02/06/2008 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SJR17 | |
| HB252 | |
| Alaska Brain Injury Network Presentation | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SCR 17 | TELECONFERENCED | |
| + | HB 252 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 6, 2008
1:35 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Thomas, Vice Chair
Senator John Cowdery (via teleconference)
Senator Kim Elton
Senator Fred Dyson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE CONCURRENT RESOLUTION NO. 17
Relating to establishing March 2008 as Brain Injury Awareness
Month.
MOVED SCR 17 OUT OF COMMITTEE
CS FOR HOUSE BILL NO. 252(STA)
"An Act requiring paid leave from employment for organ and bone
marrow donation."
MOVED CSHB 252(STA) OUT OF COMMITTEE
Alaska Brain Injury Network Presentation
PREVIOUS COMMITTEE ACTION
BILL: SCR 17
SHORT TITLE: BRAIN INJURY AWARENESS MONTH: MARCH 2008
SPONSOR(s): SENATOR(s) MCGUIRE
01/23/08 (S) READ THE FIRST TIME - REFERRALS
01/23/08 (S) HES
02/06/08 (S) HES AT 1:30 PM BUTROVICH 205
BILL: HB 252
SHORT TITLE: LEAVE FOR ORGAN/BONE MARROW DONATIONS
SPONSOR(s): REPRESENTATIVE(s) LEDOUX
05/03/07 (H) READ THE FIRST TIME - REFERRALS
05/03/07 (H) HES, STA
05/08/07 (H) HES AT 3:00 PM CAPITOL 106
05/08/07 (H) Moved CSHB 252(HES) Out of Committee
05/08/07 (H) MINUTE(HES)
05/10/07 (H) HES RPT CS(HES) 4DP 2NR 1AM
05/10/07 (H) DP: ROSES, GARDNER, CISSNA, WILSON
05/10/07 (H) NR: SEATON, FAIRCLOUGH
05/10/07 (H) AM: NEUMAN
05/12/07 (H) STA AT 9:00 AM CAPITOL 106
05/12/07 (H) Moved CSHB 252(STA) Out of Committee
05/12/07 (H) MINUTE(STA)
05/13/07 (H) STA RPT CS(STA) 5DP 1NR
05/13/07 (H) DP: DOLL, GRUENBERG, JOHANSEN, ROSES,
LYNN
05/13/07 (H) NR: COGHILL
05/14/07 (H) TRANSMITTED TO (S)
05/14/07 (H) VERSION: CSHB 252(STA)
05/15/07 (S) READ THE FIRST TIME - REFERRALS
05/15/07 (S) HES, STA, FIN
02/06/08 (S) HES AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
SENATOR McGUIRE
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SCR 17.
JILL HODGES, Executive Director
Alaska Brain Injury Network
Anchorage, AK
POSITION STATEMENT: Supported TBI awareness & education.
RICHARD WARRINGTON, Appointed Ambassador
Brain Injury Association of America
Anchorage, AK
POSITION STATEMENT: Provided a personal perspective on the issue
of TBI.
MARY WARRINGTON, Board Member
Alaska Brain Injury Network
Anchorage, AK
POSITION STATEMENT: Provided a personal perspective on the issue
of TBI.
CAPTAIN RICHARD BARKER, Clinical Psychologist
Elmendorf Air Force Base
Anchorage, AK
POSITION STATEMENT: Explained how the military is handling TBI
diagnosis and treatment.
STEPHANIE TANNER, representing herself
Anchorage, AK
POSITION STATEMENT: Stressed the importance of prompt
identification & treatment of TBI.
DR. RUSSELL S. CHERRY, Neuropsychologist
Providence Hospital
Anchorage, AK
POSITION STATEMENT: Testified to the importance of TBI
awareness, education & improved treatment systems.
ACTION NARRATIVE
CHAIR BETTYE DAVIS called the Senate Health, Education and
Social Services Standing Committee meeting to order at 1:35:34
PM. Present at the call to order were Senators Elton, Thomas,
Dyson, and Chair Davis.
SCR 17-BRAIN INJURY AWARENESS MONTH: MARCH 2008
1:35:54 PM
CHAIR DAVIS announced SCR 17 to be up for consideration.
SENATOR McGUIRE, sponsor of SCR 17, said the reason this is
important to her is that her brother was in a car accident in
1992 and suffered a traumatic brain injury. At that time Alaska
was ill prepared to respond to her family's need for
information. The point of the resolution is to make March of
2008 Brain Injury Awareness Month, to raise awareness of the
problem and bring attention to prevention, treatment and the
support that is available to victims and their families. Brain
injury is the leading cause of death and disability among
children and young adults in Alaska. An estimated 12,000 people
state wide have suffered from traumatic brain injury (TBI) and
most have suffered in silence.
1:38:16 PM
SENATOR McGUIRE continued that the problem is often overlooked
because victims of traumatic brain injury are not often
encountered in public and the families of victims don't tend to
talk about it. Although passing a resolution cannot fix the
problem in any immediate way, passing a resolution and the
testimony that goes with it can highlight a really important
problem.
1:40:42 PM
SENATOR DYSON said he had asked before whether the committee
would consider making it "Brain Injury Month" rather than
"Traumatic Brain Injury Month" in light of the fact that Alaska
leads the nation in non-traumatic brain injuries, particularly
pre-natal alcohol syndrome. He wondered whether the committee
had considered his request to make that change in the focus of
this month.
SENATOR McGUIRE pointed out that the title of the resolution is
"Brain Injury Awareness Month," but agreed that it would be
helpful to offer more statistics about non-traumatic brain
injury and said she was willing to do so. She added that the
Brain Injury Network has evolved to include a focus on non-
traumatic brain injuries and would be able to provide more
information.
1:42:19 PM
JILL HODGES, Executive Director, Alaska Brain Injury Network,
Anchorage AK, said it is important to keep traumatic injury in
focus because the state has begun to develop capacity for other
sorts of brain injuries such as fetal alcohol syndrome (FASD)
and stroke, but awareness and services for traumatic brain
injury were still very limited. She felt that if they could beef
up the system for traumatic brain injury, the other acquired
brain injuries would also benefit from increases to state funded
brain injury programs.
1:43:19 PM
SENATOR DYSON said he inferred that, although non-traumatic
brain injury is hugely important, they would prefer not to
dilute their efforts here away from traumatic brain injury.
MS. HODGES agreed.
1:44:38 PM
SENATOR THOMAS commented that he shares the same concerns that
Senator Dyson articulated, although he was unwilling to hold up
the resolution based on his concerns. He stated that there is a
fair amount of information available about traumatic brain
injury and non-traumatic brain injury. Both are important and
should be emphasized. The title is already appropriate and he
encouraged them to continue to look at the possibility of
broadening the focus as the resolution moves forward.
1:45:57 PM
RICHARD WARRINGTON, Ambassador, Brain Injury Association of
America, Anchorage AK, said he is the survivor of a traumatic
brain injury that occurred over 30 years ago and is still
disabled from his injury. He encouraged the committee to pass
the resolution and apprised them that congress was also
considering a resolution to create a national brain injury
awareness month.
1:47:10 PM
MARY WARRINGTON, Board Member, Alaska Brain Injury Network,
Anchorage AK, said her two brothers suffered brain injuries and
people need to be made aware of the problem.
SENATOR THOMAS moved to report SCR 17 from committee with
individual recommendations and attached fiscal note(s). There
being no objection, the motion carried.
HB 252-LEAVE FOR ORGAN/BONE MARROW DONATIONS
CHAIR DAVIS announced the consideration of HB 252. [Before the
committee was CSHB 252(STA).]
1:48:58 PM
REPRESENTATIVE GABRIELLA LEDOUX, sponsor of HB 252, introduced
the Richard Foster, Stanley M. Robbins and Alex Cesar Donor Act,
an act requiring paid leave from employment for organ and bone
marrow donation. She said the bill would only apply to state
workers and would require the employer to provide not less than
40 or more than 80 hours of leave. According to the Life Alaska
Donor Services, approximately 160 patients in Alaska were
waiting for kidney transplants, but fewer than 20 were
transplant recipients each year. Fewer than 100 people in Alaska
were awaiting bone marrow transplants.
She stated that about 30 states now have laws similar to HB 252
and 23 of those apply only to state employees. Congress was
considering a bill that would make living organ or bone marrow
donation part of the Family Medical Leave Act, but the bill
before the committee would not apply to the general workforce.
1:50:37 PM
SONYA HYMER, Staff to Representative LeDoux, explained that
Richard Foster is a Representative from Nome who is waiting for
a kidney transplant. Stanley M. Robins is Representative
Cissna's late husband and was staff to Senator Gruenberg for
many years, and Alex Tasar is the little boy who received a bone
marrow donation last year from a man in New Mexico. This bill
would allow a donor to take paid leave from work to undergo
testing and surgery.
1:52:26 PM
Section 2 and 3 are conforming amendments.
Section 4 is substantive. It allows State of Alaska employees to
take not less than 40 or more than 80 hours of paid
administrative leave for screening, testing and surgery related
to organ donation.
1:53:34 PM
SENATOR COWDERY joined the meeting via teleconference.
SENATOR THOMAS noted that the sponsor statement had statistics
for the number of kidney transplants done in the state each
year, but not for bone marrow transplants. He wondered if Ms.
Hymer could give him a ballpark figure
MS. HYMER said that approximately five people per year donate
bone marrow but she did not know whether the procedures were
done in Alaska.
SENATOR THOMAS asked why the bill was not broadened to encourage
other employers to allow their employees to participate without
loss of income.
REPRESENTATIVE LEDOUX answered that she felt the bill would
stand a better chance of passing if it were limited to state
employees
1:56:10 PM
SENATOR THOMAS said the concern is probably rightly placed. He
felt however, that the matter should be addressed in some
fashion so it would not be so great a financial and medical
burden to potential donors.
1:58:23 PM
CHAIR DAVIS said there were two people online to answer
questions.
SENATOR THOMAS said he would like to get statistics regarding
bone marrow transplants but they could email that information to
him.
1:58:57 PM
SENATOR COWDERY asked whether any other states have passed
similar legislation.
REPRESENTATIVE LEDOUX said 30 other states have laws similar to
this, of which 23 apply only to state employees.
1:59:33 PM
SENATOR ELTON said he was disappointed that the bill was limited
to state employees, but he moved that HB 252 be moved from
committee with individual recommendations and attached fiscal
note(s). There being no objection, CSHB 252(STA) moved from
committee.
^ALASKA BRAIN INJURY NETWORK PRESENTATION
2:00:21 PM
CHAIR DAVIS announced the committee would hear a presentation on
traumatic brain injury.
2:00:41 PM
JILL HODGES, Executive Director, Alaska Brain Injury Network
(ABIN), responding to a question Senator Cowdery had asked
earlier, explained that March was chosen for Alaska's brain
injury awareness month because it is consistent with what is
taking place nationally. She said that ABIN takes part in the
Mental Health Trust Authority "You Know Me" campaign in March
and do awareness outreach to outlying communities in April.
Also, the military planned public forums between February and
May and asked that the March forum in Anchorage focus on
traumatic brain injury.
2:02:04 PM
MS. HODGES introduced Captain Barker from Elmendorf AFB,
Stephanie Tanner, the wife of a soldier who suffered a traumatic
brain injury in 2004, and Dr. Russell Cherry, a
neuropsychologist at Providence Hospital who has broad
experience working with traumatic brain injury.
2:03:46 PM
MS. HODGES said that TBI-specific programming is standard in
many other states. The coordination of funding programs, case
management, providers who develop TBI infrastructure, and "step-
down" programs is very important to ensure that people access
the programs needed for the best outcome in each case. She
applauded the military for recognizing the problem of TBI and
developing the funding and programs needed to treat returning
soldiers. She said that the role of each individual is to
understand what TBI really is and how to respond to it. Most
people don't think of it until it strikes their family, but it
is very common in Alaska and 20 percent of the individuals
affected don't make it.
2:07:26 PM
SENATOR ELTON asked whether TBI is always due to a physical
event.
MS. HODGES referred the question to Dr. Cherry, but said that
there are acquired and traumatic brain injuries. In Alaska, the
definition of a traumatic brain injury is "a blow to the head,"
but that falls under acquired brain injuries, so traumatic brain
injuries are a type of acquired brain injury.
2:08:39 PM
CAPTAIN RICHARD BARKER, Clinical Psychologist, Elmendorf Air
Force Base, delivered a PowerPoint presentation focusing on the
military aspect of TBI.
Slide: Showed different types of IED [Improvised Explosive
Device]. The first was a stationary IED that is very target
specific. The second was a vehicle born IED, which usually has a
larger explosive charge and impacts a greater number of people.
Slide: Captain Barker said that mild Post-Concussive Syndrome
(PCS) has become the signature injury of the war and implies a
milder form of brain injury. People afflicted with Post-
Concussive Syndrome are treated here and usually respond
favorably in 3 to 12 months, but some have lifelong difficulty.
Captain Barker stressed that Alaska does not have the capability
to deal with moderate to severe head injuries.
Slide: Defense and Veterans' Brain Injury Center (DVBIC) defines
TBI as "...an injury to the brain resulting from a blast, a
fall, direct impact or motor vehicle accident, which causes an
alteration in mental status resulting in a plethora of both
physical and cognitive problems." He said they are finding that
combat injuries have more serious implications than the sports
injuries they had been using as models for treatment.
Slide: Factoids on combat MTBI [Mild Traumatic Brain Injury]
MTBI from a blast causes the brain to be badly jarred, which can
stretch, cut or twist axons.
° Approximately 1.4 million TBIs occur in the US every year.
° Twenty-two percent of OIF [Operation Iraqi Freedom]
veterans reported MTBI-inducing events.
° Seven percent of those reported continuation of MTBI
symptoms.
° A study of about 7500 cases performed at a major theater
hospital, showed that 23 percent were positive for TBI,
while 75 percent complained of symptoms.
Captain Barker explained that the military attempts to catch TBI
using a Post Deployment Health Assessment (PDHA) when soldiers
return home, but they are working on ways to identify it
earlier.
2:14:07 PM
Neuro-imaging studies are frequently negative, causing providers
to rule out TBI prematurely. Those with ruptured eardrums are
three times more likely to suffer TBI.
2:14:57 PM
Slide: The Department of Defense (DOD) is starting to use the
Automated Neuropsychological Assessment Metric (ANAM). It is a
brief cognitive screening performed prior to deployment to
provide a baseline for comparison with tests performed when
members return home.
2:15:48 PM
Slide: Among 50 participants at a DVBIC facility study, there
were a lot of comorbid issues involved, which made diagnosis
difficult.
Slide: Captain Barker listed the three key elements to recovery.
Education and Reassurance: It is important to educate service
members, providers and the community before deployment, during
treatment and as victims recover.
2:17:09 PM
SENATOR DYSON said he represents Eagle River and Elmendorf as
part of his legislative district and offered to assist their
efforts in every way he can. He also said he would be glad to
hear about any increase in or improvement to existing community
services that they might need.
CAPTAIN BARKER said that Dr. Cherry would be speaking directly
to that as a provider in the community.
SENATOR DYSON said he would leave Captain Barker his card and
thanked him and those he represents for what they are doing.
2:18:51 PM
CAPTAIN BARKER continued his , pointing out that reassurance
must go along with education. Reassuring the active duty members
and their families that they will get better has a very positive
impact on recovery.
Barriers to recovery are:
° 60 days post-injury with ongoing high-stress duty
° Repeated injury
° Comorbid conditions such as PTSD, major depression, pain
disorders, substance abuse
2:20:23 PM
Treatment Issues: TBI versus PTSD
There is a lot of overlap between TBI and PTSD. The best way to
differentiate is that the symptoms that occur immediately after
the event are usually TBI related. PTSD usually does not
manifest until some time later, often after the member has
slowed down and is in a safer environment.
2:21:08 PM
CAPTAIN BARKER said that in June or July of last year they began
to educate providers and the community on TBI related issues in
preparation for the army soldiers who would soon be returning.
They joined forces with the Army and Air Force to set up a
clinic for the mild to moderate TBI problems they expected to
see and pulled in about 50 additional neurologists,
neuropsychologists, mental health, occupational and speech
therapy professionals to assist in this short-term fix. Since
thth
the soldiers from the 425 returned on about the 25 of January,
they have seen 100 patients through the neurologic clinic alone,
and expect to see many more when the "honeymoon phase" is over
and members are trying to reintegrate into their relationships
and civilian jobs. They are still trying to establish a long-
term, self-sustaining MTBI clinic.
2:23:57 PM
SENATOR ELTON said he assumed that the diagnosis of TBI was
based on symptoms rather than on physical testing such as an
MRI.
CAPTAIN BARKER said they are working toward a "whole person"
concept, trying to get the entire history of each person's
possible exposure to TBI-inducing accidents as well as looking
into PTSD issues. That means a lot of interviewing and multiple
types of testing in order to make as accurate a diagnosis as
possible.
SENATOR ELTON postulated that if a person diagnosed with TBI did
not improve over time, the diagnosis could evolve into PTSD.
CAPTAIN BARKER replied that it isn't that black and white; both
problems can exist at the same time. There was a study published
in the New England Journal of Medicine that said mild TBI has
significant impact on physical, functional and psychological
problems; but when you take into account depression and PTSD,
those factors dissipate. There is a lot of co-morbidity, so one
can't say with conviction that because the symptoms continue it
is something other than TBI.
2:26:56 PM
SENATOR THOMAS asked if any regular tests are routinely
administered after service overseas.
CAPTAIN BARKER said there are no standardized tests that a
person has to take. When an individual is exposed to a blast in
the field, they try to administer what is called the MACE, a
five minute evaluation of impulsivity, judgment and cognitive
processes. The PDHA is administered after returning to the
United States, but that is very subjective and can be
manipulated. A reassessment is performed 90 to 100 days after
the PDHA to see if anything has come up since initial testing.
SENATOR THOMAS asked if the two tests are standard operating
procedure.
CAPTAIN BARKER answered that the PDHA is, but the MACE is not.
SENATOR THOMAS asked if Captain Barker knows of any reason a
person might not mention symptoms, whether it might have an
affect on employment.
CAPTAIN BARKER said that is a myth, but would not say that it
had no basis in fact. There is also a stigma associated with
admitting weakness.
2:30:04 PM
SENATOR THOMAS opined that, because of that potential the
standard paperwork should be more specific and call for some
follow-up.
2:30:25 PM
STEPHANIE TANNER, Wife of Sergeant Scott Tanner, OIF Veteran,
gave a personal perspective of TBI. She said her husband was
exposed to over 30 IED explosions in Iraq. During the past year
and a half his mental capacity has declined rapidly. They sought
medical help and he was diagnosed with TBI in 2007. The case
manager assigned to him by the military is stretched very thin,
but she feels it would be extremely difficult, if not
impossible, for them to function without him through all of his
appointments, therapy and medications. She stressed that case
management is seriously needed for TBI patients.
2:32:45 PM
SENATOR ELTON asked if Ms. Tanner receives any services.
MRS. TANNER said that services are made available to her by
military, but so much of her day is spent dealing with her
husband's treatment that she has not been able to take advantage
of them.
SENATOR THOMAS asked Ms. Tanner if her husband was diagnosed
with TBI before or after returning from overseas.
MRS. TANNER replied that his Iraq deployment was from 2004 to
2005 and at that time the military did not recognize TBI as a
widespread problem; so he lived with it for a year and a half
before anyone recognized it, which has hindered his progress. It
has been shown that progress is severely impacted if TBI
patients don't get help and management within the first year.
2:34:16 PM
DR. RUSSELL S. CHERRY, Neuropsychologist, Providence Hospital,
said he would reiterate some stories to illustrate the
importance of TBI awareness. TBI is the most common cause of
injury for individuals aged 15 to 40. This is particularly
relevant in Alaska, because our rate statewide is seven times
the national average. In the bush, the rate of TBI is
approximately 14 times the national average.
He said that during the three years he worked at Alaska Native
Medical Center, he saw four to five patients per week who were
injured while driving ATVs and snow machines without a helmet.
He noted that alcohol is a factor in about half of all brain
injuries.
At Providence Hospital he sees about two mild cases of TBI each
day in which the patients' physical injuries are treated and
they are discharged to the street with no further follow-up.
Those people are often referred to his private practice six to
nine months later, when they've begun suffering problems in
their work or home life and TBI is identified. If there were a
better system of identification, many of those problems could be
prevented.
DR. CHERRY said he had seen 10 of the approximately 4000
veterans who returned from Iraq two weeks prior, and expected to
see much higher numbers as problems surfaced at home and at
work. He likened it to a tsunami approaching. This is not just a
cognitive injury; there are often psychiatric problems that
accompany it. Approximately 70 percent of those suffering from
TBI also suffer from clinical depression.
2:37:27 PM
DR. CHERRY said that as a rule, he also sees PTSD in the
military populations. He voiced frustration that, even though
Alaska leads the nation in incidents of TBI, there is no system
in place to deal with the problem.
2:38:54 PM
He found it curious that a number of medical issues such as
Alzheimer's, get much more attention and services than the one
that occurs most frequently in the population. One of the
effects of our lack of infrastructure is poor information
sharing between providers, which makes his job more difficult
because he has less access to supporting information. At
present, the onus of responsibility is on the injured person or
the care giver to manage the medical system. By definition TBI
patients have problems with attention, memory and multiple step
tasks, and typically can't follow through. A case manager or
coordinator could fill the gaps between providers, make sure
people get to appointments, help them complete the requisite
paperwork, and even present to the appointment with the patient.
2:41:17 PM
He said he often sees a brain injured person in his office with
no care-giver, no spouse and no other information. He has
nothing to go on but an interview with the patient, who may not
be able to relate the pertinent issues due to attention and
memory problems. Children in Alaska with moderate to severe TBI
are generally sent out of state, typically to Texas or
Wisconsin. They have to deal not only with recovery from brain
injury, but with loss of their support systems, which makes
recovery more difficult. In general, TBI creates a ripple affect
widening out from the victim, to the spouse, their children,
their workplaces and more.
Substance abuse is common because of depression, and people are
prone to additional injuries because of impaired judgment. They
may also be preyed upon financially by others. The cure is some
kind of case management, perhaps bachelor-level graduates to
make sure patients don't fall through the cracks, to help with
paperwork and make sure they get to appointments. It would
simplify things greatly if a standard packet providing step-by-
step information on what to do next were passed out at the ER or
other locations.
2:44:55 PM
DR. CHERRY also suggested that a network of providers with a
common release would make it easier to share information to the
advantage of the patient. He felt that we should to do a better
job of screening for brain injury in certain locations like the
ER, physical therapy or rehabilitation clinics. In the ER,
people are often treated for broken limbs and lacerations to the
head but no one looks at what happened to the brain. Vocational
rehabilitation specialists trained specifically in brain injury
would also be helpful, because victims of TBI have a different
set of circumstances than other populations, which may include
cognitive problems and emotional or impulse-control issues.
Because of their unique needs, they do best working with a
rehabilitation specialist who has been trained in TBI.
2:46:23 PM
Staff at assisted living facilities should be trained to
understand and manage TBI. Too often when patients are sent to
an assisted living facility, they come into conflict with staff
who responds inappropriately to their behavior because they
don't realize the person has a brain injury. The military has a
multidisciplinary clinic to help address the soldiers' needs,
but when their neuropsychologists and some other personnel leave
in a few months, they will be left without the ability to deal
with the problems that surface after they are gone. He would
like to see a partnership between the military and Providence or
other major local hospitals in the community, making sure that
everyone is "on the same page."
He suggested looking at telemedicine in the bush, to overcome
some of the transportation issues, and creating liaisons with
the Anchorage school district and the mental health and wellness
courts so victims could be identified to the systems, allowing
them to better cope with the issues.
2:49:18 PM
DR. CHERRY felt that with a few relatively simple interventions,
we could make a huge difference in the quality of life of the
patients, their family members, and the community at large.
2:49:31 PM
CHAIR DAVIS asked if there were any support groups for TBI.
2:49:56 PM
MS. HODGES said Access Alaska has head injury support groups
around the state and has opened up their groups to the military.
Margie Thompson with the Department of Labor (DOL), and Jeff
Irwin with Southeast Alaska Independent Living (SAIL) facilitate
the head injury support group in Juneau, which is one of the
most active support groups in the state.
CHAIR DAVIS asked if Ms. Thompson is a volunteer or if it is
part of her job.
MS. HODGES answered that she thinks it is a component of her
job.
CHAIR DAVIS said it would be good for Ms. Hodges to provide the
committee with a list of what help she would like the
legislature to provide so they can be working on it.
MS. HODGES said Virginia has done a phenomenal job of funding
through the General Fund and through Medicaid with a Traumatic
Brain Injury Waiver. Their reports show that case management and
clubhouse programs offer the most bang for the buck. She said
that they do have some budget and program requests that she
would like to see in this year's budget. Governor Palin's budget
contains a small line-item of $100,000 for brain injury training
for providers.
She explained that BIN advocates to the four statutory boards:
the Commission on Aging, the Advisory Board on Alcohol and Drug
Abuse, the Governor's Council and the Mental Health Board, and
asks these boards to make recommendations to the Mental Health
Trust Authority on behalf of brain injury. The Trust approved
four requests for the current year. In the Trust budget are
$25,000 to enhance information and referral and $175,000 for
training, which was reduced in the governor's budget. Within the
Housing Focus Area they had a GFMH budget recommendation of
$200,000 for brain injury services development to start the
momentum within the department. That amount was not included in
Governor Palin's budget.
2:54:31 PM
She would like to see those Trust Authority budget
recommendations moved into the legislative budget. The $200,000
would go toward the case management component for the current
year. She referred to the "Promising Practices for State
Systems" document, pointing to continuum of care models for
brain injury, information on where the funding should come from
and on how they work throughout the lifetime of a person with
brain injury. The rehabilitation component is a maximum of two
years, after which the person is on his or her own. These people
need places to go where they can be socially appropriate,
productive, and develop confidence in themselves.
2:55:58 PM
MS. HODGES related the story of a young man they met in Texas
last November at a long-term home for people with cognitive
disabilities. Corey had an ATV accident in Kotzebue at age 10
and was sent to Texas because he had severe TBI. He was 26 when
they met him and was doing well in Texas; but people like Corey
are able to function at a level that is appropriate only when
they have the right supports and are living in the right
environment. Without those supports, people like Corey are
unable to function appropriately in society and may cause
problems for themselves and society as well.
2:57:43 PM
CHAIR DAVIS asked for a list of the things Ms. Hodges would like
to see in the budget and things that need to be discussed in the
community. She mentioned that she was recently at a meeting
about TBI where they introduced the idea of a "Club House" and
was impressed with the concept. She felt that, given the high
rate of injury in Alaska, a lot of work has yet to be done.
2:58:50 PM
SENATOR ELTON said if something like this happened in his family
the first thing he would want to know is whether their insurance
would cover it, which leads into a larger discussion of mental
health parity. He asked how the insurance industry looks at it,
whether it is considered a mental health issue or a medical one.
DR. CHERRY responded that neuropsychological evaluations are
billed under medical codes, so mental health parity is not an
issue. It can become sticky is later on, if clinically
significant depression or anxiety comes into play during the
treatment phase Sometimes the insurance company can create
problems with that. He invited the committee to imagine trying
to navigate that insurance system with a brain injury.
3:00:44 PM
SENATOR ELTON said it seems that the insurance industry might be
reluctant to pay for case management that would, in the end,
cost them money.
DR. CHERRY explained that, although it would cost them money at
the onset, according to statistical research, a strong argument
could be made that if you provide people with the right services
during the acute phases of recovery from brain injury, their
productivity and ability to regain function is significantly
improved. It is in the first two years after the injury that
things are reconnecting and intervention has its greatest
effect.
3:02:07 PM
SENATOR McGUIRE highlighted the importance of that in her
family. It ultimately saved the insurance company money to
provide her brother with treatment for two years. The point at
which he was relearning to tie his shoes and use the bathroom on
his own is when a regular insurance policy would have stopped
paying. The cost to the system of sending a young man out into
the world without even the most basic life skills would be
tremendous. She said she looks forward to working with Senator
Davis and the committee to see what they can build. It would
benefit not only the families and survivors of brain injury, but
save the state money as well.
3:04:21 PM
SENATOR THOMAS said this doesn't seem to be an unusual
situation, that they too often deal with problems rather than
solutions in this committee. He encouraged Dr. Cherry to put
together a list of concepts he thinks should be incorporated
into existing statute.
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 3:05:12 PM.
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