Legislature(2019 - 2020)BUTROVICH 205

03/09/2020 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:32:04 PM Start
01:32:37 PM Confirmation Hearing
01:47:40 PM SB229
02:18:02 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Consideration of Governor’s Appointees: TELECONFERENCED
State Medical Board - David Boswell
*+ SB 229 LIABILITY OF CONSULTING PHYSICIANS TELECONFERENCED
Heard & Held
-Invited Testimony Followed by Public Testimony-
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 9, 2020                                                                                          
                           1:32 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                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S)                                                                                                         
State Medical Board                                                                                                           
David Boswell - Fairbanks                                                                                                       
                                                                                                                                
     - CONFIRMATION ADVANCED                                                                                                    
                                                                                                                                
SENATE BILL NO. 229                                                                                                             
"An Act relating to immunity for consulting physicians,                                                                         
podiatrists, and osteopaths."                                                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 229                                                                                                                  
SHORT TITLE: LIABILITY OF CONSULTING PHYSICIANS                                                                                 
SPONSOR(s): SENATOR(s) KIEHL                                                                                                    
                                                                                                                                
02/24/20       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/24/20       (S)       HSS, JUD                                                                                               
03/09/20       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
DAVID BOSWELL, Appointee                                                                                                        
State Medical Board                                                                                                             
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified as appointee to the State Medical                                                               
Board.                                                                                                                          
                                                                                                                                
SENATOR JESSE KIEHL                                                                                                             
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified as sponsor of SB 229.                                                                           
                                                                                                                                
CATHY SCHLINGHEYDE, Staff                                                                                                       
Senator Jesse Kiehl                                                                                                             
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided information on SB 229.                                                                           
                                                                                                                                
ROBERT CRAIG, Chief Executive Officer                                                                                           
Alaska Heart and Vascular Institute                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 229.                                                                           
                                                                                                                                
JACOB KELLY, M.D.                                                                                                               
Alaska Heart and Vascular Institute                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 229.                                                                           
                                                                                                                                
BOB URATA, M.D., Valley Medical Care                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 229.                                                                           
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:32:04 PM                                                                                                                    
CHAIR DAVID  WILSON called the  Senate Health and  Social Services                                                            
Standing Committee  meeting to order  at 1:32 p.m. Present  at the                                                              
call  to order  were Senators  Begich, Shower,  and Chair  Wilson.                                                              
Senator   von   Imhof   and  Senator   Giessel   arrived   shortly                                                              
thereafter.                                                                                                                     
                                                                                                                                
^CONFIRMATION HEARING                                                                                                           
                    CONFIRMATION HEARING(S)                                                                                 
                      State Medical Board                                                                                   
                                                                                                                                
1:32:37 PM                                                                                                                    
CHAIR WILSON announced the consideration of the confirmation                                                                    
hearing for David Boswell, appointee to the State Medical Board.                                                                
                                                                                                                                
1:33:07 PM                                                                                                                    
DAVID  BOSWELL,   Appointee,  State   Medical  Board,   Fairbanks,                                                              
Alaska,  said  he has  been  a  minister  at the  Northern  Lights                                                              
Church of Christ  for 15 years. He is active in  the community. He                                                              
and  his wife  had  four  children  before foster  parenting  nine                                                              
children, four of whom were adopted.                                                                                            
                                                                                                                                
MR. BOSWELL  said he  has always  been interested  in the  medical                                                              
field. He studied  genetics and biochemistry at  the University of                                                              
Alberta. At  that time, he was  called to seminary and  received a                                                              
bachelor's degree  in theology. Serving on the  medical board will                                                              
give  him an  opportunity  to  give back  to  the  community in  a                                                              
meaningful way.  He said  he is committed  to performing  this job                                                              
to the best  of his ability, that  his life has been  dedicated to                                                              
service  in serving  the church.  He expressed  his gratitude  for                                                              
the opportunity to serve the people of the state.                                                                               
                                                                                                                                
1:36:15 PM                                                                                                                    
SENATOR  BEGICH asked  him to  touch on  why he  is interested  in                                                              
serving  on the  board  and whether  he had  applied  to serve  on                                                              
other boards.                                                                                                                   
                                                                                                                                
MR.  BOSWELL  replied  he  currently   serves  on  the  Governor's                                                              
Council  on  Disabilities  and   Special  Education.  His  adopted                                                              
children have varying degrees of fetal alcohol syndrome.                                                                        
                                                                                                                                
SENATOR BEGICH asked why he applied to be on the medical board.                                                                 
                                                                                                                                
MR. BOSWELL replied  these are the two boards he  thought he would                                                              
be  best suited  to  serve.  As a  minister,  it is  an  excellent                                                              
opportunity to use his ethics training to serve the community.                                                                  
                                                                                                                                
SENATOR BEGICH  asked what,  other than  his background  in ethics                                                              
and undergraduate  work in biomedical,  contribute to  his ability                                                              
to   oversee   professional   licensing   for   Alaskas    medical                                                              
professionals.                                                                                                                  
                                                                                                                                
MR.  BOSWELL  answered  that  as  a  minister  he  is  comfortable                                                              
working   with   people  from   all   socioeconomic   backgrounds,                                                              
including physicians,  legal professionals,  and the  average guy.                                                              
That puts  him in  a unique  position to  represent a  great cross                                                              
section of Alaska, he said.                                                                                                     
                                                                                                                                
SENATOR BEGICH  pointed out that  the board adopts  regulations to                                                              
carry  out law  and  deals with  final licensing  decisions.  More                                                              
importantly,   it  takes  disciplinary   action  against   medical                                                              
professionals who  may violate those licensing laws.  He asked Mr.                                                              
Boswell  if he  has been  involved  in any  processes and  systems                                                              
that  provide  disciplinary  action  against  people  who  violate                                                              
state law.                                                                                                                      
                                                                                                                                
MR. BOSWELL  responded that this would  be his first time  in that                                                              
kind of position  but being a father of eight has  prepared him to                                                              
do be involved in disciplinary action.                                                                                          
                                                                                                                                
SENATOR BEGICH suggested  that serving on the medical  board would                                                              
extend beyond family disciplinary matters.                                                                                      
                                                                                                                                
MR. BOSWELL replied he understood that.                                                                                         
                                                                                                                                
SENATOR BEGICH asked  if he had taken time to  familiarize himself                                                              
with the regulations and state statutes of the board.                                                                           
                                                                                                                                
MR. BOSWELL  answered  that since  his appointment  a month  and a                                                              
half ago, he  has spent considerable time learning  the state laws                                                              
regarding licensing and the board.                                                                                              
                                                                                                                                
SENATOR BEGICH  asked if he  could separate his  religious beliefs                                                              
from his secular role.                                                                                                          
                                                                                                                                
MR. BOSWELL responded absolutely.                                                                                               
                                                                                                                                
1:40:54 PM                                                                                                                    
SENATOR  VON IMHOF  asked whether,  in  his role  as minister,  he                                                              
goes into  hospitals with  families dealing with  the end  of life                                                              
and works with hospice, doctors, or nurses.                                                                                     
                                                                                                                                
MR.  BOSWELL replied  he has  done  that in  15 years  of being  a                                                              
minister.                                                                                                                       
                                                                                                                                
SENATOR  VON IMHOF  asked if  he has  discussions with  physicians                                                              
when patients are near the end of life and what has he learned.                                                                 
                                                                                                                                
MR.  BOSWELL replied  he  has  not necessarily  had  conversations                                                              
with  physicians about  end-of-life  issues. He  spends time  with                                                              
patients  and  their families.  He  has  been with  families  when                                                              
physicians have those types of conversations with families.                                                                     
                                                                                                                                
1:43:10 PM                                                                                                                    
SENATOR GIESSEL asked if he has observed a board meeting.                                                                       
                                                                                                                                
MR.  BOSWELL answered  no. The  last State  Medical Board  meeting                                                              
occurred  when  he  was in  Juneau  meeting  with  the  Governor's                                                              
Council on Disabilities and Special Education.                                                                                  
                                                                                                                                
SENATOR  GIESSEL asked  if he  was  aware that  the State  Medical                                                              
Board is  a quasi-adjudicatory authority  board and  that licenses                                                              
are a property right.                                                                                                           
                                                                                                                                
MR.  BOSWELL responded  that he  had not  thought of  it in  those                                                              
terms.                                                                                                                          
                                                                                                                                
SENATOR  GIESSEL said  that is  the  case, so  discipline is  very                                                              
structured   and    meted   out   with   care    and   significant                                                              
documentation, not just based on board member's opinions.                                                                       
                                                                                                                                
1:45:25 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
1:45:36 PM                                                                                                                    
SENATOR VON  IMHOF stated  that in  accordance with AS  39.05.080,                                                              
the  Senate   Health  and   Social  Services  Standing   Committee                                                              
reviewed  the   following  and   recommends  the  appointment   be                                                              
forwarded to a joint session for consideration:                                                                                 
                                                                                                                                
State Medical Board                                                                                                           
David Boswell - Fairbanks                                                                                                       
                                                                                                                                
[Signing  the   reports  regarding  appointments  to   boards  and                                                              
commissions  in no way  reflects individual  members' approval  or                                                              
disapproval  of   the  appointees;  the  nominations   are  merely                                                              
forwarded   to   the  full   legislature   for   confirmation   or                                                              
rejection].                                                                                                                     
                                                                                                                                
1:45:55 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
           SB 229-LIABILITY OF CONSULTING PHYSICIANS                                                                        
                                                                                                                                
1:47:40 PM                                                                                                                    
CHAIR   WILSON   reconvened   the  meeting   and   announced   the                                                              
consideration  of  SENATE  BILL  NO.  229,  "An  Act  relating  to                                                              
immunity    for   consulting    physicians,    podiatrists,    and                                                              
osteopaths."                                                                                                                    
                                                                                                                                
He stated his intent  to hear an overview of the  bill and invited                                                              
and public testimony. He invited Senator Kiehl to the table.                                                                    
                                                                                                                                
1:48:05 PM                                                                                                                    
SENATOR JESSE  KIEHL, Alaska State  Legislature, spoke  as sponsor                                                              
of  SB  229.  When Alaska  passed  medical  malpractice  caps,  he                                                              
thought the caps  were too low. However, the  practice of medicine                                                              
is complex. There  are specialties and subspecialties  and medical                                                              
professionals  frequently  consult with  one  another  to get  the                                                              
necessary  advice  and  expertise.   A  generalist  might  call  a                                                              
specialist in a  bodily system or organ to help  decide whether to                                                              
treat a symptom  or refer a patient for full workup  and treatment                                                              
by that specialist.  A specialist might call a  psychiatrist about                                                              
a  mental health  condition that  is  complicating treatment.  The                                                              
sole practice  doctor in  a small  town might call  a doctor  in a                                                              
hub or larger  city to decide whether  to treat an injury  at home                                                              
or call  for a  medevac with the  costs and  risks that  those can                                                              
bring. The  term for these  consultations is "curbside  consults."                                                              
Patients do not  see these consultations, but  these consultations                                                              
are an essential part of Alaskans health care.                                                                                  
                                                                                                                                
SENATOR  KIEHL said  SB 229  protects  curbside consultations.  He                                                              
recalled  that  over  a year  ago,  the  Minnesota  Supreme  Court                                                              
considered  a case  where  something went  wrong  and decided  the                                                              
consulting doctor  could be liable  for damages to a  patient. The                                                              
consulting doctor had  never seen or treated the  patient or taken                                                              
a  fee.  It was  in  many  ways a  first-of-its-kind  ruling  that                                                              
alarmed the medical  community. Without this bill,  if that ruling                                                              
holds,  Alaska would  see  significant  increases  in health  care                                                              
costs as medical  malpractice insurance rises. With  Alaskas  long                                                              
distances  and  small  communities  with few  specialists,  it  is                                                              
likely that health  care would suffer if doctors  stopped curbside                                                              
consults.  It  will  create  more risk  to  patients  if  treating                                                              
doctors lose access to their colleagues experience and advice.                                                                  
                                                                                                                                
SENATOR  KIEHL said  SB 229  shields  the consulting  doctor in  a                                                              
curbside consult  from liability if  the patient gets  injured. SB                                                              
229  will ensure  that  an injured  patient  still  has access  to                                                              
justice.  Under   SB  229,  the  treating  doctor   cannot  reduce                                                              
liability  by  shifting  some  of  the  blame  to  the  consulting                                                              
doctor.  The  treating  doctor  remains  responsible  for  patient                                                              
care. That is the  fundamental point of the bill.  Alaskans can go                                                              
to  the  doctor, get  seen,  doctors  can  get needed  advice  and                                                              
expertise  from  colleagues,  and Alaskans  will  benefit  without                                                              
raising costs, without  raising risks, and without  denying anyone                                                              
access to justice.                                                                                                              
                                                                                                                                
CHAIR  WILSON  noted  that  it  is  a  one-section  bill,  so  the                                                              
committee did not need an in-depth sectional analysis.                                                                          
                                                                                                                                
1:53:08 PM                                                                                                                    
SENATOR  SHOWER asked  if SB  229  will affect  other health  care                                                              
providers  who  give  advice,  such  as  nurse  practitioners  and                                                              
nurses.                                                                                                                         
                                                                                                                                
SENATOR  KIEHL replied  that  since he  has  introduced the  bill,                                                              
some  people  in the  medical  community  have suggested  that  it                                                              
should be expanded  to include advance practice  registered nurses                                                              
and physician  assistants. It  makes sense, but  he does  not have                                                              
any  amendments.  He  said  he has  been  working  to  begin  that                                                              
drafting process.                                                                                                               
                                                                                                                                
SENATOR SHOWER asked if there are any other similar court cases.                                                                
                                                                                                                                
SENATOR KIEHL deferred to his staff to respond.                                                                                 
                                                                                                                                
1:55:19 PM                                                                                                                    
CATHY  SCHLINGHEYDE,  Staff,  Senator Jesse  Kiehl,  Alaska  State                                                              
Legislature, Juneau,  Alaska, said that  she does not have  a case                                                              
involving   an  advanced   practice   registered   nurse  as   the                                                              
consultant, but she could do some research.                                                                                     
                                                                                                                                
SENATOR  GIESSEL  thanked Senator  Kiehl  for  being open  to  her                                                              
input on SB 229.  She often consults with pharmacists  about how a                                                              
medication  she  might prescribe  would  interact  with a  disease                                                              
condition or other medication, as do her physician colleagues.                                                                  
                                                                                                                                
CHAIR WILSON called on invited testimony.                                                                                       
                                                                                                                                
1:56:35 PM                                                                                                                    
ROBERT CRAIG, Chief  Executive Officer, Alaska Heart  and Vascular                                                              
Institute,  Anchorage, Alaska,  said  he has  been  at the  Alaska                                                              
Heart and  Vascular Institute for  about four years. He  has about                                                              
30  years of  experience  in  health care  administration.  Alaska                                                              
Heart Institute  has 32 physicians providing  cardiology expertise                                                              
in Alaska in  the form of general cardiology,  interventional, and                                                              
electrophysiology.  The goal with  SB 229 is  not to start  a tort                                                              
issue or  seek immunity for the  care doctors provide  to patients                                                              
but to resolve  this consult dilemma. Often the  Heart Institute's                                                              
physicians receive  calls about  patients who are  not established                                                              
with the practice  from locations where there is  no cardiologist,                                                              
typically  in remote  and small  communities.  Rather than  insist                                                              
that these  patients be flown  in or travel  to the  institute, it                                                              
is more  desirable to  have a collaborative  discussion  about the                                                              
care  than contributing  to increases  in health  care costs.  The                                                              
institutes  physicians  have always  answered these  calls freely,                                                              
without  compensation, regardless  of the  time of  day or  night.                                                              
The institute  believes the calls  are valuable for  the expertise                                                              
provided, which  helps to  ensure the  patient receives  the right                                                              
care at  the right time. These  calls provide assistance  to other                                                              
health  care  providers  in remote  areas  without  the  physician                                                              
being left vulnerable.                                                                                                          
                                                                                                                                
1:59:47 PM                                                                                                                    
JACOB   KELLY,  M.D.,   Alaska  Heart   and  Vascular   Institute,                                                              
Anchorage,  Alaska, said  he has  been a  cardiologist in  advance                                                              
heart failure  and cardiac transplant  cardiologist in  Alaska for                                                              
three years.  He came to Alaska  for the unique ability  to pursue                                                              
an  outdoor lifestyle  and to  care  for a  diverse population  of                                                              
patients who  are often off the  road system. In the  tradition of                                                              
medicine, practitioners  share, teach,  and learn together.  It is                                                              
human nature  to want to deliver  care to all  individuals despite                                                              
location,  ability to  pay, race,  gender,  location. This  drives                                                              
him  and his  colleagues to  practice  medicine in  Alaska and  to                                                              
provide  curbside  consults  with  medical  providers  across  the                                                              
state.                                                                                                                          
                                                                                                                                
DR.  KELLY  said  he  often  receives  calls  at  night  regarding                                                              
someone  experiencing atypical  chest pain.  These patients  often                                                              
have low to  low intermediate risk  and may live in a  region that                                                              
is quite remote.  It would disrupt the workflow  and the patients                                                               
ability to  pay to immediately  transfer the patient,  potentially                                                              
on multiple  flights, to Anchorage  when sometimes the  doctor can                                                              
help  the   provider  reassess   the  risk,   provide  some   good                                                              
education,  and if the  patient's condition  worsens, the  patient                                                              
could be  transferred to Anchorage.  However, there is  risk there                                                              
for him with opening  this up to curbside consultation  and the .1                                                              
to 1 percent  of the times it  could be more severe.  He often has                                                              
patients with heart failure symptoms.                                                                                           
                                                                                                                                
CHAIR WILSON  asked if  there is a  difference between  formal and                                                              
informal consultations.                                                                                                         
                                                                                                                                
DR.  KELLY  replied  an  informal  consult  on  the  phone  giving                                                              
general  advice   can  be  30   seconds  to  three   minutes.  The                                                              
conversation  typically  ends  with  the  statement  that  if  the                                                              
patient  gets  sicker  or  the   practitioner  is  concerned,  the                                                              
provider  should call  the institute  back.  The practitioner  may                                                              
give a brief  reading of an  EKG or chest x-ray.  He characterized                                                              
these  types  of calls  as  unofficial  or curbside  consults.  He                                                              
acknowledged  some  intermediate  things  could be  trickier  when                                                              
there  may  be  borderline  amounts  of  material.  Telehealth  is                                                              
attempting  to address  this. The  difficulty  with telehealth  is                                                              
that  someone must  engage vital  signs  and a  certain amount  of                                                              
durable   and  electronic   equipment   is   needed  to   transfer                                                              
information. A  full consult involves  seeing the patient  or with                                                              
an official  telehealth visit,  a practitioner  can visualize  the                                                              
patient, receive vitals, and review the patient's chart.                                                                        
                                                                                                                                
SENATOR  VON IMHOF  asked if  there  is generally  fee-for-service                                                              
with telehealth,  if so, it would  fall outside of the  purview of                                                              
this bill.                                                                                                                      
                                                                                                                                
DR. KELLY  agreed that telehealth  is a separate  billable charge,                                                              
and that  does not fall under  this bill. He said  that telehealth                                                              
is complicated and not specific to this bill.                                                                                   
                                                                                                                                
2:05:44 PM                                                                                                                    
SENATOR VON IMHOF  said the definition of telehealth  is expanding                                                              
and  the  bill  sponsor  should   contemplate  what  triggers  the                                                              
difference  between   a  curbside  consult  and   telehealth.  She                                                              
offered her belief that the trigger is if money changes hands.                                                                  
                                                                                                                                
SENATOR BEGICH pointed  out that line 14 specifically  states "not                                                              
compensated", which  would be the  trigger. This bill  will ensure                                                              
that informal conversations between physicians can continue.                                                                    
                                                                                                                                
2:08:06 PM                                                                                                                    
BOB  URATA, M.D.,  Valley Medical  Care, Juneau,  Alaska, said  he                                                              
has  been practicing  family medicine  in Juneau  since 1984.  The                                                              
purpose of  SB 229 is to  protect consultations from  lawsuits and                                                              
to  allow this  important service  for his  patients to  continue.                                                              
These  consultations improve  overall  care and  keep costs  under                                                              
control. He  utilizes this service  in his practice at  least five                                                              
times  a  week.  He calls  various  specialists,  including  heart                                                              
doctors,  cancer   specialists,  chest  surgeons,   neurosurgeons,                                                              
high-risk obstetricians,  endocrinologists  who deal with  thyroid                                                              
and diabetes,  and neurologists.  He encouraged members  to expand                                                              
the  bill  to   include  midlevel  practitioners   like  physician                                                              
assistants  and   nurse  practitioners.  He  has   given  curbside                                                              
consults for patients  and providers in Yakutat,  Skagway, Haines,                                                              
and Gustuvus.  These midlevel  practitioners  are the only  health                                                              
care available  in those towns.  These professionals  provide good                                                              
care, but occasionally  call to discuss patients, who  may need to                                                              
be   sent  to   Juneau   or  Anchorage   for   further  care.   He                                                              
characterized  these as more  of a  triage-type curbside  consult.                                                              
He  agreed with  Senator  Giessel  that the  consultations  should                                                              
include  pharmacists.  He  finds   that  with  the  complexity  of                                                              
various  medications  now, he  needs  to  ask a  pharmacist  about                                                              
different  side  effects,  drug interactions,  and  other  similar                                                              
things.                                                                                                                         
                                                                                                                                
2:11:08 PM                                                                                                                    
CHAIR WILSON opened  public testimony and after  ascertaining that                                                              
no one wished to testify, closed public testimony on SB 229.                                                                    
                                                                                                                                
SENATOR KIEHL  said the  question on  telehealth is excellent.  SB                                                              
229 does  not immunize doctors who  treat their patients.  Only if                                                              
a  health care  provider  is with  a patient  providing  treatment                                                              
would the  providers  consultation  with another doctor  elsewhere                                                              
fall under  the bill. Generally  speaking, when a  provider treats                                                              
a patient  by telehealth, there  is a doctor-patient  relationship                                                              
and the doctor presents a billing for services.                                                                                 
                                                                                                                                
SENATOR  KIEHL referenced  a  question  about the  development  of                                                              
malpractice  law.  He  related   his  understanding  that  medical                                                              
malpractice  has developed more  by case  law than by  legislative                                                              
action. The  new development from  the Minnesota Supreme  Court is                                                              
a step in the  wrong direction. This bill would  put a legislative                                                              
marker down  in Alaska  to say that  Alaska is  not going  in that                                                              
direction.                                                                                                                      
                                                                                                                                
SENATOR  VON  IMHOF  said  she   wanted  to  make  sure  that  the                                                              
committee  does   not  confuse   the  definition  of   telehealth.                                                              
Telehealth  is different  than the electronic  transfer of  health                                                              
information, like emailing  lab results or an x-ray  that a doctor                                                              
elsewhere  would review.  She said  she  appreciates that  Senator                                                              
Begich spoke  about compensation  for the  consultation.  If there                                                              
is a  transfer of  information electronically  and another  doctor                                                              
reviews  it  to provide  consultation  [at  no  cost], it  is  not                                                              
telehealth.                                                                                                                     
                                                                                                                                
SENATOR  KIEHL agreed.  The  consulting doctor  would  be the  one                                                              
protected  in the  bill. That  doctor  could review  an EKG  under                                                              
this bill  as long  as the  consulting doctor  does not  determine                                                              
treatment for the patient.                                                                                                      
                                                                                                                                
SENATOR GIESSEL  said another way  to describe the  distinction of                                                              
curbside versus  telehealth is that someone cannot  be compensated                                                              
for  something   that  is  not   documented.  If   the  consulting                                                              
physician gets  a lab result and  actually writes a  report, which                                                              
is then sent  back to the  person who asked for  the consultation,                                                              
that clinician  can bill for  the time  to write the  report. That                                                              
is  the  process  a  telehealth   clinician  uses  for  telehealth                                                              
documents and  for payment. She  viewed curbside  consultations as                                                              
ones between  health care  providers who  might discuss  a patient                                                              
with a heart  murmur, who has a  sore throat, and what  that might                                                              
mean. Someone  is giving informal  advice and not billing  for it.                                                              
It is very different from telehealth.                                                                                           
                                                                                                                                
SENATOR KIEHL said these physicians want to be able to continue                                                                 
to have unpaid consultations, which plays a role in health care                                                                 
for Alaskans.                                                                                                                   
                                                                                                                                
2:16:32 PM                                                                                                                    
CHAIR WILSON suggested that the bill sponsor and committee chair                                                                
may  want   to  consider  drafting   amendments  or   a  committee                                                              
substitute to address the concerns.  He held SB 229 in committee.                                                               
                                                                                                                                
SENATOR GIESSEL noted that she had submitted a series of                                                                        
questions about the Nurse Licensure Compact in SB 179.                                                                          
                                                                                                                                
CHAIR WILSON said he would continue to work to obtain that                                                                      
information.                                                                                                                    
                                                                                                                                
2:18:02 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Standing Committee at 2:18 p.m.                                                                                                 
                                                                                                                                

Document Name Date/Time Subjects
HSS Medical Board Boswell #1.pdf SHSS 3/9/2020 1:30:00 PM
Confirmation Hearing - Med Board - D Boswell
SB 229 v. A 2.25.2020.pdf SHSS 3/9/2020 1:30:00 PM
SHSS 3/23/2020 1:30:00 PM
SB 229
SB 229 Sponsor Statement 2.25.2020.pdf SHSS 3/9/2020 1:30:00 PM
SHSS 3/23/2020 1:30:00 PM
SB 229
SB 229 Sectional Analysis v. A 2.25.2020.pdf SHSS 3/9/2020 1:30:00 PM
SHSS 3/23/2020 1:30:00 PM
SB 229
SB 229 Fiscal Note Dept of Law 3.6.20.pdf SHSS 3/9/2020 1:30:00 PM
SHSS 3/23/2020 1:30:00 PM
SB 229
SB 229 ASMA Support 3.9.20.pdf SHSS 3/9/2020 1:30:00 PM
SHSS 3/23/2020 1:30:00 PM
SB 229