04/05/2004 02:08 PM Senate HES
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ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 5, 2004
2:08 p.m.
TAPE (S) 04-19
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Lyda Green, Vice Chair
Senator Gary Wilken
Senator Bettye Davis
Senator Gretchen Guess
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
Occupational Safety and Health Review Board:
Thor R. Christianson
Board of Dental Examiners:
Mary Ann Cerney
Dr. Arne R. Pihl
State Medical Board:
Dr. Robert A. Breffeilh
Dr. John T. Duddy
Dr. G. Bert Flaming
Dr. David M. Head
Michael J. Tauriainen
Board of Certified Direct-Entry Midwives:
Dr. Mark E. Richey
Board of Nursing:
Patricia M. Swenson
Board of Pharmacy:
Cindy Bueler
Captain Gary M. Givens
Michael Pauley
CONFIRMATIONS ADVANCED
SENATE BILL NO. 243
"An Act relating to immunization of postsecondary students for
meningitis; and providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 385
"An Act relating to homeland security, to civil defense, to
emergencies and to disasters, including disasters in the event
of attacks, outbreaks of disease, or threats of attack or
outbreak of disease; establishing the Alaska division of
homeland security and emergency management in the Department of
Military and Veterans' Affairs and relating to the functions of
that division and that department; and providing for an
effective date."
HEARD AND HELD
SENATE BILL NO. 222
"An Act requiring certain hospitals to make certain disclosures
on patient billings."
HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 243
SHORT TITLE: POSTSECONDARY STUDENT IMMUNIZATION
SPONSOR(s): SENATOR(s) ELTON
01/12/04 (S) PREFILE RELEASED 1/2/04
01/12/04 (S) READ THE FIRST TIME - REFERRALS
01/12/04 (S) HES
04/05/04 (S) HES AT 1:30 PM BUTROVICH 205
BILL: SB 385
SHORT TITLE: SECURITY;DIV. HOMELAND SECURITY/EMER. MGT
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES
04/05/04 (S) READ THE FIRST TIME - REFERRALS
04/05/04 (S) HES, FIN
04/05/04 (S) HES AT 1:30 PM BUTROVICH 205
BILL: SB 222
SHORT TITLE: MEDICAL PATIENT BILLING DISCLOSURES
SPONSOR(s): SENATOR(s) DYSON
05/14/03 (S) READ THE FIRST TIME - REFERRALS
05/14/03 (S) HES, L&C
04/05/04 (S) HES AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
DR. ROBERT BREFFEILH
Juneau, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for State
Medical Board.
CAPTAIN GARY GIVENS
Eagle, River, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for Board
of Pharmacy.
MR. THOR CHRISTIANSON
Sitka, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for
Occupational Safety and Health Review Board.
MS. MARY ANN CERNEY
Fairbanks, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for Board
of Dental Examiners.
DR. JOHN DUDDY
Anchorage, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for State
Medical Board.
MR. MICHAEL TAURIAINEN
Soldotna, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for State
Medical Board.
DR. DAVID HEAD
Nome, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for State
Medical Board.
MS. PATRICIA SWENSON
Anchorage, Alaska
POSITION STATEMENT: Confirmation Hearing, candidate for Board
of Nursing.
SENATOR KIM ELTON
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Presented sponsor statement for SB 243.
MR. DAVID LIEBERSBACH
Acting Assistant Commissioner
Office of Homeland Security and Emergency Management;
Director of Alaska Division of Emergency Services,
Department of Military & Veterans Affairs
PO Box 5800
Ft. Richardson, AK 99505-0800
POSITION STATEMENT: Presented SB 385.
MR. WES KELLER
Staff to Chair Dyson
Alaska State Capitol
Juneau, AK 99801-1182
POSITION STATEMENT: Answered a question pertaining to SB 385.
MR. JOHN CRAMER
Director, Division of Administrative Services
Department of Military & Veterans Affairs
PO Box 5800
Ft. Richardson, AK 99505-0800
POSITION STATEMENT: Answered questions pertaining to SB 385.
MR. AL STOREY
Division of Alaska State Troopers
Department of Public Safety
3700 East Tudor Road
Anchorage, Alaska 99507
POSITION STATEMENT: Testified they had not analyzed SB 385 yet.
ACTION NARRATIVE
TAPE 04-19, SIDE A
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 2:08 p.m.
Present at the call to order were Senators Green, Wilken, Guess,
and Chair Dyson. Senator Davis arrived while the meeting was in
progress. Also present was Senator Elton.
^ CONFIRMATION HEARINGS
Occupational Safety and Health Review Board:
Thor R. Christianson
Board of Dental Examiners:
Mary Ann Cerney
Dr. Arne R. Pihl
State Medical Board:
Dr. Robert A. Breffeilh
Dr. John T. Duddy
Dr. G. Bert Flaming
Dr. David M. Head
Michael J. Tauriainen
Board of Certified Direct-Entry Midwives:
Dr. Mark E. Richey
Board of Nursing:
Patricia M. Swenson
Board of Pharmacy:
Cindy Bueler
Captain Gary M. Givens
Michael Pauley
CHAIR DYSON asked Dr. Breffeilh if he wanted to continue serving
on the State Medical Board.
DR. ROBERT BREFFEILH confirmed this was correct.
CHAIR DYSON asked Captain Givens why he wanted to serve on the
Board of Pharmacy.
CAPTAIN GARY GIVENS testified from Anchorage that he has been on
the Board of Pharmacy since March, was on the Pharmacy
Association committee for six years, and his interest is in the
pharmacy affairs in the state, in protecting public safety, and
being active in the community.
CHAIR DYSON asked Mr. Christianson why he wanted to serve on the
Occupational Health and Safety Board.
MR. THOR CHRISTIANSON responded he was involved with the seafood
business for a number of years and is now in the EMS field,
which emphasizes injury prevention. This board looks
interesting, and he feels he could help with different aspects
of safety issues.
CHAIR DYSON asked Ms. Cerney why she was interested in being on
the Board of Dental Examiners.
MS. MARY ANN CERNEY said she has served for five years and is
interested in serving in a profession in which she is fairly
well versed. She confirmed she was living and working in
Fairbanks.
CHAIR DYSON asked Dr. Duddy where he was practicing, and why he
wanted to serve on the State Medical Board.
DR. JOHN DUDDY responded he was in private practice in Anchorage
and wanted to give back to the community and help to ensure
there were good practicing physicians within the state.
CHAIR DYSON asked Mr. Tauriainen why he wanted to serve on the
State Medical Board.
MR. MICHAEL TAURIAINEN replied he is a civil engineer, and was
appointed to be the public member. His interest stems from his
philosophy that less is better than more regulation, and also in
those regulations being applied fairly. He said he has been
serving in an appointed role since August of 2003.
SENATOR GRETCHEN GUESS asked how he judges, not just the number,
but also the quality of regulations.
MR. TAURIAINEN said he was impressed with the free market system
to sort things out. By not restricting the market or limiting
the value of competition, there are new techniques, procedures,
and equipment.
SENATOR GUESS asked if he considers safety within that
evaluation mechanism, regarding ensuring competition.
MR. TAURIAINEN said certainly.
CHAIR DYSON asked Dr. Head why he wanted to serve on the State
Medical Board.
DR. DAVID HEAD responded this was his second term, and he enjoys
interactions with other members on the board and physicians in
the state. He also mentioned he has experience in Bush Alaska.
CHAIR DYSON asked Ms. Swenson why she wanted to serve on the
Board of Nursing.
MS. PATRICIA SWENSON responded she wanted to serve on the board
for many years and believes in giving back to the state.
Serving on boards has been difficult in the past due to her
irregular work schedule and family responsibilities, but she
could now fulfill board responsibilities. She allowed her
nursing license to lapse about ten years ago because she didn't
plan on returning to the profession. After finding there were
public members on the board, she checked with the ethics
attorney for the state and was told this position on the board
would not be a conflict. Her background in nursing, legislative
experience, and on the Alaska Workforce Investment Board allows
her to approach the board's issues from different points of
view.
MS. SWENSON told members she received a letter from the Alaska
Nurses Association (ANA) via the Governor's office. She noted
she had not received the letter from the ANA and it was
unfortunate they did not speak with her before sending that
letter. She believes ANA does not understand her function for
the Alaska Workforce Investment Board, and assumptions have been
made regarding her employment that are not true. Despite her
designation as a project coordinator and its description
according to "Workplace, Alaska," her duties and
responsibilities are far different. She is a staff member to
that board and as such, functions as a facilitator, staffs
committees, does community outreach, attends meetings, gathers
and disperses information, and so forth.
2:25 p.m.
MS. SWENSON continued that she interfaces with the University of
Alaska, ASHNA [Alaska State Hospital and Nursing Home], Native
Healthcare Corporations, Alaska Work Partnership, local unions,
members of the hospitality industry, and so forth. She does not
design educational programs or review grant applications, and
was not involved with the design or implementation of programs
that will come before the Board of Nursing. She said she does
not write grants or receive the administration of grants and
does not assist agencies with the writing of proposals or with
subsequent technical assistance. She said specific personnel
are hired for those jobs. She has never had any sway about who
or who does not get money. ANA cites ASHNA's nursing preceptor
program as a program she was involved with; those grants were
funded before she was employed by DOL, she stated, and her
presumption is those funds would continue because ASHNA writes
good proposals that provide needed services.
MS. SWENSON continued she has not been actively involved in
developing a grant for an apprenticeship model for nursing. The
U.S. DOL office of apprenticeship would be in charge of money
and curriculum development of such a program. An apprenticeship
model of nursing - RNs or LPNs - is not a viable option, and the
University is doing a great job of creating healthcare programs
for both urban and rural areas so neither the Alaska DOL or U.S.
DOL needs to become involved. The DOL has a strict process for
scoring grant proposals, and she stated she has never sat on
such a review committee.
CHAIR DYSON noted she hasn't practiced nursing since 1986.
MS. SWENSON confirmed she hasn't been practicing for quite some
time, and had let her nursing license go about ten years ago.
SENATOR GUESS referred to ANA's letter [March 23, 2004,
attention Senator Dyson] and asked about the perceived conflict
of interest and how that may reflect on the board and on this
administration.
MS. SWENSON said she did not perceive a conflict of interest;
she was involved in a "totally different aspect of what goes on
here." Even though she attends meetings, so does the ANA. She
mentioned there have been public board members in the past
receiving direct remuneration from healthcare entities; the
person who was the public member before her worked for public
health in Barrow, and was paid by a healthcare corporation. She
said she doesn't receive money from anybody, and most people
think it's a good idea for her to be on the board.
CHAIR DYSON said generally, regarding boards dealing with
technical and sophisticated topics, the public member, as a
consumer or interested citizen, can present a different
perspective. He asked if her years of professional experience
and training would limit her ability to serve as a public
member.
MS. SWENSON said no, her years of nursing were just one part of
her broader perspective.
SENATOR LYDA GREEN moved to forward the names of the candidates
to the larger body for confirmation. [This includes all names
listed above.]
CHAIR DYSON asked if there was any objection. Seeing and
hearing none, it was so ordered.
2:43 p.m.
SB 243-POSTSECONDARY STUDENT IMMUNIZATION
The committee took up SB 243.
CHAIR DYSON noted that Senator Davis had joined the meeting
approximately 10 minutes ago.
SENATOR KIM ELTON, sponsor of the bill, provided the sponsor
statement, saying SB 243 addresses postsecondary educational
institutions in Alaska notifying students of the dangers of this
type of meningitis. This is a potentially fatal bacterial
infection that most commonly attacks the brain and spinal cord
or presents as a bacteria in the blood. It can result in
permanent brain damage, hearing loss, learning disability, organ
failure, loss of limbs, and sometimes death. Twenty-six hundred
people contract this disease each year, and about 10 to 15
percent die from the disease. College students, especially
freshmen living in dormitories, have been found to be at-risk
and are six times more likely to contract this type of
meningitis. The Center for Disease Control and Prevention (CDC)
recommend that all college students, particularly freshmen
living in dormitories, learn more about the disease and consider
vaccination.
SENATOR ELTON continued that SB 243 doesn't mandate vaccination
but provides that Alaskan postsecondary institutions notify
students planning to reside on campus housing, of the risk.
Students would be required to sign a document provided by the
institution, indicating they have received an immunization or
have received a notice of the information regarding
immunization. The bill is not unusual; it is the same bill
that's been presented in 23 other states that either have
pending or adopted the legislation.
CHAIR DYSON asked if there was a fiscal note.
SENATOR ELTON replied postsecondary education had a zero fiscal
note. He explained this would be additional information
attached to already existing information - probably on the same
page - requiring a potential student to notify the institution
that he/she has been immunized or had received the information.
CHAIR DYSON said before acting on the bill, he wanted to hear
from the administration.
SENATOR GREEN asked if there were additional diseases - other
than meningitis - on campus environments that have caused this
level of concern.
SENATOR ELTON said he would check on this but meningitis was the
one that the CDC brought to the attention of states and higher
education institutions.
SENATOR GREEN asked if this issue required legislation.
SENATOR ELTON said probably not. If postsecondary education
wanted to proceed, nothing would restrict that; this bill is
based on model legislation adopted in other states.
CHAIR DYSON asked if there was information from Alaska's
university system in the packet.
SENATOR ELTON said the information was from CDC and other
sources.
CHAIR DYSON said he would appreciate information from the
university administration and also from the state's public
health or disease control office.
SENATOR ELTON mentioned that conversations had already been held
with university lobbyists.
CHAIR DYSON said he would like knowing that the university
supports, or at least does not have a problem with SB 243. He
announced the bill would be held until that additional
information was obtained.
1:40 p.m.
SB 222-MEDICAL PATIENT BILLING DISCLOSURES
The committee took up SB 222.
CHAIR DYSON introduced SB 222, saying that hospitals in
particular, have a multi-tiered billing system, and if a person
is a self-payor, he/she pays 100 percent while the larger third-
party payers negotiate discounts at a minimum of 30 percent.
This rewards irresponsible behavior and encourages folks to not
take responsibility for their own healthcare; those with
Medicaid/Medicare often do not pay anything. Every medical
hospital in the nation has a number of services for which they
do not recover cost, and those costs gets shifted to those
paying their own bills. SB 222 requires, if state funding is
received, that the discount rates be published. It also
requires hospitals to reveal information such as "how much of
your bill was a subsidy for indigent people, with the goal in
mind that you'd be able to use that as a charitable gift on your
income tax."
CHAIR DYSON referred to a proposed committee substitute (CS)
pertaining to supplies not exceeding reasonable costs over the
street value, with the desire being to "shine some daylight on
the processes that are going on."
CHAIR DYSON announced that SB 222 would be held in committee for
future consideration.
2:45 p.m.
SB 385-SECURITY;DIV. HOMELAND SECURITY/EMER. MGT
The committee took up SB 385.
CHAIR DYSON said he understands that in response to terrorism
threats, the governor has issued an executive proclamation to
coordinate activities, the administration has prepared a house
bill, and the HES committee has sponsored SB 385.
MR. DAVID LIEBERSBACH, acting assistant commissioner for the
Office of Homeland Security and Emergency Management, and
Director of the Alaska Division of Emergency Services within the
Department of Military and Veteran's Affairs, testified that the
primary purpose of SB 385 is to revise AS 26.20, a statute
enacted in 1951, and to update it to reflect the current
situation with homeland security. For the most part, "civil
defense" references in existing statute will now reflect
"homeland security and civil defense." This bill is not related
to the federal Patriot Act, but is a result of Alaska needing to
include homeland security. Mr. Liebersbach explained SB 385
would consolidate the Division of Homeland Security and Division
of Emergency Services, and eliminate the position of assistant
commissioner (his position); there would be one instead of two
directors. There is a zero fiscal note, and if successful,
$100,000 would be given back.
MR. LIEBERSBACH referenced AS 26.20, and said SB 385 would
repeal obsolete provisions, and gave the following examples: 1)
authorizing the establishment of local organizations for civil
defense, with authority to issue orders and adopt regulations;
2) giving civil defense orders and regulations adopted by the
governor, DMVA, local districts, and other authorized agencies,
the "effect of law;" 3) automatically suspending conflicting
laws, ordinances or regulations; 4) directing the federal
government and local law enforcement to enforce civil defense
orders and regulations; and 5) prohibiting civil defense
organizations from participating in any form of political
activity. SB 385 would also formalize the combining of
personnel from the Division of Emergency Services and DMVA;
Alaska's homeland security issues will be coordinated by the
DMVA.
CHAIR DYSON noted that concerns have been expressed by other
divisions/departments such as DPS, DEC, and [DOT&PF], and asked
Mr. Liebersbach to comment.
MR. LIEBERSBACH replied the solutions to those concerns have
been incorporated into the final draft of SB 385. "Direct" has
been modified to "coordinate," so that DMVA will not be
directing personnel of other agencies without expressed
authorization for delegation by the governor, as "these
departments are all directed by the governor." There was also
concern about DPS authority to establish roadblocks. DMVA will
only assist in manning or taking care of roadblocks in
consultation with DOT&PF and DPS. There are instances where
National Guard personnel or state defense forces can staff
roadblocks, since troopers don't have that capability. During
the holiday season in Valdez, this was done to provide personnel
to staff roadblocks during a heightened security situation.
CHAIR DYSON asked Mr. Liebersbach about other concerns DPS might
have.
TAPE 04-19, SIDE B
CHAIR DYSON asked if DPS was aware of the meeting today.
MR. WES KELLER, staff to Chair Dyson, responded DPS was aware of
this meeting; he was not sure if [DOT&PF] was aware of the
meeting.
MR. LIEBERSBACH said concerns of DEC, DOT&PF, and DPS were with
the oversight of homeland security planning, and the directing
of plans by those agencies. That language was revised to
"coordinating the plans" rather than "directing them."
CHAIR DYSON referred to the deletion of "districts of the
state," and asked if this was in reference to judicial
districts.
MR. LIEBERSBACH said he didn't know but would find out. Every
agency of the state has districts or regions that are different;
they recognize political subdivisions and local political
authority. He said he didn't know of existing civil defense
districts currently in use.
CHAIR DYSON referenced p.2, lines 26 and 27, and considered
including British Columbia (B.C.) and the Yukon Territory, but
said this may already be covered in paragraph (3). He asked
about Mr. Liebersbach's reference to training a state defense
force to be military police. At the end of that process, if the
governor declares an emergency, some police powers - such as
arrest - would be involved; he asked if this was correct.
MR. JOHN CRAMER, Director, Division of Administrative Services,
Department of Military and Veteran's Affairs, said he believes
the volunteers would not have arresting powers, but would be
utilized and activated during times of disaster or crises. The
training process includes a military police-type academy, and at
the end of that training, they are considered to be constables.
MR. LIEBERSBACH added that before being certified, there is
orientation and oversight from the state troopers. Generally
those people work in conjunction with either local or state law
enforcement so someone from those agencies is supporting or
working with them.
CHAIR DYSON asked about concern that this had an intrusive
Patriot Act aspect.
MR. CRAMER explained that earlier iterations of HB 185 (from
last year) included provisions in proposed language that would
have allowed the Division of Homeland Security to exercise
certain powers. Some of those had to do with confiscating
certain assets or equipment; that language has been taken out of
the bill.
CHAIR DYSON asked if there was a provision in state law, or this
bill, providing that if equipment in private ownership is
needed, it could be commandeered for public purpose for a period
of time.
MR. CRAMER said he believes that assumption is correct, that
existing law allows for the state, in certain instances, to
acquire personal property, and there must be fair compensation
for its use. He said he didn't believe this was included in
this legislation.
CHAIR DYSON read from page 7, line 29, as follows: "plan and
make arrangements for the availability and use of private
facilities, services, and property and, if necessary..." and
asked if "property" included, not only real estate, but also an
airplane, boat, or dump truck. He suggested possibly defining
"property" to include other useful equipment. He also suggested
that - throughout the bill - the use of "coordination" of
federal, state, local and private agencies, also include cross-
border coordination, "to work with our neighbors."
MR. LIEBERSBACH said under AS 26.23, the governor has authority
to enter into compacts with other states and bordering
provinces. Under that authority, recognized by the U.S.
Congress, Alaska entered into a compact with the Yukon
Territory, British Columbia, Washington, Oregon, and Idaho, for
exactly this type of work. He added, "We could bring that
forward."
CHAIR DYSON said, "Only if you think it is necessary." He noted
Idaho and Montana have been working with B.C. and Alberta and
have addressed practicalities such as firefighting equipment,
air fuel capacity, equipment and personnel compatibility, and
border crossing documentation.
MR. LIEBERSBACH said a homeland security exercise was already
scheduled for September with the Yukon Territory, but they could
look into this issue further.
CHAIR DYSON announced SB 385 would be held in committee until
Wednesday.
MR. AL STOREY, Division of State Troopers, testified they had
not yet seen a copy of SB 385, and would get back with the
committee later in the week.
CHAIR DYSON asked that the commissioner be notified that most of
his concerns had been addressed.
There being no further business to come before the committee, he
adjourned the meeting at 3:12 p.m.
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