Legislature(2013 - 2014)BUTROVICH 205

02/21/2014 01:30 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 169 STATEWIDE IMMUNIZATION PROGRAM TELECONFERENCED
Heard & Held
*+ SB 162 HYDROCODONE PRESCRIPTION BY OPTOMETRISTS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
= SB 161 AUTOPSIES AND DEATH CERTIFICATES
Moved SB 161 Out of Committee
= SB 151 HIGH-RISK CHEMICALS FOR CHILD EXPOSURE
Moved SB 151 Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 21, 2014                                                                                        
                           1:31 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Bert Stedman, Chair                                                                                                     
Senator Peter Micciche, Vice Chair                                                                                              
Senator Kevin Meyer                                                                                                             
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Pete Kelly                                                                                                              
Senator Johnny Ellis                                                                                                            
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 169                                                                                                             
"An  Act establishing  in  the Department  of  Health and  Social                                                               
Services a  statewide immunization program and  the State Vaccine                                                               
Assessment  Commission; creating  a  vaccine assessment  account;                                                               
requiring a  fee assessment from  health care insurers  and other                                                               
program  participants   for  statewide   immunization  purchases;                                                               
repealing  the temporary  child and  adult immunization  program;                                                               
and providing for an effective date."                                                                                           
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 162                                                                                                             
"An  Act  authorizing  a  licensed  optometrist  to  prescribe  a                                                               
pharmaceutical agent containing hydrocodone."                                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 161                                                                                                             
"An Act  relating to duties  and procedures of the  state medical                                                               
examiner and  the Department of  Health and Social  Services; and                                                               
relating to death certificates."                                                                                                
                                                                                                                                
     - MOVED SB 161 OUT OF COMMITTEE                                                                                            
                                                                                                                                
SENATE BILL NO. 151                                                                                                             
"An  Act relating  to  chemicals  that are  of  high concern  for                                                               
children and to  the manufacture and sale  of products containing                                                               
certain  flame retardant  chemicals;  relating  to an  interstate                                                               
chemicals  clearinghouse; adding  an unlawful  act to  the Alaska                                                               
Unfair Trade Practices and Consumer Protection Act; and                                                                         
providing for an effective date."                                                                                               
                                                                                                                                
     - MOVED SB 151 OUT OF COMMITTEE                                                                                            
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 169                                                                                                                  
SHORT TITLE: STATEWIDE IMMUNIZATION PROGRAM                                                                                     
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
02/10/14       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/10/14       (S)       HSS                                                                                                    
02/21/14       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 162                                                                                                                  
SHORT TITLE: HYDROCODONE PRESCRIPTION BY OPTOMETRISTS                                                                           
SPONSOR(s): SENATOR(s) OLSON                                                                                                    
                                                                                                                                
02/07/14       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/07/14       (S)       HSS                                                                                                    
02/21/14       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 161                                                                                                                  
SHORT TITLE: AUTOPSIES AND DEATH CERTIFICATES                                                                                   
SPONSOR(s): SENATOR(s) OLSON                                                                                                    
                                                                                                                                
02/07/14       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/07/14       (S)       HSS                                                                                                    
02/19/14       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/19/14       (S)       Heard & Held                                                                                           
02/19/14       (S)       MINUTE(HSS)                                                                                            
                                                                                                                                
BILL: SB 151                                                                                                                  
SHORT TITLE: HIGH-RISK CHEMICALS FOR CHILD EXPOSURE                                                                             
SPONSOR(s): SENATOR(s) OLSON                                                                                                    
                                                                                                                                
01/31/14       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/31/14       (S)       HSS, JUD                                                                                               
02/19/14       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/19/14       (S)       Heard & Held                                                                                           
02/19/14       (S)       MINUTE(HSS)                                                                                            
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SENATOR CATHY GIESSEL                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of SB 169.                                                                                        
                                                                                                                                
JANE CONWAY, Staff                                                                                                              
Senator Cathy Giessel                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Described the changes in SB 169 on behalf of                                                              
the sponsor.                                                                                                                    
                                                                                                                                
WARD HURLBERT, Chief Medical Officer                                                                                            
Division of Public Health                                                                                                       
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided information related to SB 169.                                                                   
                                                                                                                                
ROSALYN SINGLETON, Physician                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 169.                                                                           
                                                                                                                                
LILY LOU, M.D., Medical Director                                                                                                
Newborn Intensive Care Unit                                                                                                     
Providence Children's Hospital                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 169.                                                                           
                                                                                                                                
PATRICIA SENNER, Director                                                                                                       
Professional Practices                                                                                                          
Alaska Nurses Association                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 169.                                                                           
                                                                                                                                
RANDI SWEET, representing herself                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 169.                                                                           
                                                                                                                                
AMY DRESSEL, Pediatrician                                                                                                       
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 169.                                                                           
                                                                                                                                
DAVE SCOTT, Staff                                                                                                               
Senator Donny Olson                                                                                                             
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented information on SB 162, SB 161, and                                                              
SB 151 on behalf of the sponsor.                                                                                                
                                                                                                                                
MICHAEL BENNETT, Optometrist                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 162.                                                                           
                                                                                                                                
RACHEL REINHARDT, Ophthalmologist                                                                                               
American Academy of Ophthalmology                                                                                               
Seattle, Washington                                                                                                             
POSITION STATEMENT: Testified in opposition to SB 162.                                                                        
                                                                                                                                
STEVEN DOBSON, Optometrist                                                                                                      
Alaska Optometric Association                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 162.                                                                           
                                                                                                                                
JEFF GONNASON, Optometrist                                                                                                      
Alaska Optometry Association                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 162.                                                                           
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:31:55 PM                                                                                                                    
CHAIR BERT STEDMAN  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:31 p.m.  Present at the                                                               
call to order were Senators Micciche, Meyer, and Chair Stedman.                                                                 
                                                                                                                                
             SB 169-STATEWIDE IMMUNIZATION PROGRAM                                                                          
                                                                                                                                
1:32:41 PM                                                                                                                    
CHAIR STEDMAN  announced that the  first order of  business would                                                               
be SB  169. He  said it  is the  first hearing  on the  bill. The                                                               
intent is to  adopt a new Committee Substitute,  have the sponsor                                                               
introduce the bill, take public  testimony, and then set the bill                                                               
aside for further review.                                                                                                       
                                                                                                                                
1:32:47 PM                                                                                                                    
SENATOR  MEYER moved  to adopt  the CS  for SB  169, labeled  28-                                                               
LS1219\P, as the working document.                                                                                              
                                                                                                                                
CHAIR STEDMAN objected for discussion purposes.                                                                                 
                                                                                                                                
SENATOR CATHY GIESSEL, Alaska  State Legislature, Juneau, Alaska,                                                               
sponsor of  SB 169, introduced the  bill. She stated that  SB 169                                                               
would permanently  put the  state vaccine  program in  place with                                                               
monies  other than  the  state's money.  She  related that  after                                                               
Senator  Stevens left  the U.S.  Senate, the  Center for  Disease                                                               
Control changed how  they viewed Alaska. Alaska  had been getting                                                               
$4.3  million per  year to  provide vaccines  for all  residents.                                                               
That  funding  decreased  to $700,000.  The  state's  vaccination                                                               
program  was   greatly  curtailed.  She  recalled   the  vaccine-                                                               
preventable diseases that the program targeted.                                                                                 
                                                                                                                                
SENATOR GIESSEL  related that two  years ago, after  hearing this                                                               
same bill, the  state funded the program for $4  million per year                                                               
for 3 years. At the end of  3 years, the Department of Health and                                                               
Social Services  (DHSS) was  charged with finding  a way  to fund                                                               
the  program,   in  collaboration  with  the   state's  insurance                                                               
companies. She said that is what this bill does.                                                                                
                                                                                                                                
1:35:45 PM                                                                                                                    
JANE  CONWAY,   Staff,  Senator   Cathy  Giessel,   Alaska  State                                                               
Legislature, Juneau, Alaska,  described the changes in  SB 169 on                                                               
behalf of the sponsor. She said  changes were made from version O                                                               
to version  P, the current CS.  She noted the original  bill used                                                               
the  name "State  Vaccine Assessment  Commission"  for the  group                                                               
being set  up to  administer the vaccine  program. That  name was                                                               
changed to  the "State  Vaccine Assessment  Council" so  it would                                                               
not be confused with the  current "State Health Care Commission."                                                               
All throughout  the bill the  term was changed. Another  term was                                                               
changed in  version P; "health  care insurer" was changed  to "an                                                               
assessable entity"  for a  broader usage.  It is  a term  used by                                                               
other states for their vaccine assessment programs.                                                                             
                                                                                                                                
MS. CONWAY referred  to page 5, line 18; the  manner in which the                                                               
definition  "assessable  entity"  is written  is  different  than                                                               
version O, but  is using the same reference by  definition and it                                                               
encompasses  the  detail  list  from  version  O.  This  language                                                               
recommended by legislative legal services.                                                                                      
                                                                                                                                
CHAIR STEDMAN removed his objection  to adopting version P. There                                                               
being no objection, version P was before the committee.                                                                         
                                                                                                                                
1:38:10 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:39:42 PM                                                                                                                    
SENATOR  MEYER   inquired  about  the  change   in  wording  from                                                               
"commission"  to "council."  He  asked if  the  council would  be                                                               
treated like a commission in the  sense that people from all over                                                               
the state make up the members,  they meet on a regular basis, and                                                               
are subject to an audit.                                                                                                        
                                                                                                                                
MS.  CONWAY  explained  that  the  council is  a  group  that  is                                                               
appointed  by the  commissioner of  Public  Health; it  is not  a                                                               
board. The  council will meet throughout  the year to set  up the                                                               
program  and  assess  the  entities. They  will  work  under  the                                                               
auspices  of DHSS  and they  will serve  without compensation  or                                                               
reimbursement.                                                                                                                  
                                                                                                                                
SENATOR MEYER  asked if they would  serve at the pleasure  of the                                                               
commissioner.                                                                                                                   
                                                                                                                                
MS.  CONWAY said  the commissioner  of DHSS  would appoint  an 8-                                                               
member board.                                                                                                                   
                                                                                                                                
1:42:04 PM                                                                                                                    
WARD HURLBERT, Chief Medical Officer,  Division of Public Health,                                                               
Department of Health and Social  Services (DHSS), Juneau, Alaska,                                                               
provided  information related  to SB  169. He  shared a  story to                                                               
highlight the vast  changes from vaccinations in  Alaska. He said                                                               
in 1953  in Ketchikan there were  93 cases of polio,  83 of which                                                               
were  paralytic. Today,  a woman  came  in and  was resistant  to                                                               
having her  child immunized because  she did not know  what polio                                                               
was. He  told a story about  a measles outbreak in  Dillingham in                                                               
1961 when children  died from the disease. He said  it has been a                                                               
long  time since  an Alaskan  has been  lost to  measles, due  to                                                               
vaccinations.                                                                                                                   
                                                                                                                                
DR.   HURLBERT   shared   data   about   the   effectiveness   of                                                               
vaccinations.  The flu  vaccine is  only about  50 percent  to 60                                                               
percent  effective  for  those  over  65  years  old.  Worldwide,                                                               
smallpox no longer  exists. It is nearly the same  with polio. He                                                               
concluded that immunizations have made a big difference.                                                                        
                                                                                                                                
1:44:56 PM                                                                                                                    
He explained  that the proposed  methodology in the bill  is used                                                               
by 9  other states. He called  it a "win/win" because  the payers                                                               
have  to pay  less because  the  state will  buy vaccinations  at                                                               
wholesale rates. The  modest surcharge will pay  for vaccines for                                                               
underinsured  children.  About five  years  ago  Alaska was  49th                                                               
among  states  in immunization  rates  for  ages two  and  under.                                                               
Currently, Alaska  is 37th or 38th  and about 65 percent  of kids                                                               
are immunized.  He predicted that this  legislation would improve                                                               
these numbers much like New Hampshire was able to do.                                                                           
                                                                                                                                
1:46:29 PM                                                                                                                    
ROSALYN   SINGLETON,  M.D.,   representing  herself,   Anchorage,                                                               
Alaska, testified  in support of  SB 169.  She called the  bill a                                                               
cost-saving model which  will improve access to  vaccines for all                                                               
Alaskans,  streamline the  distribution of  vaccines, and  reduce                                                               
the huge  administrative burden  that health  providers currently                                                               
have. She  said vaccinations demonstrated the  dramatic effect of                                                               
reducing Hepatitis A  from the highest to the lowest  rate in the                                                               
country. Also, Alaska has been free of measles since 2000.                                                                      
                                                                                                                                
She said Alaska's  expanse challenges the ability  to provide on-                                                               
time immunizations, so ready access  to vaccines is critical. Due                                                               
to   the  administrative   burden,   some   providers  in   small                                                               
communities  no  longer  can  provide   all  of  the  recommended                                                               
vaccines due  to having to  front costs and keep  separate stocks                                                               
of vaccine  from state and  private purchases. She  remarked that                                                               
she  has received  calls from  providers and  parents who  cannot                                                               
access vaccines.                                                                                                                
                                                                                                                                
She  said   other  states  have  experienced   cost  savings  and                                                               
streamlined  distribution when  using  the model  the bill  would                                                               
create.                                                                                                                         
                                                                                                                                
1:49:28 PM                                                                                                                    
LILY LOU,  M.D., Medical Director,  Newborn Intensive  Care Unit,                                                               
Providence Children's  Hospital, Anchorage, Alaska,  testified in                                                               
support of  SB 169. She shared  that she is the  president of the                                                               
Alaska Chapter  of the American  Academy of Pediatrics  (AAP) and                                                               
the District 8 representative, for  the Western United States and                                                               
Canada,  to  the  executive  committee  of  the  AAP  section  on                                                               
perinatal pediatrics. She  said she is speaking  as an individual                                                               
in  favor   of  the  bill   for  four  reasons.  First,   is  the                                                               
effectiveness of  vaccines, second,  is good  stewardship, third,                                                               
is access to care, and fourth, is the future.                                                                                   
                                                                                                                                
DR. LOU  related that  the prevention  of infectious  diseases by                                                               
immunization has  been one  of the  most significant  advances in                                                               
health care  in human history.  She shared statistics  related to                                                               
16 measles outbreaks in 2011, the  cost of which was estimated to                                                               
be $5.3  million. She maintained  that vaccinations  will protect                                                               
everyone and  a universal  purchase program  will likely  lead to                                                               
savings.                                                                                                                        
                                                                                                                                
She said  a vaccine  assessment account will  allow the  state to                                                               
benefit  from  volume  purchasing at  discounted  federal  rates.                                                               
Other states have shown significant  savings and have streamlined                                                               
the process.  The new  system will provide  more access  to care,                                                               
especially in  small communities.  It will  also have  a positive                                                               
effect on the future.                                                                                                           
                                                                                                                                
1:54:04 PM                                                                                                                    
PATRICIA SENNER, Director,  Professional Practices, Alaska Nurses                                                               
Association, Anchorage,  Alaska, testified in support  of SB 169.                                                               
She  spoke  of  frustrations  she   has  experience  as  a  nurse                                                               
practitioner providing  immunizations since the state  moved away                                                               
from universal coverage.  She said she had to  keep separate sets                                                               
of  vaccines for  those eligible  and not  eligible for  vaccines                                                               
through the  state. That made  for increased costs  and increased                                                               
administrative difficulties, as well as for waste.                                                                              
                                                                                                                                
1:55:54 PM                                                                                                                    
RANDI SWEET,  representing herself, Anchorage,  Alaska, testified                                                               
in support of SB 169.                                                                                                           
                                                                                                                                
1:56:37 PM                                                                                                                    
AMY DRESSEL,  Pediatrician, Juneau, Alaska, testified  in support                                                               
of SB 169.  She listed many reasons for supporting  the bill. She                                                               
said  vaccines are  very expensive  and there  are problems  with                                                               
access. The  bill helps all vaccine-eligible  children in Alaska.                                                               
Alaska is lowest  on the national vaccine record.  The bill would                                                               
help  all  Alaskans,  provide   favorable  rates,  and  universal                                                               
access, decrease the  administrative burden, and make  for a more                                                               
efficient system.                                                                                                               
                                                                                                                                
1:59:06 PM                                                                                                                    
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
CHAIR STEDMAN  detailed five fiscal  notes: one fiscal  note that                                                               
reflects the fund transfer to  the new vaccine assessment account                                                               
in  the  amount  of  $4,496,000  from  an  appropriation  in  the                                                               
Governor's current  FY 15 budget;  one net zero fiscal  note from                                                               
the  Department  of Health  and  Social  Services (DHSS),  Public                                                               
Health Division,  showing the  program's expenses  of $26,950,000                                                               
and the  same amount  in program  revenue; and  one indeterminate                                                               
fiscal note  from the  Department of  Health and  Social Services                                                               
(DHSS), Medicaid Service Division; one  zero fiscal note from the                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED); and  one indeterminate fiscal  note from  the Department                                                               
of Administration.                                                                                                              
                                                                                                                                
2:00:34 PM                                                                                                                    
SENATOR MICCICHE asked if it was  an initial $4.4 million to fund                                                               
the  program  and   then  about  $33,000  in  fees   to  make  it                                                               
sustainable.                                                                                                                    
                                                                                                                                
MS. CONWAY clarified that $4 million  is left over in the vaccine                                                               
program  now and  will  be  transferred to  the  new model.  That                                                               
amount will  help to  purchase the initial  vaccine for  the next                                                               
year. The department  will then use a formula to  assess how many                                                               
vaccines will be needed statewide  and purchase them in bulk with                                                               
money from the assessable entities.  After the initial $4 million                                                               
the program becomes funded by insurance payers.                                                                                 
                                                                                                                                
SENATOR MICCICHE  stated that $4.4  million is  leftover previous                                                               
funding.                                                                                                                        
                                                                                                                                
MS. CONWAY said correct.                                                                                                        
                                                                                                                                
CHAIR STEDMAN held SB 169 in committee.                                                                                         
                                                                                                                                
        SB 162-HYDROCODONE PRESCRIPTION BY OPTOMETRISTS                                                                     
                                                                                                                                
2:02:55 PM                                                                                                                    
CHAIR STEDMAN announced that the  next order of business would be                                                               
SB 162.  He said it  is the first hearing  on SB 162.  The intent                                                               
today  is to  have the  sponsor introduce  the bill,  take public                                                               
testimony, and set the bill aside for further review.                                                                           
                                                                                                                                
2:03:34 PM                                                                                                                    
DAVID   SCOTT,  Staff,   Senator   Donny   Olson,  Alaska   State                                                               
Legislature, Juneau,  Alaska, presented SB  162 on behalf  of the                                                               
sponsor.  He  explained  that  the  bill  would  retain  licensed                                                               
optometrists'  authority to  prescribe  hydrocodone to  patients.                                                               
Currently,  on  the   federal  level,  there  is   an  effort  to                                                               
reschedule  hydrocodone from  Schedule  III to  Schedule II.  The                                                               
sponsor  does not  want  there  to be  a  lapse in  optometrists'                                                               
ability to treat  their patients. He emphasized that  SB 162 does                                                               
not increase the scope of the practice of optometry.                                                                            
                                                                                                                                
He noted that  the sponsor is aware of the  concern regarding the                                                               
nationwide  epidemic of  prescription painkiller  abuse. He  drew                                                               
attention to  page 1, lines  13 and 14,  of the bill  which state                                                               
that the prescription cannot exceed four days.                                                                                  
                                                                                                                                
He  highlighted new  language on  page 1,  lines 11  and 12  that                                                               
ensures there  is no lapse  in the current practice  of optometry                                                               
to prescribe hydrocodone.                                                                                                       
                                                                                                                                
CHAIR  STEDMAN  said there  is  one  zero  fiscal note  from  the                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED).                                                                                                                        
                                                                                                                                
SENATOR MEYER asked what kind of drug hydrocodone is.                                                                           
                                                                                                                                
MR. SCOTT  explained is commonly  referred to Vicodin when  it is                                                               
mixed with acetaminophen and is a painkiller.                                                                                   
                                                                                                                                
SENATOR MEYER asked if the bill only pertains to optometrists.                                                                  
                                                                                                                                
MR.  SCOTT  said yes.  Other  medical  professionals already  can                                                               
prescribe hydrocodone.                                                                                                          
                                                                                                                                
SENATOR  MEYER questioned  if  the bill  should  be broadened  to                                                               
other medical professions.                                                                                                      
                                                                                                                                
MR. SCOTT  explained that physicians already  can prescribe these                                                               
medications. Hydrocodone is the  only painkiller optometrists can                                                               
prescribe.                                                                                                                      
                                                                                                                                
2:07:11 PM                                                                                                                    
SENATOR MICCICHE agreed with the  previous answer. He inquired if                                                               
the bill limits the prescription to one four-day quantity.                                                                      
                                                                                                                                
MR. SCOTT read from page 1,  lines 13 and 14, "the pharmaceutical                                                               
agent .  . .  is prescribed  in a quantity  that does  not exceed                                                               
four days of prescribed use if it is a controlled substance."                                                                   
                                                                                                                                
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
2:07:56 PM                                                                                                                    
MICHAEL  BENNETT,  Optometrist,   Juneau,  Alaska,  testified  in                                                               
support  of   SB  162.  He   clarified  that  when   the  initial                                                               
pharmaceutical   bill  for   optometry   was   passed  in   2007,                                                               
optometrists were restricted to  Schedule III narcotics, of which                                                               
Vicodin  is the  drug  of  choice. They  were  not authorized  to                                                               
prescribe  Schedule II  narcotics, such  as oxycontin,  with even                                                               
more  abuse  potential.  He  explained  that  if  the  FDA  moves                                                               
hydrocodone  into  a  Schedule  II  classification,  optometrists                                                               
would not have a drug to prescribe for acute, severe pain.                                                                      
                                                                                                                                
He pointed  out that hydrocodone is  used relatively infrequently                                                               
in  eye care  practice.  It is  used for  eye  trauma. Eyes  heal                                                               
quickly and only  a short-term prescription is  required. If pain                                                               
management  is  required  for  longer  periods,  the  patient  is                                                               
referred to a higher level of  care. It is also used for chemical                                                               
injuries  and  an acute  form  of  glaucoma frequently  found  in                                                               
American Eskimos.                                                                                                               
                                                                                                                                
He emphasized  that SB  162 is not  an expansion  of prescriptive                                                               
authority  that has  been in  place for  seven years.  There have                                                               
been no reports  of issues or incidents to the  state board or to                                                               
the DEA.                                                                                                                        
                                                                                                                                
2:10:55 PM                                                                                                                    
RACHEL   REINHARDT,   Ophthalmologist,    American   Academy   of                                                               
Ophthalmology,  Seattle, Washington,  testified in  opposition to                                                               
SB 162.  She said there  is a  national crisis for  drug overdose                                                               
deaths related to  prescription narcotics. The FDA  is making the                                                               
recommendation  to change  hydrocodone-containing narcotics  to a                                                               
more  restrictive class  -  Schedule  II. There  has  been a  300                                                               
percent increase  in the sale  of these prescriptions  since 1999                                                               
and a  five-fold increase in  the death rate. Alaska  ranks fifth                                                               
of  all states  for prescription  narcotic overdose  deaths, more                                                               
than  twice  the   national  average  for  the   death  rate  for                                                               
prescription  overdoses.  Hydrocodone  is  the  number  one  drug                                                               
abused. The point is to restrict  the number of providers who can                                                               
prescribe hydrocodone.                                                                                                          
                                                                                                                                
She  contested  the uses  of  hydrocodone  for optometrists.  She                                                               
noted a  similar bill was  defeated in Washington  and maintained                                                               
that  SB 162  is premature.  She  concluded that  $72 billion  is                                                               
spent every  year on medical  costs associated  with prescription                                                               
overdoses. The bill  sets a precedent for  mid-level providers to                                                               
request an  exception, undercutting the research  related to drug                                                               
deaths.                                                                                                                         
                                                                                                                                
2:17:14 PM                                                                                                                    
STEVEN  DOBSON,   Optometrist,  Alaska   Optometric  Association,                                                               
Anchorage,  Alaska,  testified in  support  of  SB 162.  He  said                                                               
optometrists have  been able to  prescribe a limited  quantity of                                                               
hydrocodone  for  the past  seven  years  for the  management  of                                                               
acute,  severe ocular  pain  due to  injuries  or infections.  He                                                               
maintained that  the potential for  abuse is with  chronic, long-                                                               
term recurrent  pain management conditions. The  bill would allow                                                               
optometrists to  continue to prescribe hydrocodone  compounds for                                                               
a  limited period  and for  limited use  without expanding  their                                                               
current scope of practice. He  stressed that this medication is a                                                               
god-send  for  extreme  ocular  pain.  He shared  a  story  of  a                                                               
patient's pain and the benefit of relief.                                                                                       
                                                                                                                                
2:20:13 PM                                                                                                                    
SENATOR  MICCICHE shared  the concern  for hydrocodone  abuse. He                                                               
asked if there is another compound that could be used.                                                                          
                                                                                                                                
DR. DOBSON said in the case  he just gave there is no substitute.                                                               
He pointed  out that due  to the geographic broadness  of Alaska,                                                               
optometrists  are  often  the  front line  for  urgent  eye  care                                                               
emergencies. He agreed that there  is a problem with prescription                                                               
drug abuse, but maintained that  it is not from optometric urgent                                                               
eye care because it is so  specific and for such a limited amount                                                               
of time.                                                                                                                        
                                                                                                                                
2:21:47 PM                                                                                                                    
JEFF   GONNASON,  Optometrist,   Alaska  Optometry   Association,                                                               
Anchorage, Alaska, testified  in support of SB 162.  He defined a                                                               
controlled substance as  a drug or chemical that  is regulated by                                                               
the  government.  He  said  they   are  classified  according  to                                                               
Schedules, with  Schedule I being  the highest for  potential for                                                               
abuse. For  example, Schedule II  drugs require  more restrictive                                                               
regulations  than  Schedule  III  drugs to  help  prevent  abuse.                                                               
Fourteen years  ago the  Alaska Legislature  authorized qualified                                                               
optometrists  to  prescribe   medication  including  Schedule  II                                                               
drugs, but the  governor at the time vetoed the  bill. In 2007, a                                                               
new bill  was signed  into law with  the current  restrictions of                                                               
only Schedule  III, IV, and V,  not including Schedule II,  and a                                                               
restriction  of  only  supplying  a maximum  4-day  supply  of  a                                                               
controlled substance.                                                                                                           
                                                                                                                                
He  explained   that  Alaska  therapeutic  optometrists   have  a                                                               
registered DEA number on file with  the state. There have been no                                                               
instances of  abuse or complaints  or actions by the  state board                                                               
or  any other  drug  enforcement agency.  The  bill is  necessary                                                               
because the  FDA is recommending reclassifying  hydrocodone and a                                                               
vital tool  for managing pain will  be taken away. He  noted that                                                               
he  met with  two ophthalmologists  who had  no objection  to the                                                               
bill; neither wanted  to rekindle old turf  battles. He concluded                                                               
that SB 162 does not change anything; it keeps status quo.                                                                      
                                                                                                                                
2:25:54 PM                                                                                                                    
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
CHAIR STEDMAN held SB 162 in committee.                                                                                         
                                                                                                                                
            SB 161-AUTOPSIES AND DEATH CERTIFICATES                                                                         
                                                                                                                                
2:26:43 PM                                                                                                                    
CHAIR STEDMAN announced that the  next order of business would be                                                               
SB  161. He  reminded the  committee that  SB 161  was previously                                                               
heard on  February 19  when the sponsor  introduced the  bill and                                                               
public testimony was taken.                                                                                                     
                                                                                                                                
DAVID   SCOTT,  Staff,   Senator   Donny   Olson,  Alaska   State                                                               
Legislature, Juneau,  Alaska, reviewed  SB 161  on behalf  of the                                                               
sponsor. He said the purpose of  the bill is to add compassion to                                                               
the process  of how  the Alaska  State Medical  Examiner's Office                                                               
deals with  the transportation of remains,  specifically in rural                                                               
Alaska. The old forms directed  families toward expensive funeral                                                               
homes which were not necessary. He  mentioned that the bill has a                                                               
new zero fiscal note.                                                                                                           
                                                                                                                                
CHAIR  STEDMAN noted  the bill  would  go to  the Senate  Finance                                                               
Committee next.                                                                                                                 
                                                                                                                                
2:28:54 PM                                                                                                                    
SENATOR  MEYER  moved  to  report  SB  161  from  committee  with                                                               
individual recommendations and attached zero fiscal note.                                                                       
                                                                                                                                
CHAIR  STEDMAN announced  that without  objection,  SB 161  moves                                                               
from the Senate Health and Social Services Standing Committee.                                                                  
                                                                                                                                
                                                                                                                              
         SB 151-HIGH-RISK CHEMICALS FOR CHILD EXPOSURE                                                                      
                                                                                                                                
2:29:40 PM                                                                                                                    
CHAIR STEDMAN  announced that the  final order of  business would                                                               
be SB 151.  He noted it was  the second hearing on  the bill. The                                                               
sponsor introduced  the bill  and public  testimony was  taken at                                                               
the February 19 meeting.                                                                                                        
                                                                                                                                
DAVID   SCOTT,  Staff,   Senator   Donny   Olson,  Alaska   State                                                               
Legislature, Juneau,  Alaska, reviewed  SB 151  on behalf  of the                                                               
sponsor.  He  explained  that  the  purpose of  the  bill  is  to                                                               
prohibit   products   containing   chlorinated  tris,   a   flame                                                               
retardant. It would also require  the Department of Environmental                                                               
Conservation to publish  a list of chemicals of  high concern for                                                               
children, to periodically update the  list, and to participate in                                                               
the Interstate Chemicals Clearinghouse.                                                                                         
                                                                                                                                
2:30:52 PM                                                                                                                    
SENATOR MEYER asked if other states participate in this program.                                                                
                                                                                                                                
MR. SCOTT said  they do and he  offered to provide a  list of the                                                               
states.                                                                                                                         
                                                                                                                                
SENATOR MICCICHE commented that  research shows the chemicals are                                                               
problematic   to  the   health   of  young   people.  He   voiced                                                               
appreciation for the bill.                                                                                                      
                                                                                                                                
SENATOR MICCICHE moved to report SB 151 from committee with                                                                     
individual recommendations and attached fiscal notes.                                                                           
                                                                                                                                
CHAIR STEDMAN announced that without objection, SB 151 is                                                                       
reported from Senate Health and Social Services Standing                                                                        
Committee.                                                                                                                      
                                                                                                                                
2:32:42 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Stedman adjourned the Senate Health and Social Services                                                                   
Standing Committee at 2:32 p.m.                                                                                                 

Document Name Date/Time Subjects
CSSB169 vsn P.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 3 Support Letters.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 DCCED fiscal note.pdf HHSS 4/8/2014 3:00:00 PM
SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 DHSS fiscal note #2.pdf HHSS 4/8/2014 3:00:00 PM
SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 DHSS fiscal note.pdf HHSS 4/8/2014 3:00:00 PM
SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 DOA fiscal note.pdf HHSS 4/8/2014 3:00:00 PM
SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 Fund Transfers fiscal note.pdf HHSS 4/8/2014 3:00:00 PM
SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 Dr. Brown support letter.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 Support Atwood.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 Support Brand.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 Support Letters.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 Support Singleton.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 vsn O.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 AKVax ScheduleKids.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 Sectional Analysis.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 Sponsor Statement Immunization Program.pdf HHSS 4/8/2014 3:00:00 PM
SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 Support Anch Pediatric.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 Support Jacob.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 Support Woodard.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 Vaccines In AK short vsn.pptx SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 VaxBenefit CostRatio.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 VaxFundsNonFedMap Adults_AIM.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 VaxFundsNonFedMapKids_AIM.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 VaxSupply MapKids_AIM.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169 WhoPaysFor VaccineInAK.pdf HHSS 4/8/2014 3:00:00 PM
SHSS 2/21/2014 1:30:00 PM
SB 169
SB169FAQ1pg_16Feb2014.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB169FlowChart10_Feb2014.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 162 - Blower support.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 - Dobson support letter.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 - Epidemiology bulletin.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 - FDA announcement.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 - Lentfer support.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 - Sponsor Statement.docx SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 AAO letter.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 AK Optometric Assoc support letter.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 ASAM letter.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
SB 162 DCCED fiscal note.pdf SHSS 2/21/2014 1:30:00 PM
SB 162
AK SB 169_BIO Letter_2 21 14 Final.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
SB 169 AaNA and Dr. Lou testimony.pdf SHSS 2/21/2014 1:30:00 PM
SB 169
CSSB 169(HSS).pdf SHSS 2/21/2014 1:30:00 PM
SB 169