine and Aerospace Medicine. Dr.
Hudson noted that he had been involved with mid-level
practitioners, using them in a variety of remote situations. Dr.
Hudson had been involved in the training and sponsoring of
paramedics. Dr. Hudson said that his expertise lies in rural
Alaska. In response to Chairman Wilken, Dr. Hudson specified that
he was discharged from the U.S. Airforce in 1981 as Major. In
response to Senator Green, Dr. Hudson said that part of his love
was the safety of snowmobilers. Dr. Hudson has encouraged marked
and safe trails around Alaska in order to encourage tourism.
SENATOR LEMAN noted that Dr. Hudson was the Director of the
Iliuliak Family Clinic in Unalaska which the Legislature worked on
several years ago. DON HUDSON said that the clinic has had its ups
and downs, but almost always consistently on a positive note. Dr.
Hudson discussed the interaction with the fishing industry. The
Iliuliak Family Clinic is a great rural clinic with 60 weeks of
physician coverage and tremendous community involvement.
DON OLSON , appointee to the State Medical Board, commented that
influence of his high school teachers in Unalakleet lead him to
medical school. Dr. Olson discussed his college education. Since
1984, Dr. Olson has been practicing medicine in Nome and focusing
on rural Alaska. Dr. Olson went to law school in the early 1990s.
CHAIRMAN WILKEN pointed out that Dr. Olson and Dr. Hudson were both
pilots. Chairman Wilken informed the committee that Dr. Sarah Isto
is not present today, she is on a long planned family vacation.
TAPE 97-36, SIDE B
MARY LOUISE MADDEN , appointee to the Professional Teaching
Practices Commission, informed the committee that she was
completing her first year on the PTPC. Ms. Madden has been in
Alaska since 1971 and has been involved in education most of that
time at various levels. Currently, Ms. Madden is an adjunct
teacher at the University of Alaska. Ms. Madden believed that PTPC
was a valuable commission and she was pleased to serve.
Number 588
SENATOR LEMAN noted that in 1990 a bill dealing with the sexual
misconduct of teachers passed; has that bill been effective? MARY
LOUISE MADDEN said that such incidents were rare, but not nil which
is preferred. Such incidents are vigorously pursued as the
profession has better information. Now perpetrators cannot come to
Alaska and receive certification without Alaska knowing his/her
background. In further response to Senator Leman, Ms. Madden said
that there are ways to identify inappropriate behavior and everyone
is becoming more aware of those indicators.
SENATOR GREEN commented on the problems surrounding a student that
turns 18 before graduation. Senator Green also noted the loophole
for persons hired through consultants who do not adhere to the same
level of scrutiny as persons hired through the regular personnel
process. Senator Green requested that Ms. Madden notify her of any
way she may attack that problem.
In response to Chairman Wilken, MARY LOUISE MADDEN said that she
was a Juneau resident and was teaching her class at the University
which is why she could not be present at the hearing.
LOU MATHESON , appointee to the Professional Teaching Practices
Commission, informed the committee that he had been in Alaska for
18 years as an administrator in rural Alaska. Currently, Mr.
Matheson represents the Secondary School Principals Association on
the PTPC. Mr. Matheson said that he was appointed by Governor
Hickel and served a three year term which expired June 6, 1996.
Upon that expiration, the Secondary School Principals Association
nominated Mr. Matheson for another term, 1996-1997 school year.
Mr. Matheson endorsed the previous comments regarding the
importance of the PTPC.
CHAIRMAN WILKEN asked the committee to review the resumes. If any
additional information is necessary that should be requested by
Wednesday's hearing otherwise, Chairman Wilken assumed that he
could report the names back to the Senate.
SB 96 REGULATION OF HOSPICE CARE
Number 530
CHAIRMAN WILKEN announced that SB 96 would be the next order of
business before the committee. Chairman Wilken noted that the K
version of the bill was before the committee.
BEN BROWN , Staff to Senator Kelly, discussed the changes that
version K includes. On page 8, line 21 after "which" the word
"including" was deleted and "may include" was inserted. That
language was inserted because sometimes a volunteer hospice would
not include all the items listed for bereavement services. Page 9,
line 14 the reference to 24 hour, seven days a week was deleted
because in a volunteer context that would not occur. That language
is on page 5 under the definition of nursing services as provided
by nonvolunteer hospice programs.
CHAIRMAN WILKEN asked Ms. Sonner to provide her testimony and noted
that the packet included her letter.
RITCHIE SONNER , Hospice & Home Care of Juneau, supported SB 96 as
written. With the changes to SB 96, Ms. Sonner did not believe it
to be burdensome administratively or financially. Hospice & Home
Care of Juneau is a small volunteer hospice with few funds. SB 96
is written to protect the consumer. Ms. Sonner noted that she was
not a supporter of regulation, but in this situation she
recommended the passage of SB 96.
SENATOR LEMAN asked Ms. Sonner if her notion that SB 96 was not
burdensome was the general consensus among volunteer hospices.
RITCHIE SONNER believed so, but noted there were folks on line who
could speak to that. SENATOR LEMAN did not want to burden such
organizations unnecessarily.
CHARLES QUARRE , President of the Central Peninsula Hospice, stated
that he maintained his previous testimony regarding concerns of the
administrative and financial burdens of SB 96. Mr. Quarre noted
that many industries are regulated by market forces. The volunteer
hospices adhere to the guidelines of the National Hospice
Organization which are almost identical to those specified in the
bill. Mr. Quarre suggested reviewing the advisability of incurring
additional expense and regulations in this area. Mr. Quarre
questioned if there are current statutes that address abuses in
this system. In response to Chairman Wilken, Mr. Quarre agreed
that he was speaking in opposition to SB 96. Mr. Quarre requested
that the volunteer hospice may be noted in the bill, but be
excluded from the provisions if not entirely.
CHAIRMAN WILKEN asked Mr. Quarre if he had any suggestions
regarding how to accomplish that within SB 96. CHARLES QUARRE
suggested that if the bill is to pass, the volunteer hospice could
be recognized but excluded from the provisions of the bill.
Number 427
BEN BROWN explained that if hospices are to be regulated, there
must be a standard that applies to any organization using the term
hospice. In the Commonwealth of Virginia, a bill excluding the
volunteer hospices was passed which resulted in volunteer hospices
being unable to use the term hospice in their name. Mr. Brown
acknowledged that language could be used to avoid that problem.
However, that would result in regulating only a portion of the
industry providing hospice services. Mr. Brown recognized that the
volunteer hospices in Alaska are exceeding the standards specified
in the bill, but that may not continue as time passes. Eliminating
the reference to the volunteer programs in SB 96 would not
accomplish the primary goal and the remainder of the hospice
community may not want that to go forward.
RITCHIE SONNER noted that there are shams, although not in Alaska
currently. Thirty-eight states have had to regulate hospices in
even a more restrictive manner. SB 96 is a proactive bill to
protect consumers who are in a vulnerable state. Ms. Sonner feared
the possibility of an opportunist. Ms. Sonner pointed out that
eliminating the reference to volunteer hospices would allow anyone
to refer to themselves as a hospice. SB 96 should be passed as is
or not at all.
SENATOR WARD inquired as to the number of cases of abuse in Alaska
this year. BEN BROWN did not believe there was a situation of
abuse in Alaska currently. SENATOR WARD suggested that regulation
could harm the process that is currently working. BEN BROWN
referred to Article 2 when saying that the Administrator of Health
Facilities Licensing & Certification will be reviewing mainly
nonvolunteer hospices a couple days a year. The volunteer programs
have a lower standard to adhere and the department has no intention
of charging volunteer hospices. Mr. Brown reiterated that the
volunteer hospices are already exceeding the standards in SB 96.
Mr. Brown noted that nurses and doctors have associations that
regulate them, only attorneys regulate themselves. Mr. Brown did
not know what more could be done to lighten the burden without
making the legislation meaningless.
Number 366
SENATOR WARD agreed that there was no middle ground. Senator Ward
inquired as to the public safety reasons for SB 96 within Alaska.
BEN BROWN could not give an example within the hospice community.
There was a problem in an assisted living home which lead to
changes in law. Mr. Brown noted that an assisted living home was
a comparable field.
BARBARA RICH , Hospice of the Tanana Valley, said that she was
speaking for the Board of Directors. Ms. Rich noted that all of
the concerns regarding the bill initially speaking only to
volunteer hospices when relevant were addressed. Ms. Rich noted
that she was concerned with the administrative and financial costs
of SB 96. Mr. Shelby of the Department of Health & Social Services
assured Ms. Rich that it would be very minimal: a yearly on-site
inspection would occur with a report following. The standards in
the bill are minimal. SB 96 would protect vulnerable patients and
families. Ms. Rich said that there has never been a problem in
this area and the impetus is to continue that record.
In response to Senator Ward, Ms. Rich said that the Hospice of the
Tanana Valley has not experienced any problems. Ms. Rich was
concerned that others may not do so. With regard to the expansion
of the regulations, Ms. Rich did not believe there could be
expansion. Ms. Rich said that she had heard of others who have
lower standards as well as problems with this in other states.
SENATOR WARD was not sure that regulation was necessary for a
problem that does not exist. BARBARA RICH believed that the
certified hospices would be regulated due to the presence of
nursing staff and such.
JOY JANSSEN , representing the forming Petersburg Hospice, informed
the committee that Petersburg was in the process of forming a
hospice beginning with neighbor to neighbor care. Ms. Janssen
asked if neighbor to neighbor care was given without using the name
hospice, would the organization still be regulated under this bill.
BEN BROWN replied no. SB 96 applies only to groups representing
themselves as hospices. Mr. Brown said that it would be a
judgement call for the Department of Law upon the request of the
Department of Health & Social Services. Mr. Brown pointed out the
definition of "hospice services" when noting that providing only
one service at home or not meeting all the needs listed could
possibly eliminate Ms. Janssen's concerns. Identifying an
organization as a hospice is the triggering mechanism and the
secondary definition is providing hospice services.
Number 251
MAXINE WORHATCH , testifying from Petersburg, asked if insurance,
personal or group, would be necessary if a group fell under this
bill as a volunteer. BEN BROWN said that was not covered by SB 96.
Mr. Brown believed that most volunteer hospices carried insurance.
SB 96 does not mandate liability insurance. Mr. Brown referred Ms.
Worhatch to Ms. Sonner or Ms. Rich. MAXINE WORHATCH commented that
it does not seem necessary to regulate volunteer hospices. Why
would someone volunteer and then take advantage of a patient?
ERICA WORHATCH asked if a hospice became licensed would the hospice
be liable if a neighbor who was not a hospice volunteer wanted to
help. BEN BROWN said that if a person wanted to help a dying
neighbor, of course that can be done. As long as that neighbor did
not say he/she was affiliated with a particular hospice, that
hospice would not be liable for his/her actions.
CHAIRMAN WILKEN suggested that those in Petersburg could consult
the many successful volunteer hospices such as those represented by
Ms. Sonner and Ms. Rich.
SHELBERT LARSEN , Administrator of Health Facilities Licensing &
Certification for DHSS, said that his agency would probably develop
and enforce the regulations if this statute were to pass. Mr.
Larsen believed that SB 96 was a good bill, providing minimum
standards for hospice programs. Mr. Larsen did not believe SB 96
would be burdensome for either the for profit or volunteer
hospices.
CHAIRMAN WILKEN referred to Article 2, page 7, line 18 when asking
if other volunteer organizations were required to show proof of
auto insurance and valid drivers license. BEN BROWN said that he
had asked Terri Lauterbach about that matter. Ms. Lauterbach was
unaware of other volunteer organizations requiring such. That
requirement was included because it was in the main statute and
seemed appropriate to put in SB 96. This has not been a concern
for anyone. Mr. Brown said that it would not be appropriate for an
individual to be driving around a terminally ill patient without
auto insurance and a valid drivers license. This is one reason for
a hospice to have liability insurance. Liability would be
increased if the two requirements were not met.
SENATOR GREEN informed everyone that her husband was employed by
the Auto Insurance Provider. Senator Green recalled that when she
drove for Scouts or her church, she was required to have proof of
insurance. Senator Green did not believe that those requirements
were unique to hospices.
SENATOR WARD requested that SB 96 be held until Kenai could provide
an amendment to eliminate the volunteers from the bill. Senator
Ward did not know when the amendment would be ready. Senator Ward
said that he did not want to move SB 96 out of committee; people
should not be regulated for a problem that does not exist.
CHAIRMAN WILKEN said that he would prefer not to hold SB 96 beyond
Wednesday. There being no further business before the committee,
the meeting was adjourned at 10:35 a.m.
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