Legislature(2019 - 2020)BUTROVICH 205

02/17/2020 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:30:11 PM Start
01:30:32 PM SB173
02:55:37 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 173 LICENSE MOBILE INTENSIVE CARE PARAMEDICS TELECONFERENCED
Heard & Held
-Invited Testimony Followed by Public Testimony-
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 17, 2020                                                                                        
                           1:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Mike Shower                                                                                                             
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 173                                                                                                             
"An Act  relating to mobile  intensive care  paramedics; relating                                                               
to  duties of  the  State  Medical Board  and  the Department  of                                                               
Health  and  Social  Services; and  providing  for  an  effective                                                               
date."                                                                                                                          
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 173                                                                                                                  
SHORT TITLE: LICENSE MOBILE INTENSIVE CARE PARAMEDICS                                                                           
SPONSOR(s): SENATOR(s) REVAK                                                                                                    
                                                                                                                                
02/03/20       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/03/20       (S)       HSS, L&C                                                                                               
02/17/20       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SENATOR JOSH REVAK                                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Spoke as sponsor of SB 173.                                                                               
                                                                                                                                
KIM SKIPPER, Staff                                                                                                              
Senator Josh Revak                                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided the sectional analysis for SB 173.                                                               
                                                                                                                                
JILL LEWIS, Deputy Director                                                                                                     
Division of Public Health                                                                                                       
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
SONDRA LECLAIR, Section Chief                                                                                                   
Rural and Community Health Systems                                                                                              
Division of Public Health                                                                                                       
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
SARA CHAMBERS, Director                                                                                                         
Division of Corporations, Business and Professional Licensing                                                                   
Department of Commerce, Community and Economic Development                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
ALYSIA JONES, Executive Administrator                                                                                           
State Medical Board                                                                                                             
Division of Corporations, Business and Professional Licensing                                                                   
Department of Commerce, Community and Economic Development                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
JULIE ANDERSON, representing self                                                                                               
Haines, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
ANDREW PANTISKAS, EMS Officer                                                                                                   
Capital City Fire/Rescue                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
BRIAN WEBB, representing self                                                                                                   
In room                                                                                                                         
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
WILMA VINTON, representing self                                                                                                 
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
ANJELA JOHNSTON, Chair                                                                                                          
EMS Training Committee                                                                                                          
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
TIMOTHY PETERSON, M.D., Co-Chair                                                                                                
State EMS Medical Direction Committee                                                                                           
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
EUGENE WISEMAN, representing self                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
MIO RHIEN, South Tongass Volunteer Fire Department                                                                              
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
MICHAEL LEVY, M.D., representing himself                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
ALEX BOYD, Assistant Chief                                                                                                      
Director of Training                                                                                                            
Anchorage Fire Department                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
MARK JOHNSON, representing self                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 173.                                                                           
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:11 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call  to order  were  Senators von  Imhof,  Begich, Giessel,  and                                                               
Chair Wilson. Senator Shower arrived shortly thereafter.                                                                        
                                                                                                                                
        SB 173-LICENSE MOBILE INTENSIVE CARE PARAMEDICS                                                                     
                                                                                                                                
1:30:32 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 173,                                                                
"An Act relating to mobile intensive care paramedics; relating                                                                  
to  duties of  the  State  Medical Board  and  the Department  of                                                               
Health  and  Social  Services; and  providing  for  an  effective                                                               
date."                                                                                                                          
                                                                                                                                
He stated his intent to hear  an initial overview and a sectional                                                               
analysis and take public testimony on SB 173.                                                                                   
                                                                                                                                
1:30:58 PM                                                                                                                    
SENATOR  JOSH REVAK,  Alaska State  Legislature, Juneau,  Alaska,                                                               
sponsor  of SB  173,  said  this bill  seeks  to consolidate  the                                                               
oversight of the emergency medical  services (EMS) system under a                                                               
single agency. Currently,  regulation of the EMS  system is split                                                               
between  the  State  Medical  Board  within  the  [Department  of                                                               
Commerce,  Community and  Economic Development  (DCCED)] and  the                                                               
EMS section within  the Department of Health  and Social Services                                                               
(DHSS).  This issue  arose because  paramedics did  not exist  in                                                               
Alaska before  1974. After 1974,  the term mobile  intensive care                                                               
paramedic  was created  for  the  new scope  of  practice in  the                                                               
Anchorage and  Fairbanks fire departments. The  emergency medical                                                               
system  (EMS) within  DHSS did  not  exist in  Alaska code  until                                                               
1981.   The  responsibility   to  license   and  credential   the                                                               
paramedics was  placed under  the State  Medical Board.  In 1984,                                                               
the EMS section became fully  functional. However, the paramedics                                                               
remained under the State Medical Board.                                                                                         
                                                                                                                                
SENATOR  REVAK said  paramedics provide  an essential  part of  a                                                               
comprehensive emergency  medical services system. This  bill will                                                               
transfer  paramedic licensure  to  the  Alaska Emergency  Medical                                                               
Services  office, DHSS.  The  Alaska  Emergency Medical  Services                                                               
office is currently responsible  for certifying emergency medical                                                               
technicians  (EMTs),   EMT  instructors,  EMT   training,  ground                                                               
ambulance,   medevac   services,   paramedic   instructors,   and                                                               
paramedic  training.  However,  paramedics are  licensed  by  the                                                               
State Medical Board.                                                                                                            
                                                                                                                                
SENATOR REVAK said SB 173 does  not change the scope of practice,                                                               
license requirements,  or fee  structure. Medical  direction will                                                               
be provided  by the existing  DHSS Chief Medical Officer  and the                                                               
EMS  Medical Directors'  Committee, The  State Emergency  Medical                                                               
Services office is well-positioned to  support this change with a                                                               
staff of  six full-time positions,  five of whom are  required to                                                               
have  paramedic experience.  Existing  data systems  are able  to                                                               
incorporate paramedic  licensure, making the transfer  a seamless                                                               
transition.  Aligning  all EMS  services  under  a single  agency                                                               
promotes  public safety  while bringing  new efficiencies  to the                                                               
licensure process.                                                                                                              
                                                                                                                                
1:35:00 PM                                                                                                                    
KIM SKIPPER, Staff, Senator Josh Revak, Alaska State                                                                            
Legislature, Juneau, Alaska, gave the sectional analysis for SB                                                                 
173:                                                                                                                            
                                                                                                                                
     Sec.    1     amends    08.64.107,     State    Medical                                                                    
     Board/Regulation of physician  assistants and intensive                                                                    
     care  paramedics,  to  remove regulation  of  paramedic                                                                    
     licensure from the Medical Board. (See also Sec. 8.)                                                                       
                                                                                                                                
     Sec. 2 amends 08.64.170,  License to practice medicine,                                                                    
     podiatry,   or  osteopathy,   allowing  paramedics   to                                                                    
     practice  medicine   to  render   emergency  lifesaving                                                                    
     service  under  "another  law"  instead  of  under  the                                                                    
     Medical Board's authority. (See also Sec. 6)                                                                               
                                                                                                                                
     Sec.  3   amends  08.64.360,  Penalty   for  practicing                                                                    
     without  a  license  or in  violation  of  chapter,  to                                                                    
     remove paramedics. (See also Sec. 10)                                                                                      
                                                                                                                                
     Sec. 4  amends 08.64.369, Health care  professionals to                                                                    
     report certain injuries,  to change paramedics licensed                                                                    
     under the  Medical Board to those  licensed under DHSS,                                                                    
     for  health  care  providers who  must  report  certain                                                                    
     injuries to the Department of Public Safety.                                                                               
                                                                                                                                
     Sec. 5 amends  12.55.185(11), Sentencing and Probation,                                                                    
     to change  paramedics licensed under the  Medical Board                                                                    
     to those licensed under DHSS.                                                                                              
                                                                                                                                
     Sec.  6   amends  18.08.075,  Authority   of  emergency                                                                    
     medical  technician,  to  allow paramedics  to  provide                                                                    
     emergency medical care. (See also Sec. 2.)                                                                                 
                                                                                                                                
     Sec.    7   amends    18.08.080,   Emergency    Medical                                                                    
     Services/Regulation,   to   require   DHSS   to   adopt                                                                    
     regulations   establishing   standards  for   paramedic                                                                    
     licenses.                                                                                                                  
                                                                                                                                
     Sec. 8 adds a  new subsection 18.08.082(a)(5), Issuance                                                                    
     of  certificates; designations,  to  add regulation  of                                                                    
     paramedic licensure to DHSS. (See also Sec. 1.)                                                                            
                                                                                                                                
     Sec. 9  amends 18.08.082(b), Issuance  of certificates;                                                                    
     designations,  to  clarify  that DHSS  is  the  central                                                                    
     certifying  and  licensing  agency  for  all  emergency                                                                    
     medical services.                                                                                                          
                                                                                                                                
1:36:58 PM                                                                                                                    
     Sec. 10  amends 18.08.084(a), Certificate  required, to                                                                    
     prohibit  a  person  from  practicing  as  a  paramedic                                                                    
     without a license. (See also Sec. 3.)                                                                                      
                                                                                                                                
     Sec.  11  amends   18.08.089,  Authority  to  pronounce                                                                    
     death,  to ensure  consistent use  of the  term "mobile                                                                    
     intensive care" paramedic throughout the law.                                                                              
                                                                                                                                
     Sec.  12  adds  a  new  paragraph  (14)  to  18.08.200,                                                                    
     Emergency  Medical  Services/Definitions,  to  add  the                                                                    
     definition of  "mobile intensive care  paramedic". (See                                                                    
     also Sec. 14.)                                                                                                             
                                                                                                                                
     Sec.  13  amends   37.05.146(c)(77)(F),  Definition  of                                                                    
     program   receipts   and   non-general   fund   program                                                                    
     receipts, to  add fees for  licensure of  paramedics to                                                                    
     the list of fees collected by DHSS.                                                                                        
                                                                                                                                
     Sec.  14  repeals  08.64.366,  Liability  for  services                                                                    
     rendered  by a  mobile  intensive  care paramedic  (See                                                                    
     18.08.086,  Immunity   from  liability,   under  DHSS).                                                                    
     Repeals 08.64.380,  Medicine/Definitions to  remove (3)                                                                    
     "emergency   lifesaving   service"  and   (4)   "mobile                                                                    
     intensive care paramedic" (See also Sec. 12).                                                                              
                                                                                                                                
     Sec.   15  amends   the  uncodified   law  to   provide                                                                    
     transitional authorities:                                                                                                  
                                                                                                                                
     (a) A  current paramedic license issued  before January                                                                    
     1,  2021  remains  valid until  it  expires  under  the                                                                    
     Medical  Board,   is  suspended   or  revoked,   or  is                                                                    
     converted to a license under DHSS.                                                                                         
     (b) The Department of  Commerce, Community and Economic                                                                    
     Development  and the  Medical  Board  will transfer  to                                                                    
     DHSS  on   January  1,  2021,  files   of  all  pending                                                                    
     paramedic-related     records      and     proceedings,                                                                    
     applications, and disciplinary actions.                                                                                    
     (c)  Authority  for  DHSS to  adopt  regulations  which                                                                    
     shall  include the  conversion  of unexpired  paramedic                                                                    
     licenses issued under the Medical Board.                                                                                   
                                                                                                                                
     Sec. 16  provides an immediate effective  date for DHSS                                                                    
     to adopt regulations.                                                                                                      
                                                                                                                                
     Sec. 17 provides an effective date of January 1, 2021.                                                                     
                                                                                                                                
CHAIR WILSON called representatives from  DHSS to explain how the                                                               
transition would work.                                                                                                          
                                                                                                                                
1:39:43 PM                                                                                                                    
JILL  LEWIS,   Deputy  Director,   Division  of   Public  Health,                                                               
Department of Health and Social  Services (DHSS), Juneau, Alaska,                                                               
said the Division  of Public Health (DPH) has a  broad mission to                                                               
protect  and  promote  the health  of  Alaskans,  which  includes                                                               
disease  and injury  prevention, vital  records, and  the medical                                                               
examiner's  services  to  ensure   access  to  health  care,  and                                                               
preparedness for all  hazards. This change is needed  to make the                                                               
system  more  efficient. This  change  has  been developed  in  a                                                               
deliberative   process   involving   hundreds   of   stakeholders                                                               
throughout the EMS community.                                                                                                   
                                                                                                                                
1:41:40 PM                                                                                                                    
SONDRA  LECLAIR,  Section  Chief,   Rural  and  Community  Health                                                               
Systems,  Division of  Public Health,  Department  of Health  and                                                               
Social  Services  (DHSS),  Anchorage,   Alaska,  said  Rural  and                                                               
Community  Health Systems  houses the  EMS Office.  She explained                                                               
that  the  EMS system  is  comprehensive  and multifaceted.  Each                                                               
component,  including EMTs,  paramedics, ambulance  services, and                                                               
others are vital to a well-functioning system.                                                                                  
                                                                                                                                
She began  a PowerPoint,  "SB 173  License Mobile  Intensive Care                                                               
Paramedics." She reviewed slide 2, SB 173:                                                                                      
                                                                                                                                
     Transfers oversight  and licensure of  Mobile Intensive                                                                    
     Care  Paramedics from  the State  Medical Board  to the                                                                    
     Department  of   Health  and  Social   Services  (DHSS)                                                                    
     effective January 1, 2021.                                                                                                 
                                                                                                                                
MS. LECLAIR reviewed slide 3, Aligns a Fragmented System:                                                                       
                                                                                                                                
        square4 Regulation and oversight of the EMS system is                                                                   
          split between the State Medical Board and                                                                             
          Department of Health and Social Services.                                                                             
                                                                                                                                
        square4 Reduces the administrative burden for fire/EMS                                                                  
          services, paramedics who will coordinate with                                                                         
          only one state agency                                                                                                 
          o    Licensure, certification                                                                                         
          o    Patient care data entry                                                                                          
                                                                                                                                
        square4 Increases efficiency and communication with all                                                                 
          EMS provider types                                                                                                    
                                                                                                                                
        square4 Representation on the Governor's Alaska Council                                                                 
          on Emergency Medical Services                                                                                         
                                                                                                                                
She  said it  is  important  to create  a  seamless line  of                                                                    
communication  and   representation.  Further,  if   SB  173                                                                    
becomes  law, paramedics  will  have  representation on  the                                                                    
council that  creates guidelines  and protocols  that impact                                                                    
their daily work.                                                                                                               
                                                                                                                                
1:44:50 PM                                                                                                                    
SENATOR  VON  IMHOF  said   licensed  occupations  typically  are                                                               
regulated by a  board comprised of their peer, such  as the Board                                                               
of  Barbers and  Hairdressers.  The licensure  for paramedics  is                                                               
being  transferred from  the  State Medical  Board  to DHSS.  She                                                               
asked  if that  is  because the  paramedics are  part  of an  EMS                                                               
system or  is it because their  peers do not want  to oversee the                                                               
paramedics.                                                                                                                     
                                                                                                                                
MS.  LEWIS replied  the State  Medical Board  fully supports  the                                                               
transfer of paramedic licensure in  order to better integrate the                                                               
system.  The  EMS office's  mission  not  only will  license  and                                                               
certify  elements but  will ensure  a  comprehensive EMS  system.                                                               
This helps ensure that the  entire system is robust, sustainable,                                                               
and resilient.                                                                                                                  
                                                                                                                                
SENATOR VON  IMHOF asked whether  there would be  another request                                                               
for another licensed occupation to be wrapped in with EMS.                                                                      
                                                                                                                                
MS.  LEWIS replied  she  will present  a slide  to  show the  EMS                                                               
elements the DHSS  already regulates. There is just  the one link                                                               
in the whole system that is not already under the umbrella.                                                                     
                                                                                                                                
1:47:19 PM                                                                                                                    
SENATOR GIESSEL asked if emergency  room personnel emergency room                                                               
doctors would also be moved to DHSS.                                                                                            
                                                                                                                                
MS. LEWIS  answered no. She  explained that those  physicians are                                                               
appropriately  licensed  by  the State  Medical  Board.  However,                                                               
paramedics align better with the  expertise in emergency medicine                                                               
and field services.                                                                                                             
                                                                                                                                
SENATOR GIESSEL  said pages 4-5  of the bill describe  the duties                                                               
for  mobile  intensive  care   paramedics,  which  includes  pain                                                               
management, opioid use, and in  Section 12, advanced life support                                                               
under the  direct or indirect  supervision of a  physician. These                                                               
individuals are  being licensed to perform  very advanced medical                                                               
services  under   the  direct   or  indirect  supervision   of  a                                                               
physician.   Paramedics  are   authorized   to  perform   medical                                                               
interventions,  which is  the reason  paramedics  fall under  the                                                               
State Medical Board. She asked how that has changed.                                                                            
                                                                                                                                
MS. LEWIS answered that the direct  oversight of a paramedic by a                                                               
sponsoring physician  will not change under  the bill. Currently,                                                               
under  DHSS regulations,  EMTs  must  have sponsoring  physicians                                                               
under DHSS  regulations. However, many paramedics  work under the                                                               
medical direction  of a physician under  the regulations provided                                                               
by the DHSS's EMS Office.                                                                                                       
                                                                                                                                
SENATOR GIESSEL  replied it sounds  a lot like the  delegation of                                                               
authority  that is  embodied in  a registered  nurse or  advanced                                                               
practice registered  nurse. However, certified nursing  aides and                                                               
medical assistants  are not  being moved to  DHSS. She  asked for                                                               
further clarification  on the reason to  transfer paramedics from                                                               
the State Medical Board.                                                                                                        
                                                                                                                                
1:51:32 PM                                                                                                                    
SENATOR  BEGICH  asked  for  clarification  about  Ms.  LeClair's                                                               
statement  that  the  EMS  does  not  have  records  of  all  the                                                               
paramedics and how this bill would address that.                                                                                
                                                                                                                                
MS. LECLAIR  replied EMS uses  an automated  communication system                                                               
designed  for oversight  and communication  with the  prehospital                                                               
individuals   it  certifies,   including   EMTs,  and   ambulance                                                               
services, but paramedics are not included.                                                                                      
                                                                                                                                
SENATOR  BEGICH asked  if  the bill  is  necessary to  coordinate                                                               
those systems.                                                                                                                  
                                                                                                                                
MS. LECLAIR answered  that in order to require  paramedics to log                                                               
in  and  use the  EMS  system,  paramedics  must fall  under  its                                                               
licensure and certification system.                                                                                             
                                                                                                                                
She reviewed slide 4, Protects the public health.                                                                               
                                                                                                                                
        square4 Aligns all emergency medical services under an                                                                  
          agency whose sole purpose is to ensure a                                                                              
          comprehensive statewide EMS system.                                                                                   
        square4 Allows for full integration of paramedics into                                                                  
          quality initiatives such as stroke, cardiac                                                                           
          arrest,   trauma,    telehealth,   and   community                                                                    
          paramedicine.                                                                                                         
        square4 Medical direction by the Department of Health and                                                               
          Social Services' Chief Medical Officer and an EMS                                                                     
          Medical Directors' Committee.                                                                                         
                                                                                                                                
She  said the  data integration  between the  two departments  is                                                               
complex and  likely costly if  it can be  done at all.  This bill                                                               
would bring  all prehospital services  under the EMS  office. EMS                                                               
has six full-time  staff to ensure that  patients receive quality                                                               
care  from their  EMS providers  and to  provide support  for EMS                                                               
providers.  When  one  body provides  oversight,  it  assists  in                                                               
integration at all levels, she said.                                                                                            
                                                                                                                                
MS.  LECLAIR explained  that two  elements  of medical  direction                                                               
will continue if paramedics are  transitioned to DHSS. First, the                                                               
physician-sponsorship will  not change.  Second DHSS  has medical                                                               
direction at the department and  section level. The Chief Medical                                                               
Officer   provides  the   overall  medical   direction  for   the                                                               
department, but  DHSS also  has an EMS  medical director  and EMS                                                               
Medical  Directors' Committee.  That  committee  is comprised  of                                                               
individuals who  specialize in emergency medicine  and/or who are                                                               
active  medical   directors  of  EMS  services.   This  committee                                                               
provides  oversight and  recommendations for  standard protocols,                                                               
quality initiatives, and  scope of practice and  ensure there are                                                               
liaisons  on  the  training  committees,  so  that  training  and                                                               
medical direction are well aligned at the council level.                                                                        
                                                                                                                                
1:57:10 PM                                                                                                                    
MS. LECLAIR  referred to slide  5, Regulation of the  EMS System.                                                               
This  slide outlines  the  organization of  the  EMS system.  EMS                                                               
currently  has regulatory  authority to  oversee the  elements of                                                               
the  prehospital  emergency  medical  services.  The  first  four                                                               
elements  [DHSS   Chief  Medical   Officer,  Alaska   Council  on                                                               
Emergency  Medical  Services,  State EMS  Medical  Director,  EMS                                                               
Medical  Directors' Committee],  indicate  the medical  direction                                                               
referred to earlier.  Under those four elements are  the types of                                                               
providers,   training,  instruction,   or   services  that   DHSS                                                               
certifies  and  oversees,  including  paramedic  instructors  and                                                               
training programs,  EMTs and their programs,  ambulance services,                                                               
and others. However,  one element of the  prehospital system that                                                               
DHSS does not regulate are  the paramedic personnel who are under                                                               
the  State  Medical Board.  As  Ms.  Lewis mentioned,  DHSS  held                                                               
extensive  discussions  with the  State  Medical  Board, and  the                                                               
board unanimously  voted to support  the transition  of paramedic                                                               
oversight to DHSS.                                                                                                              
                                                                                                                                
CHAIR WILSON asked to see documentation on that decision.                                                                       
                                                                                                                                
1:58:47 PM                                                                                                                    
MS. LECLAIR reviewed slide 6, Continuity During Transition:                                                                     
                                                                                                                                
        square4 Existing licenses are   valid   until    the                                                                    
          registration  expires or  is  converted  to a  new                                                                    
          license under the Department  of Health and Social                                                                    
          Services                                                                                                              
                                                                                                                                
        square4 Transfer files, records,  and   proceedings,                                                                    
          including  applications and  disciplinary actions,                                                                    
          to the  Department of  Health and  Social Services                                                                    
          (DHSS)                                                                                                                
                                                                                                                                
MS. LECLAIR reviewed slide 7, SB 173:                                                                                           
                                                                                                                                
        square4 No change to current scope of practice, licensure                                                               
          requirements, or fee structure                                                                                        
                                                                                                                                
        square4 600 paramedics licensed in Alaska                                                                               
                                                                                                                                
        square4 Less than 50 new applications annually                                                                          
                                                                                                                                
        square4 Licenses are for two years                                                                                      
                                                                                                                                
        square4 No fiscal impact.                                                                                               
                                                                                                                                
MS. LECLAIR reviewed slide 8, Infrastructure in {lace:                                                                          
                                                                                                                                
 She said DHSS has the infrastructure to take on the additional                                                                 
licensure oversight.                                                                                                            
                                                                                                                                
        square4 The State EMS Office is well-positioned to                                                                      
          provide   the    efficiency,   organization,   and                                                                    
          oversight required to support this change.                                                                            
                                                                                                                                
        square4 The office has the capacity. Taking on paramedics                                                             
          licensure  can   be  accomplished   with  existing                                                                    
          resources and does  not require additional funding                                                                    
          or staffing.                                                                                                          
                                                                                                                                
        square4 The office has the expertise. Six full-time                                                                   
          staff, 5  of which are required  to have paramedic                                                                    
          experience, with  more than 100 years  of combined                                                                    
          experience  with  the emergency  medical  services                                                                    
          system.                                                                                                               
                                                                                                                                
        square4 The office has the infrastructure. Existing data                                                              
          systems and procedures are ready to incorporate                                                                       
          paramedic licensure.                                                                                                  
                                                                                                                                
She elaborated  on the  current system,  stating that  just under                                                               
3,500 EMTs  are certified by  the EMS system and  several hundred                                                               
new  applications are  received each  year. The  office also  has                                                               
certifications  for instructors,  ambulance services,  and others                                                               
for  a  total  of  just under  4,000  who  receive  certification                                                               
through  the  EMS Office.  Paramedics  would  represent about  17                                                               
percent  of the  current number  of providers  in the  system and                                                               
about 8 percent  of the new applications received  each year. The                                                               
EMS database is  specifically set up to help  the office automate                                                               
the licensure and  certification process. The office  has a full-                                                               
time EMS  database manager  to ensure that  it runs  smoothly and                                                               
that people  receive the needed  information. Those  elements are                                                               
in  place so  the  office  can absorb  the  additional impact  of                                                               
bringing paramedics into the section.                                                                                           
                                                                                                                                
SENATOR GIESSEL said she was  struck by this amazing capacity and                                                               
astonished  to hear  that taking  on  additional licensure  would                                                               
have no  fiscal impact.  She related  her understanding  that the                                                               
office must employ  an investigator and have  an attorney general                                                               
to deal with complaints and licensing issues.                                                                                   
                                                                                                                                
2:03:02 PM                                                                                                                    
MS.  LEWIS responded  that DHSS  has enough  staff to  absorb the                                                               
additional work because licensing  paramedics would not represent                                                               
a  substantial increase  in the  workload, plus  the systems  are                                                               
fairly  efficient.  DHSS  would  not  need  additional  staff  or                                                               
budgetary  authority   to  receive   the  fees.  The   number  of                                                               
investigations  were less  than  eight per  year  over a  10-year                                                               
period. Lat  year there  was just one.  She anticipated  that the                                                               
amount of investigative work would be manageable.                                                                               
                                                                                                                                
CHAIR WILSON asked about the  fees collected by the State Medical                                                               
Board.                                                                                                                          
                                                                                                                                
MS. LEWIS  answered that DCCED  could explain the  fee structure,                                                               
but  DHSS does  not anticipate  changing the  fee structure.  She                                                               
reported   that  there   are   roughly  600   biennially-licensed                                                               
paramedics.                                                                                                                     
                                                                                                                                
CHAIR WILSON asked if paramedics  and EMTs pay the same licensure                                                               
fee.                                                                                                                            
                                                                                                                                
MS. LEWIS  agreed that  EMTs all  pay the  same amount.  The vast                                                               
majority of  EMTs are  volunteers, so DHSS  strives to  keep fees                                                               
reasonable to encourage participation.  She pointed out that EMTs                                                               
generally  pay for  their own  training and  sometimes their  own                                                               
equipment.                                                                                                                      
                                                                                                                                
SENATOR  GIESSEL   asked  how  much   the  State   Medical  Board                                                               
subsidizes the cost of paramedic regulation.                                                                                    
                                                                                                                                
MS.  LEWIS replied  she was  not the  best person  to answer  the                                                               
question.                                                                                                                       
                                                                                                                                
SENATOR BEGICH  asked if  DHSS would  collect paramedic  fees for                                                               
licensure, which was not clearly reflected in the fiscal note.                                                                  
                                                                                                                                
MS.  LEWIS responded  that because  DHSS keeps  the EMTs  rate so                                                               
low, it subsidizes  EMTs with other state and  federal funds. The                                                               
additional fees for the paramedics  will offset some of that cost                                                               
without  requiring additional  staff. DHSS  could redirect  funds                                                               
currently being used to subsidize  licensure and certification to                                                               
other aspects of the emergency medical system (EMS).                                                                            
                                                                                                                                
CHAIR WILSON said  fiscal notes do not always show  true costs of                                                               
either increments  or decrements. Technically,  adding paramedics                                                               
would be a decrement, he said.                                                                                                  
                                                                                                                                
2:09:16 PM                                                                                                                    
MS. LEWIS answered  that the fiscal note is net  zero because the                                                               
amount collected by  DCCED would be the same  amount collected by                                                               
DHSS, which is less than $50,000.                                                                                               
                                                                                                                                
SENATOR GIESSEL  said she the  legislature gets fiscal  notes for                                                               
small  board  changes.  She  said  she  shares  Senator  Wilson's                                                               
consternation that this bill has zero fiscal note.                                                                              
                                                                                                                                
MS. LECLAIR reviewed slide 9, In Closing.                                                                                       
                                                                                                                                
   square4 Paramedics are an essential part of a comprehensive                                                                  
     medical services system.                                                                                                   
                                                                                                                                
   square4 Aligning all EMS services under a single agency                                                                      
     promotes public safety while bringing new efficiencies                                                                     
     to the licensure process.                                                                                                  
                                                                                                                                
She  summarized by  stating that  Alaska is  one of  three states                                                               
that  does  not integrate  paramedics  into  the prehospital  EMS                                                               
system. The EMS unit works  regularly with EMS services to assist                                                               
paramedics  with training  and instruction.  Bringing prehospital                                                               
services providers under one state  agency will benefit paramedic                                                               
integration and communication and create efficiencies.                                                                          
                                                                                                                                
2:12:46 PM                                                                                                                    
SARA CHAMBERS,  Director, Division of Corporations,  Business and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic  Development (DCCED),  Juneau,  Alaska,  noted that  the                                                               
Division  of Corporations,  Business  and Professional  Licensing                                                               
houses the State Medical Board.                                                                                                 
                                                                                                                                
2:13:00 PM                                                                                                                    
ALYSIA  JONES,  Executive  Administrator,  State  Medical  Board,                                                               
Division  of Corporations,  Business and  Professional Licensing,                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED), Juneau, Alaska, introduced herself.                                                                                    
                                                                                                                                
CHAIR WILSON  said the  committee packets  do not  have documents                                                               
that  show the  State Medical  Board is  fully supportive  of the                                                               
transfer.                                                                                                                       
                                                                                                                                
MS. JONES  reported that at  its February 6-7 meeting,  the State                                                               
Medical  Board  voted  unanimously  to support  the  transfer  of                                                               
paramedics to DHSS as proposed by SB 173.                                                                                       
                                                                                                                                
CHAIR WILSON  asked what the  benefits of the transfer  were from                                                               
the perspective of the State Medical Board.                                                                                     
                                                                                                                                
MS.  JONES shared  that Ms.  LeClair gave  a presentation  at the                                                               
board's  November  meeting.  She  had provided  a  2014  National                                                               
Highway  Safety  Administration  report that  recommended  states                                                               
address paramedics  being removed from prehospital  services. She                                                               
recalled that  Dr. Clift, who  serves on the State  Medical Board                                                               
said  it made  sense  for the  paramedics to  be  with the  other                                                               
prehospital services.                                                                                                           
                                                                                                                                
SENATOR GIESSEL  asked whether  Ms. Jones  was the  new executive                                                               
director for the State Medical Board.                                                                                           
                                                                                                                                
MS. JONES replied she was appointed at the end of December 2019.                                                                
                                                                                                                                
SENATOR  GIESSEL  asked  how  long the  members  present  at  the                                                               
February 6 and 7, 2020 meeting had served in their terms.                                                                       
                                                                                                                                
MS.  JONES  answered  that  seven   current  board  members  were                                                               
present. One  board member  who was appointed  on February  4 was                                                               
unable  to  attend. The  rest  of  the  board members  have  been                                                               
serving from two to four years.                                                                                                 
                                                                                                                                
CHAIR WILSON asked about the  number of licensees and the current                                                               
fee structure.                                                                                                                  
                                                                                                                                
2:15:55 PM                                                                                                                    
MS.  CHAMBERS  answered  that there  are  about  600  paramedics.                                                               
Paramedics pay  biennial license fees  in the amount of  $75. The                                                               
initial  license  fees  are  slightly  higher.  This  results  in                                                               
$20,000  to $25,000  in revenue  per year  for the  State Medical                                                               
Board.  The  State  Medical  Board   total  revenues  during  the                                                               
biennial renewal  year are approximately  $2.5 million.  She said                                                               
there is no evidence that  the State Medical Board subsidizes the                                                               
activity  of the  mobile intensive  care paramedics.  Some boards                                                               
actively  and overtly  help high-level  professions  pick up  the                                                               
cost of the lower-level professions,  but not in this case. There                                                               
are  minimal  expenses  associated  with  paramedics.  The  State                                                               
Medical  Board  does  not  offer   the  overwhelming  support  of                                                               
training  and  engagement  that DHSS  can  offers  paramedics.  A                                                               
fraction  of   one  range  14  license   examiner  processes  all                                                               
paramedic  licenses. Paramedics  do  not  generate a  substantial                                                               
investigative  costs  since there  have  not  been any  extensive                                                               
investigations. Paramedics do not have  a seat on the board. With                                                               
so  much support  from the  medical director  and EMS  staff, the                                                               
State Medical  Board found  it makes sense  to make  this change.                                                               
The board considered these questions  at its November meeting and                                                               
unanimously  supported moving  paramedic licensure  to the  DHSS.                                                               
She  pointed out  that this  occurred  prior to  Ms. Jones  being                                                               
appointed to serve as executive director.                                                                                       
                                                                                                                                
SENATOR VON  IMHOF pointed out  a letter in the  committee packet                                                               
further  collaborating what  Ms.  Chambers stated.  She said  the                                                               
committee's  concern is  to ensure  that the  state EMS  does not                                                               
incur unintended cost  consequences, that a full  fiscal plan has                                                               
been thought out, and that it is truly a seamless transition.                                                                   
                                                                                                                                
MS.  CHAMBERS  offered to  furnish  the  minutes as  an  official                                                               
record of the State Medical Board's action.                                                                                     
                                                                                                                                
SENATOR  BEGICH  referred to  the  unanimous  board approval  but                                                               
noted  the  membership  of  the   Medical  Board  has  completely                                                               
changed. He asked her to assess the new members' viewpoints.                                                                    
                                                                                                                                
MS.  CHAMBERS  answered that  two  members  are continuing  their                                                               
service, but  the new  members have not  yet started  their terms                                                               
and she was unsure of their positions on this issue.                                                                            
                                                                                                                                
SENATOR  BEGICH  pointed  out  there  is  an  inconsistency  with                                                               
program  receipt  amounts. The  fiscal  note  from Public  Health                                                               
refer  to  $15,000, but  Ms.  Chambers  said  it was  $20,000  to                                                               
$25,000.                                                                                                                        
                                                                                                                                
MS.  CHAMBERS replied  she  has  worked with  Ms.  Lewis and  Ms.                                                               
LeClair.  The   DCCED  contemplates  biennial   licensure,  which                                                               
amounts to $40,000  in revenue from paramedic  fees; however, she                                                               
presents amounts in annual terms for the legislature.                                                                           
                                                                                                                                
SENATOR BEGICH said the fiscal  note refers to $10,000 to $15,000                                                               
in general fund program receipts.  He would like the committee to                                                               
know the exact  amount. Even if discrepancies are  small, such as                                                               
the  ones  in the  fiscal  notes  for  the  DHSS and  DCCED,  the                                                               
discrepancy should be resolved.                                                                                                 
                                                                                                                                
MS. CHAMBERS replied she would  address that for future hearings.                                                               
She suggested  one reason  for the difference  could be  that the                                                               
division does  not receive undesignated general  funds. All their                                                               
expenses are  funded through program  receipts, but  the Division                                                               
of Public  Health receives undesignated  general funds.  She said                                                               
she would work on articulating the different funding sources.                                                                   
                                                                                                                                
CHAIR WILSON said that issue will  need to be resolved before the                                                               
bill is moved from committee.                                                                                                   
                                                                                                                                
SENATOR GIESSEL  said a  statement has been  made that  the Chief                                                               
Medical Officer at DHSS oversees  this. The current Chief Medical                                                               
Officer is Dr.  Zink, an emergency room physician.  But the chief                                                               
medical officer could  also be a pediatrician or  a public health                                                               
specialist. Section  12 talks about advanced  life support, which                                                               
encompasses intubation,  a wide  variety of  serious medications,                                                               
including  the  injection of  those  medications  into the  heart                                                               
muscle itself. These  are not minimal activities,  she said. This                                                               
is  one  way  paramedics  are different  from  emergency  medical                                                               
technicians. She  expressed concern that yet  another activity is                                                               
being moved to the DHSS, since it is a massive department.                                                                      
                                                                                                                                
2:27:36 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 173.                                                                                 
                                                                                                                                
JULIE  ANDERSON, representing  self, Haines,  Alaska, noted  that                                                               
she had submitted a letter of  support for SB 173 as the co-chair                                                               
of the Alaska  Council on EMS's Scope  of Practice Implementation                                                               
Task Force. She started working on  the task force in November of                                                               
2018.  She   learned  that   the  state   EMS  Office   is  quite                                                               
interconnected with  national and state entities.  The EMS office                                                               
has  a  lot  of  support  from other  agencies  to  provide  this                                                               
oversight. She has a unique  perspective as an individual because                                                               
she is  licensed as  a paramedic  and as  a registered  nurse. As                                                               
Senator Revak and Ms. LeClair  described, as a paramedic she must                                                               
register with  the State  Medical Board and  the EMS  office. She                                                               
said  it can  be confusing  to know  who to  turn to  for certain                                                               
resources.  One of  the strengths  of the  nursing profession  is                                                               
their advocacy  allows them  to define themselves  in a  way that                                                               
emergency  medical services  providers cannot.  As Senator  Revak                                                               
explained,  paramedics are  a young  profession. She  offered her                                                               
belief that the  ability to unify and have advocacy  from the EMS                                                               
is meaningful and important.                                                                                                    
                                                                                                                                
MS. ANDERSON said  Haines is still waiting for a  paramedic to be                                                               
licensed  who was  certified  more  than nine  weeks  ago by  the                                                               
National Registry. She expressed  concern that there are multiple                                                               
cases of  delayed certification through the  State Medical Board.                                                               
The State EMS Office currently  has the infrastructure to process                                                               
reciprocity and streamline registration timelines.                                                                              
                                                                                                                                
2:30:53 PM                                                                                                                    
ANDREW PANTISKAS, EMS Officer,  Capital City Fire/Rescue, Juneau,                                                               
Alaska, said he  came to Alaska from Washington  state five years                                                               
ago.  He has  his certification  from the  National Registry  and                                                               
holds  a bachelor's  degree in  paramedicine, but  it still  took                                                               
over four months to get  licensed in Alaska. These timeframes can                                                               
be  shorted and  it may  be helpful  to consider  the impacts  to                                                               
Alaskans  who do  not have  access  to a  paramedic's during  the                                                               
three to  four months  it takes to  gain licensure.  He currently                                                               
manages paramedics and  EMTs, who fall under  two state entities,                                                               
yet 80 percent  of their skills are the same.  Some of these EMTs                                                               
can  administer   opiates  and  provide  advanced   cardiac  life                                                               
support. He  said it is  difficult to manage and  recertify these                                                               
professionals  under two  separate  state agencies.  SB 173  will                                                               
simplify things and allow more oversight from the state.                                                                        
                                                                                                                                
2:32:56 PM                                                                                                                    
BRIAN WEBB,  representing self, Anchorage, Alaska,  said he first                                                               
became  an  EMT in  Anchorage  in  1978.  He has  been  licensed,                                                               
registered, and certified as a  paramedic for over 40 years. When                                                               
he began prehospital  career in Anchorage, there  were fewer than                                                               
50 paramedics  statewide. Now there  are over  600. He is  one of                                                               
the   few   paramedics   still  practicing   with   institutional                                                               
knowledge. Since  the Division  of EMS did  not exist  during the                                                               
inception of  paramedics, the  State Medical  Board was  the only                                                               
logical place was to place  them. Working to move paramedics from                                                               
the State Medical Board to  EMS will bring prehospital care under                                                               
a single  entity. He has been  interested in this issue  for over                                                               
20 years,  which includes  his years working  as an  EMS training                                                               
coordinator with the regional EMS office in Anchorage.                                                                          
                                                                                                                                
MR.  WEBB said  paramedics do  not have  any peers  on the  State                                                               
Medical Board.  Moving paramedics to  the DHSS will  provide that                                                               
peer support  and oversight. EMT-2s  or EMT-3s in  Alaska provide                                                               
advanced life  support and must  have a sponsoring  physician. If                                                               
EMT-2s or EMT-3s  are not in the  DHSS, these EMTS do  not have a                                                               
sponsoring  physician to  provide  day-to-day medical  direction.                                                               
The EMS  Office is  staffed by  paramedics who  are knowledgeable                                                               
about  the  paramedic  duties  and   functions.  This  move  will                                                               
increase  regulatory oversight,  bolster standards  of care,  and                                                               
streamline and simplify  their lives. It took him  over 24 months                                                               
to  get licensed  in his  home state  when he  returned from  his                                                               
service in  the U.S. Navy, and  by then his license  had expired.                                                               
That adversely impacted him and the process needs to change.                                                                    
                                                                                                                                
2:35:54 PM                                                                                                                    
WILMA VINTON, representing self,  Fairbanks, Alaska, said she has                                                               
been an MICP (mobile intensive  care paramedic) since 2007 and an                                                               
EMT  since 1979.  She is  an assistant  chief of  EMS for  Steese                                                               
Volunteer  Fire Department.  As an  instructor, and  past adjunct                                                               
faculty  for   the  University  of  Alaska   Fairbanks  paramedic                                                               
program, she  works with  EMTs and  MICPs on  a regular  basis to                                                               
assist  them in  acquiring and  maintaining their  certifications                                                               
and  licenses.  Her  full-time   job  is  executive  director  of                                                               
Interior Region EMS Council. This  move from the Medical Board to                                                               
the State  Office of EMS  is an  excellent way to  streamline the                                                               
licensing process.  Paramedics are an  essential part of  the EMS                                                               
system. She believes it would be a seamless move.                                                                               
                                                                                                                                
She said  EMTs are regularly  certified within a week  of testing                                                               
and at  a maximum within 20  days. The EMS Office  also certifies                                                               
paramedic  coordinators and  instructors.  The licensing  process                                                               
under the Medical Board can  take several months. The board meets                                                               
only quarterly to approve licenses.  The State Office of EMS does                                                               
this  daily. Shortening  the  paramedic  certification time  will                                                               
benefit students, those from the  lower 48 seeking certification,                                                               
and military leaving the service  who wish to practice in Alaska.                                                               
MICPs would be managed by  an organization that understands their                                                               
needs and is part of the EMS system.                                                                                            
                                                                                                                                
2:38:41 PM                                                                                                                    
ANJELA JOHNSTON,  Chair, EMS Training Committee,  Juneau, Alaska,                                                               
noted that  she submitted  a letter on  behalf of  the committee.                                                               
She  is  dual  licensed  in  Alaska as  a  registered  nurse  and                                                               
paramedic. She has been affiliated  with Alaska EMS for just less                                                               
than 23 years,  and she would echo Julie  Anderson's comments. As                                                               
Ms.  Lewis  testified,  it  was   an  accident  of  history  that                                                               
paramedics were assigned to the  Medical Board. Committee members                                                               
can do  their part to  correct this  accident and make  EMS whole                                                               
again  in Alaska  by advancing  the  bill. She  urged members  to                                                               
support this bill.                                                                                                              
                                                                                                                                
2:40:06 PM                                                                                                                    
TIMOTHY  PETERSON,  M.D.,   Co-Chair,  State  Medical  Directors'                                                               
Committee, Juneau,  Alaska, said  he is  the medical  director of                                                               
Capital  City Fire/Rescue.  He is  involved in  and aware  of the                                                               
training paramedics  have. That type  of expertise is  needed for                                                               
oversight of paramedics. The State  Medical Board is a hodgepodge                                                               
of   different  medical   professions.  The   Medical  Directors'                                                               
Committee on which he serves  consists of EMS experts from across                                                               
Alaska. He  would like EMS  experts to supervise and  license EMS                                                               
providers.  The National  Highway  Safety  Administration did  an                                                               
assessment of  EMS in the state  of Alaska about five  years ago.                                                               
One  of the  main recommendations  was that  these things  be put                                                               
together  like   it  is  everywhere  else.   When  he  supervises                                                               
paramedics   and   EMTs   through  different   offices,   it   is                                                               
frustrating.                                                                                                                    
                                                                                                                                
2:42:10 PM                                                                                                                    
EUGENE WISEMAN, representing self,  Anchorage, Alaska, said he is                                                               
in his 10th relicensure cycle  as a paramedic. After listening to                                                               
the testimony,  he agrees with  those who spoken before  him. The                                                               
relationship between  paramedics and their physicians  are not at                                                               
the Medical  Board level or  Dr. Zink level. His  relationship is                                                               
with  his  medical  director.  That  is  where  the  relationship                                                               
between  EMS and  physicians  lies, at  that  lower level.  Those                                                               
individuals  write  their  protocols   and  provide  the  quality                                                               
assurance  and insurance.  That  would only  be  enhanced as  the                                                               
Medical Directors' Committee is part  of DHSS and the EMS Office.                                                               
Paramedics should be  aligned with the EMS Office  to improve the                                                               
strength  [of relationships]  with medical  directors. Paramedics                                                               
are often the mentors to the  EMTs. It hard to give them guidance                                                               
because their recertification is in different systems.                                                                          
                                                                                                                                
2:44:09 PM                                                                                                                    
MIO RHIEN,  South Tongass  Volunteer Fire  Department, Ketchikan,                                                               
Alaska, said he  is a paramedic for Guardian Flight.  He has been                                                               
a paramedic  in Alaska for 10  years. He has worked  in two other                                                               
states. Dr. Peterson's points about  consistency of licensure and                                                               
oversight are significant.  That is one of the  things he noticed                                                               
when  he came  to Alaska.  This bill  moves in  the direction  of                                                               
consistency,  which helps  to build  accountability and  keep it.                                                               
Relationships  with medical  directions sometimes  feels hampered                                                               
because paramedics  have no relationship  with the  State Medical                                                               
Board  and the  board is  not  as intimately  involved with  what                                                               
paramedics  do.  This  move  would  make  it  easier  to  recruit                                                               
paramedics because the certification process would be easier.                                                                   
                                                                                                                                
2:47:18 PM                                                                                                                    
MICHAEL  LEVY,  M.D.,  representing himself,  Anchorage,  Alaska,                                                               
said  he concurred  with  all  that was  said  before about  this                                                               
alignment.  As  the medical  director  for  the state  of  Alaska                                                               
Emergency Programs, he  is the physician that  oversees the other                                                               
physicians and  looks at scope of  practice, etc. He is  also the                                                               
President-elect  of the  National Association  of EMS  Physicians                                                               
and  probably  has the  largest  EMS  practice  in the  state  of                                                               
Alaska.  He  is  the  medical  director  of  the  Anchorage  Fire                                                               
Department,  the Kenai  Peninsula Borough,  and organizations  on                                                               
the North  Slope. He has  over 100 medics  that report to  him in                                                               
one way  or another. Moving medics  to DHSS makes a  lot of sense                                                               
to him because of what he  has seen over the years. He reiterates                                                               
what  Dr. Peterson  said. Medical  direction is  provided at  the                                                               
level of a  subspecialty of medicine. EMS medicine  is a clinical                                                               
practice.  Medical  directors  provide oversight  of  medics  and                                                               
other medical  directors as their  sole focus and  practice these                                                               
days. The new  alignment will allow medical  directors to provide                                                               
better quality.                                                                                                                 
                                                                                                                                
SENATOR  VON  IMHOF asked  if  this  move will  change  physician                                                               
oversight in any way that could compromise or increase risk.                                                                    
                                                                                                                                
DR. LEVY replied it would  only improve physician oversight. That                                                               
is not to  say that his colleagues on the  Medical Board have not                                                               
done a  good job but  realigning with the  house of EMS  can only                                                               
improve things.                                                                                                                 
                                                                                                                                
2:51:08 PM                                                                                                                    
ALEX BOYD,  Assistant Chief and  Director of  Training, Anchorage                                                               
Fire Department,  Anchorage, Alaska,  said consolidation  of this                                                               
process  mimics the  current practice  in the  EMS community.  He                                                               
said he works closely with EMTs  and paramedics on a daily basis.                                                               
He said  he seconds what Dr.  Levy said about how  this will only                                                               
improve the process.                                                                                                            
                                                                                                                                
2:52:40 PM                                                                                                                    
MARK  JOHNSON,  representing self,  Juneau,  Alaska,  said he  is                                                               
retired but serves on some of  the committees involved in the EMS                                                               
system in the state.  He was chief of EMS for  more than 25 years                                                               
in  Alaska. He  was  there when  the  paramedic regulations  were                                                               
adopted by the Medical Board.  The Governor's Advisory Council on                                                               
EMS, which  has members  appointed by  the governor  and oversees                                                               
EMS  for DHSS,  helped write  those regulations  for the  Medical                                                               
Board. That  was around 1979.  Every time those  regulations were                                                               
updated,  the board  worked  closely with  the  EMS Office.  Many                                                               
medical  board members  that he  has  known over  the years  have                                                               
asked why  the EMS could  not just take  over this for  the state                                                               
board. It  required a statute  change and many other  things were                                                               
happening in those  days. As has been pointed out,  the state EMS                                                               
program in  the vast  majority of  states does  oversee licensure                                                               
and certification of  paramedics. This is long  overdue. There is                                                               
consensus among the EMS community that this should be done.                                                                     
                                                                                                                                
2:54:24 PM                                                                                                                    
CHAIR  WILSON  closed  public  testimony   and  held  SB  173  in                                                               
committee.                                                                                                                      
                                                                                                                                
2:55:37 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee at 2:55 p.m.                                                                                                 

Document Name Date/Time Subjects
SB 173 Letters of Support 2.14.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Sponsor Statement.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 Sectional Analysis.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 Fact Sheet Feb 2020.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/12/2020 1:30:00 PM
SB 173
SB 173 Letters of Support 2.14.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Letters of Support 2.17.20.pdf SHSS 2/17/2020 1:30:00 PM
SB 173
SB 173 Fiscal Note DHSS Public Health 2.13.20.pdf SHSS 2/17/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 Fiscal Note DCCED CBPL 2.10.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
HB 29 Amendment No. 1 A.3.pdf SHSS 2/17/2020 1:30:00 PM
HB 29