Legislature(1997 - 1998)
04/16/1997 09:07 AM Senate HES
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SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE
April 16, 1997
9:07 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
SENATE BILL NO. 164
"An Act relating to the authority of an emergency medical
technician at the scene of an accident or emergency."
- HEARD AND HELD
SENATE BILL NO. 122
"An Act relating to unfair discrimination under a group health
insurance policy for services provided by marital and family
therapists; and providing for an effective date."
- MOVED CSSB 122(L&C) OUT OF COMMITTEE
SENATE BILL NO. 132
"An Act relating to registration of sex offenders and central
registry of sex offenders; relating to access to, release of, and
use of criminal justice information and systems; relating to
notices concerning sex offender registrants; and providing for an
effective date."
- MOVED SB 132 OUT OF COMMITTEE
PREVIOUS SENATE COMMITTEE ACTION
SB 164 - No previous Senate action to record.
SB 122 - See Labor and Commerce Committee minutes dated 4/8/97.
SB 132 - See Senate Health, Education & Social Services Committee
minutes dated 3/24/97.
WITNESS REGISTER
Beth Hagevig, Staff
Senator Wilken
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Read the Sponsor Statement.
Craig Lewis
Alaska EMS Association
Interior Region Emergency Medical Services Council
3522 Industrial Avenue
Fairbanks, Alaska 99701
POSITION STATEMENT: Urged support of SB 164.
Ellen Wofford, EMT-III
Delta Rescue Squad
PO Box 52
Delta Junction, Alaska 99737
POSITION STATEMENT: Supported SB 164.
Tom Dean, Chief
Tok EMS
PO Box 811
Tok, Alaska 99780
POSITION STATEMENT: Encouraged passage of SB 164.
Mark Johnson, Chief
Section of Community Health & Emergency Medical Services
Department of Health & Social Services
PO Box 110616
Juneau, Alaska 99811-0616
POSITION STATEMENT: Supported SB 164.
Rachael Moreland, Staff
Senator Leman
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Read the Sponsor Statement.
Catherine Reardon, Director
Division of Occupational Licensing
Department of Commerce & Economic Development
PO Box 110806
Juneau, Alaska 99811-0806
POSITION STATEMENT: Supported SB 122.
Beverly Lindell, President
Alaska Association of Marriage & Family Therapists
PO Box 32481
Juneau, Alaska 99803
POSITION STATEMENT: Supported SB 122.
Marianne Burke, Director
Division of Insurance
Department of Commerce & Economic Development
PO Box 110805
Juneau, Alaska 99811-0805
POSITION STATEMENT: Discussed SB 122.
ACTION NARRATIVE
TAPE 97-40, SIDE A
SB 164 AUTHORITY OF EMERGENCY MED TECHS
Number 001
CHAIRMAN WILKEN called the Senate Health, Education & Social
Services Committee (HES) to order at 9:07 a.m. and introduced
SB 164 as the first order of business before the committee.
BETH HAGEVIG , Staff to Senator Wilken, read the following Sponsor
Statement into the record:
Senate Bill 164 repairs a long overdue shortcoming in our public
safety network. Specifically, it provides EMTs with appropriate
and relevant authority at the scene of an accident as well as
during responses to medical emergencies in homes, without creating
potential conflict between emergency personnel. SB 164 is intended
to protect EMTs who arrive first on the scene of an accident or
medical emergency, or who are the only emergency responders to
arrive for some time, as is the case in many rural areas.
Currently, we ask emergency medical technicians to perform actions
necessary to their duties such as:
*controlling and directing activities at the scene of an accident;
*temporarily blocking or redirecting traffic to avoid the scene of
an accident;
*trespassing upon property in order to respond to an emergency
call;
*entering a building, including a private residence, or premises
where report of an injury or illness has taken place; and
*directing the removal or destruction of a motor vehicle or other
thing in order to prevent further harm to injured or ill
individuals;
without giving them the proper legal authority to do so. By taking
for granted that EMTs are expected to perform these duties in the
absence of any legal authority, we leave hundreds of men and women
vulnerable to the lack of cooperation on the part of the public and
potential liable suits.
Alaska relies heavily on its emergency medical personnel,
especially in rural areas where law enforcement and fire personnel
are relatively few in numbers. Just as we expect EMTs to protect
our safety in an emergency situation, we should reciprocate this
service, and give EMTs the proper legal authority to do their jobs
without compromising their personal safety.
CHAIRMAN WILKEN referred the committee to the information in the
packet which detailed the levels of EMTs in Alaska. BETH HAGEVIG
noted that ETTs although listed with the levels of EMTs, are not
technically EMTs.
Number 094
CRAIG LEWIS , Alaska EMS Association and Interior Region Emergency
Medical Services Council Inc., urged the support of SB 164. Mr.
Lewis believed that the committee packet included documents
regarding cases in other states where EMTs without this authority
were injured and held liable after the fact. The EMTs in rural
settings perform those duties listed. Mr. Lewis noted that
customarily there is a responsible person in charge, sometimes
called the Chief Medic. SB 164 does not compromise nor conflict
with any existing law enforcement or fire fighting authority.
SB 164 provides legal protection for EMTs responding in locations
where the trooper response is delayed or there are no volunteer
fire fighters to assume the role.
SENATOR GREEN referred to line 14 on page 1 when noting that during
the Millers Reach fire lots of people began directing traffic
without consistent identification that resulted in fist to cuffs
and later arrests. In SB 164, what provides consistent
identification of those in authority? CRAIG LEWIS pointed out that
SB 164 is not designed to deal with a wild land fire circumstance
as in Millers Reach. Mr. Lewis believed the bill to address motor
vehicle accidents or illnesses in homes. The majority of EMTs are
in uniform or wear some sort of patch.
CHAIRMAN WILKEN did not want just anyone to claim to be an EMT and
end up directing traffic. Should SB 164 contain language
indicating the need for EMTs to carry identification or wear a
uniform in order to know that the person is truly an EMT if
challenged? CRAIG LEWIS acknowledged that the involvement of
bystanders and the question of challenging of the EMTs is
complicated. The EMTs have credentials and cards which explain the
certification as well as uniforms. EMTs are trained in dealing
with the public. The definitions and standards defining an EMT
seem to already address the issue of identification.
Number 213
ELLEN WOFFORD , EMT-III with Delta Rescue Squad, supported SB 164.
Many EMTs are volunteers and therefore may come upon a scene and
not be in the uniform, but do carry badges and perhaps have a hat
indicating the person's EMT status.
TOM DEAN , Chief of the Tok EMS, believed he was sort of responsible
for this legislation because he questioned whether Alaskan EMTs had
authority after reading an article discussing a similar situation
in another state. SB 164 addresses what is done on a regular basis
by EMTs. Mr. Dean noted that in his area, EMTs often arrive 30
minutes to an hour before troopers at motor vehicle accidents.
SB 164 merely gives authority to EMTs to do what they are already
doing. Mr. Dean encouraged the passage of SB 164.
MARK JOHNSON , Chief of the Section of Community Health & Emergency
Medical Services in DHSS, informed the committee that the Section
of Community Health & Emergency Medical Services was responsible
for planning, coordinating, and implementing a statewide emergency
medical services system which includes the certification of all
EMTs and ambulance services. With regard to ETTs, those persons
are not equivalent to EMTs. ETTs, first responders, would not be
covered under this statute. Mr. Johnson explained that if someone
is certified by his section then, that person would receive a
certificate, a wallet card, and patches. Mr. Johnson supported
SB 164.
CHAIRMAN WILKEN inquired as to the number of people involved from
the EMT-I level to MICP. MARK JOHNSON stated that approximately
4,000 people are certified statewide.
Number 295
SENATOR WARD asked if SB 164 was enacted, would Martin Buser be
sent to jail if during an emergency situation an EMT told him not
to go home and he did. BETH HAGEVIG said that she would have to
confer with legal on that issue. Placing EMTs as enforcers was not
the intent of this legislation; the intent was to give EMTs the
authority to do what they are already doing. In general when EMTs
arrive on the scene, the EMTs rely on law enforcement to perform
enforcement duties.
SENATOR WARD restated his question. BETH HAGEVIG noted that SB 16
was modeled after the fire fighter authority legislation in which
there is a penalty if a fire fighter's instructions are disobeyed.
Ms. Hagevig reiterated that she would need to confer with an
attorney on this matter.
MARK JOHNSON believed that there was no enforcement authority with
SB 164. The reason for SB 164 is to protect EMTs; most EMTs do not
want enforcement authority. Mr. Johnson also deferred to legal
advice.
SENATOR GREEN believed Mr. Johnson, but noted that during an
ongoing emergency the functions between the various responding
groups can become blurred. This legislation may not be the proper
place to address this issue, the ability to deputize. Senator
Green referred to lines 3 and 4 on page 2; is that a typical
standard? MARK JOHNSON believed that if EMS receives a call then
that gives EMS reasonable authority to enter on the basis of that
call. This simply clarifies that. BETH HAGEVIG reiterated that
SB 164 was drafted almost verbatim from the fire fighter authority
legislation.
In response to Senator Ward, CRAIG LEWIS reiterated that the intent
of SB 164 was to provide authority not enforcement. In general,
persons who violate statutes are penalized and if SB 164 becomes
law then the penalties relevant to that would apply. There is a
$1,000 fine for failing to comply with a fire fighter's
instructions which is specifically stated in that legislation.
That is not stated in SB 164.
Number 383
SENATOR WARD asked if all persons covered under SB 164 were
required to carry photo identification. CRAIG LEWIS said no,
although most have a card issued by the state which identifies the
person and level of skill. MARK JOHNSON also replied no to Senator
Ward's inquiry.
SENATOR WARD noted that police officers are not always in uniform,
but do have identification beyond a badge, a cap, or a patch. TOM
DEAN reiterated that in the Millers Reach fire, EMTs would not be
in control in such a major fire. SENATOR WARD informed everyone of
another situation in which a person with identification took
control of an emergency situation and instructed those present to
move away from the victim. Unbeknownst to the EMT person, one of
the bystanders was a relative. Without the proper identification,
the situation could have been very difficult. TOM DEAN assumed
that there was a reason that there were instructions to separate
the people from the victim.
CHAIRMAN WILKEN redirected the conversation to the question of
identification. MARK JOHNSON reiterated that all the certified
EMTs are issued a wallet card, patches and a certificate.
CHAIRMAN WILKEN asked if adding language requiring that the EMT
certification card be carried, which is not a photo identification,
would address the identification concerns. SENATOR WARD suggested
that a specific background or designation on the person's drivers
license could be utilized to signify their EMT status. MARK
JOHNSON deferred to the DMV, but did note that SB 38 would require,
in addition to the organ donor specification, a Do Not Resuscitate
order as well. If SB 38 passes, that is a lot of information on
the drivers license.
CHAIRMAN WILKEN suggested that SB 164 be held to work on this
matter. SB 164 was held to Friday's agenda.
SB 122 INS.COVERAGE:MARRIAGE & FAMILY THERAPIST
Number 459
CHAIRMAN WILKEN introduced SB 122 as the next order of business.
He noted that there was a CS from the Labor & Commerce Committee,
when saying that he would entertain a motion to place it before the
committee.
SENATOR WARD moved to adopt CSSB 122(L&C) for discussion purposes.
Without objection, CSSB 122(L&C) was adopted.
RACHEAL MORELAND , Staff to Senator Leman, read the following
Sponsor statement into the record:
Senate Bill 122 was introduced by the Labor and Commerce Committee
at the request of the Alaska Association for Marriage and Family
Therapy (AAMFT). SB 122 will add marital and family therapists to
the list of providers against whom insurers may not discriminate.
This bill does not require insurers to add coverage of marital and
family therapists where the coverage currently is not provided. It
merely requires that insurers treat marital and family therapists
on equal footing with other licensed providers and extend the same
opportunities for coverage that the insurer offers others providing
the same services. The definition of unfair discrimination is
clarified by this bill and codifies existing practice.
Section 1, paragraph 1 adds marital and family therapists to the
unfair discrimination list under group health insurance policies
with an effective date of July 1, 1997. Paragraph 2 defines unfair
discrimination.
Legislation (Section 4, ch. 39, SLA 1993) affecting the unfair
discrimination clause was passed in 1993 with an effective date of
1998. Section 2 repeals and reenacts this section to reflect the
addition of marital and family therapists and the definition of
unfair discrimination.
Currently, health insurers offering mental health services may not
discriminate against licensed psychologists, psychological
associates or clinical social workers. SB 122 would allow those
insured with mental health coverage to choose treatment from a
licensed marital and family therapist.
AAMFT is a division of the American Association for Marriage and
Family Therapy, Inc. Marriage and family therapists (MFTs) are a
group of mental health professionals with background in a variety
of disciplines, including psychology, social work, and family
social science. MFTs are licensed or certified in 37 states and
are recognized by the U.S. Department of Health and Human Services
as one of the five core mental health disciplines in the U.S.
CATHERINE REARDON , Director of the Division of Occupational
Licensing in the Department of Commerce & Economic Development,
informed the committee that the Board of Marital and Family
Therapists works in association with this division. The board
supports the inclusion of MFTs in this nondiscrimination clause.
SENATOR LEMAN inquired as to how many people are licensed by the
board in this category. CATHERINE REARDON said that at the
beginning of this fiscal year, there were 181 persons licensed in
this category.
Number 515
BEVERLY LINDELL , President of AAMFT, requested the committee's
support for SB 122. Ms. Lindell noted that SB 122 does not mandate
coverage nor increase the scope of service nor does the bill
include any willing provider language. This legislation is
important for fairness. Ms. Lindell noted that MFTs have been
licensed in this state since 1992 and pay fees to provide that
service. MFTs are also one of the five core mental health groups
identified by the National Institute of Mental Health.
With regard to the concern of cost, Ms. Lindell informed the
committee that the Division of Insurance reported that there is no
evidence that costs would increase due to the increase in the pool
of providers. In fact, the effect of competition may actually
decrease the costs. Ms. Lindell explained that MFTs tend to be
solution focused which results in achieving a job efficiently and
quickly which could result in reduced costs to insurers. Ms.
Lindell also noted that a survey in the American Psychologist
reported that consumers refer to MFTs more often than other mental
health professionals. Further there has been much information
about family problems across the nation and in Alaska which has the
highest rate of teen suicide and sexual abuse. MFTs are the groups
that have expertise in that area and would like to practice that
with reimbursement.
CHAIRMAN WILKEN asked Ms. Burke to explain the term "unfair
discrimination" to the committee.
MARIANNE BURKE , Director of the Division of Insurance for DCED,
explained that "unfair discrimination" does not include the purpose
of utilization review for standards of clinical appropriate health
care which Ms. Burke could support. With regard to cost
containment, Ms. Burke was a bit concerned that it could be used to
force an individual to seek the cheapest service available. Ms.
Burke pointed out that the process of utilization review is a cost
containment measure. Clinically appropriate health care services
have elements of cost containment. Ms. Burke believed that the
amendment helps clarify this section of Title 21.
SENATOR LEMAN did not intend for "cost containment" to mean that
the lowest cost provider must be utilized, but rather that the
appropriate provider be utilized. Senator Leman pointed out that
there may be appropriate measures to contain cost which would not
be an unfair discrimination practice.
CHAIRMAN WILKEN asked if Ms. Burke had heard from insurance
companies in Alaska with regard to the amendment. MARIANNE BURKE
had only heard from one writer of health insurance in the state who
favored the amendment.
SENATOR LEMAN moved to report CSSB 122(L&C) out of committee with
individual recommendations and the accompanying zero fiscal note.
Without objection, it was so ordered.
SB 132 CRIMINAL JUSTICE INFO, INCL. SEX OFFENDER
Number 581
CHAIRMAN WILKEN announced SB 132 as the final order of business
before the committee.
SENATOR WARD moved to report SB 132 out of committee with
individual recommendations and accompanying fiscal notes.
CHAIRMAN WILKEN asked if there was anyone to testify or any
questions on SB 132. Hearing none, Chairman Wilken asked if there
was any objection to the motion. Hearing no objection, SB 132 was
reported out of committee.
There being no further business before the committee, the meeting
was adjourned at 9:55 a.m.
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