01/30/2012 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB172 | |
| SB144 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 172 | TELECONFERENCED | |
| *+ | SB 144 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 30, 2012
1:31 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Dennis Egan
Senator Kevin Meyer
Senator Fred Dyson
MEMBERS ABSENT
Senator Johnny Ellis
COMMITTEE CALENDAR
SENATE BILL NO. 172
"An Act relating to health care decisions, including do not
resuscitate orders."
- MOVED SB 172 OUT OF COMMITTEE
SENATE BILL NO. 144
"An Act temporarily reinstating the child and adult immunization
program in the Department of Health and Social Services; and
providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 172
SHORT TITLE: CARE DIRECTIVES/DO NOT RESUSCITATE ORDERS
SPONSOR(s): SENATOR(s) DYSON
01/20/12 (S) READ THE FIRST TIME - REFERRALS
01/20/12 (S) HSS, JUD
01/30/12 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 144
SHORT TITLE: STATE IMMUNIZATION PROGRAM
SPONSOR(s): SENATOR(s) GIESSEL, OLSON
01/17/12 (S) PREFILE RELEASED 1/6/12
01/17/12 (S) READ THE FIRST TIME - REFERRALS
01/17/12 (S) HSS, FIN
01/30/12 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
SENATOR FRED DYSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 172.
CHUCK KOPP, Staff
Senator Fred Dyson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis of SB 172
on behalf of the sponsor.
TERRY BANNISTER, Attorney
Legislative Legal and Research Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Answered questions related to SB 172.
WARD HURLBURT, M.D.
Director and Chief Medical Officer
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified on SB 172 and on SB 144.
SENATOR CATHY GIESSEL
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Co-sponsor of SB 144.
JONATHAN TAYLOR, Intern
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis of SB 144
for the sponsor.
ROSALYN SINGLETON, M.D.
American Academy of Pediatrics
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 144.
GEORGE RHYNEER, M.D.
Legislative Affairs Chair
Alaska Physicians and Surgeons
Eagle River, Alaska
POSITION STATEMENT: Testified in support of SB 144.
RANDI SWEET
United Way of Anchorage
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 144.
MARY SULLIVAN
Alaska Primary Care Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 144.
CHUCK WHEELER
Nome, Alaska
POSITION STATEMENT: Testified in support of SB 144.
GEORGE BROWN, M.D.
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 144.
ACTION NARRATIVE
1:31:37 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:31 p.m. Present at the
call to order were Senators Egan, Dyson, Meyer, and Chair Davis.
SB 172-CARE DIRECTIVES/DO NOT RESUSCITATE ORDERS
1:32:43 PM
CHAIR DAVIS announced that the first order of business to come
before the committee was SB 172, of which she is a co-sponsor.
SENATOR FRED DYSON, primary sponsor, stated that the purpose of
SB 172 is to correct possible ambiguities in end-of-life
decisions currently in statute and ensure that the intent of the
legislature is followed. It also protects patient rights and do-
not-resuscitate (DNR) orders. He emphasized that the patient's
wishes should always predominate. In the case of an incompetent
patient, the responsibility would fall to family members or
authorized surrogates.
SENATOR DYSON related that the Health Care Decisions Act, which
was passed in 2004, changed provisions in AS 13.52.120 by
establishing a presumption in favor of life. When there is a
question as to what should be done medically, the presumption is
to preserve the life of the patient. He said he believed that
when the statute is read in its entirety, it can and should be
interpreted to allow the patient, or their authorized
representative, to prevent a physician from issuing a DNR order.
This legislation would clarify the authority of DNR decisions
with respect to the patient and physicians, and amend the Alaska
Care Directive form to allow patients to accept or refuse life-
sustaining procedures. He reported no opposition to SB 172 and
noted that it has also been referred to the Senate Judiciary
Standing Committee.
1:35:56 PM
CHUCK KOPP, staff to Senator Dyson, presented the sectional
analysis:
Section 1 amends AS 13.52.045 to prohibit a health
care institution or facility from interpreting the
issuance of a DNR order as preventing the providing of
life-sustaining procedures to the patient.
Section 2 amends AS 13.52.060(e) to prohibit a health
care provider from declining, for reasons of
conscience, to comply with a DNR order that is
consistent with this chapter. It also states that the
subsection does not allow a health care provider,
institution, or facility to decline to comply with an
individual instruction or a health care decision that
requests that cardiopulmonary resuscitation (CPR) or
other resuscitative measures be provided.
Section 3 amends AS 13.52.060(f) to state that the
subsection does not allow a health care provider,
institution, or facility to decline to comply with an
advance health care directive or a health care
decision that is consistent with the chapter and that
requests that CPR or other resuscitative measures be
provided. The subsection addresses declining to comply
with an individual instruction or health care decision
that requires medically ineffective health care or
health care contrary to generally accepted health care
standards.
MR. KOPP noted a drafting error on page 2, line 13; "declined to
comply with an advanced health care directive" should be changed
to "declined to comply with an individual instruction" to make
it consistent with line 9.
CHAIR DAVIS commented that Terry Bannister was available to
answer questions.
MR. KOPP continued:
Section 4 amends AS 13.52.065(a) to limit a
physician's right to issue a DNR order only as
provided in AS 13.52.065.
Section 5 amends AS 13.52.065(b) to require that the
protocol adopted by the department for withholding CPR
comply with AS 13.52.065.
Section 6 adds new subsections (g-j). Subsection (g)
prohibits a physician from issuing a DNR order for a
patient without the express consent described in the
subsection, except as provided in (h). Subsection (h)
states that a physician may issue a DNR order for a
patient without the expressed consent required by (g)
if the patient does not have capacity, no one is
authorized to make health care decisions, and the
patient has an advanced health care directive that
indicates the patient wants a DNR order, or the
directive is silent about the issuance of a DNR order
and another physician concurs in the decision.
Subsection (i) requires a physician to revoke a DNR
order for a patient if the issuance of the DNR
violates (g), if the patient has capacity and requests
that the DNR order be revoked, if the patient does not
want a DNR order, or if the patient does not have
capacity and does not have an advance health care
directive that indicates that the patient wants a DNR,
and a person authorized to make health care decisions
for the patient requests or does not oppose the
revocation of the DNR order. A physician shall also
revoke a DNR order if the patient is under 18 years of
age and the parent or guardian of the patient requests
that the DNR order be revoked.
Subsection (j) says a physician may revoke a DNR order
issued by another physician for a patient if the
physician has a physician-patient relationship or a
health care obligation to the patient.
Section 7, amends AS 13.52.080(a) to replace a
citation to a subsection that is repealed by this
bill.
Section 8 amends AS 13.52.080(c) to provide that its
immunity provisions do not apply if a DNR order relied
on by the health care provider, institution, or
facility was issued in violation of AS 13.52.065.
Section 9 amends AS 13.52.120(b) to clarify that a
violation of the new provisions added by bill section
6, does not, in the context of the provisions required
consistency with the chapter, constitute a homicide.
It also adds a cross reference to the new (h) as an
exception for applying the subsection's approach to
suicide or homicide.
Section 10 adds AS 13.52.120(h) to state that the
provisions in (b) about homicide and suicide do not
apply to a person who orders or causes the withholding
or withdrawal of life-sustaining procedures and acts
intentionally, recklessly, with criminal negligence,
or with gross negligence.
Section 11 amends the optional form in AS 13.52.300 to
add a section regarding a patient's wishes on life-
sustaining procedures. He directed attention to page
13 of the bill.
Section 12 Amends AS 13.52.390, the definition
section, to change the definition of "health care
decision" to state that the term includes a direction
about receiving CPR or other resuscitative measures.
Section 13 repeals AS 13.52.065(f), which currently
addresses how DNR orders are made ineffective.
Section 14 adds a provision to indicate how DNR orders
made before the bill's effective date are to be
treated in light of the bill.
TERRY BANNISTER, Attorney, Legislative Legal and Research
Services, Legislative Affairs Agency, agreed that the previously
suggested correction would parallel previous language.
1:47:49 PM
WARD HURLBURT, M.D., Director and Chief Medical Officer,
Division of Public Health, Department of Health and Social
Services (DHSS), stated that SB 172 matched his experience as a
doctor and hospital administrator. He agreed with the intent of
the bill to honor the patient's wishes and to prolong life when
there is a question about what is to be done medically. He
called the bill reasonable and appropriate. He stated that the
bill would not require additional funding.
CHAIR DAVIS thanked the sponsor for addressing health care DNR
decisions. She said the bill has been sent to the Medical
Association and has been referred to the Senate Judiciary
Standing Committee.
SENATOR DYSON commented that the bill was written in
collaboration with one of the major health providers. He
preferred to move the bill.
CHAIR DAVIS said she had no problem moving the bill.
1:51:48 PM
SENATOR EGAN moved to report SB 172 from committee with
individual recommendations and attached zero fiscal note.
CHAIR DAVIS announced that without objection, SB 172 moved from
the Senate Health and Social Services Committee.
SB 144-STATE IMMUNIZATION PROGRAM
1:52:36 PM
CHAIR DAVIS announced the consideration of SB 144.
SENATOR CATHY GIESSEL, co-sponsor, introduced SB 144. She
recalled the history of smallpox inoculation in the United
States initiated by George Washington. She said that smallpox
has been essentially wiped out due to effective vaccination. She
shared the history of the Iditarod Sled Dog Race, initially
called the Great Race of Mercy, due to its role in saving Nome
from being decimated by diphtheria, which, today, has also been
eradicated due to vaccination. Polio has also been eradicated
because of vaccination programs.
She spoke of generous funding for Alaska from Senator Ted
Steven's office, which provided a "universal" vaccination
program. In 2008 the Center for Disease Control began to cut
back federal funding for the Alaska Immunization Program (AIP)
from $4.3 million to $700,000 for FY13. Due to this loss of
funding, the state has discontinued vaccinations for adults and
for around 47,000 underinsured children. SB 144 would provide
state-funded vaccinations until 2015.
1:58:16 PM
JONATHAN TAYLOR, intern to Senator Giessel, presented the
sectional analysis for the sponsor. He said that Section 1
provides a statement of legislative intent pertaining to AIP,
which is established in Section 2 of the bill. It includes a
summary of the past and future of the program and emphasizes the
temporary nature of the program.
Section 2 establishes AIP in the Department of Health and Social
Services (DHSS) and requires the department to determine
eligibility, moved to adopt regulations, and apply for available
funds. It establishes standards for provider and recipient
participation in the program and the types of vaccinations
covered.
Section 3 authorizes the immediate adoption of regulations by
DHSS.
Section 4 establishes a delayed repeal of the Act of June 30,
2015.
Section 5 provides an immediate effective date.
1:59:43 PM
SENATOR GIESSEL introduced Rosalyn Singleton and George Rhyneer.
2:00:31 PM
ROSALYN SINGLETON, M.D., American Academy of Pediatrics,
testified in support of SB 144. She recalled her experience as a
pediatrician before vaccinations were available. She shared what
would happen if vaccinations were not reinstated. If the bill
does not pass, next year the state would provide vaccines only
for children who are eligible under Medicaid and Alaska Native
programs or who are uninsured. This puts Alaska at risk for
outbreaks of measles and other infections.
2:03:13 PM
GEORGE RHYNEER, M.D., Legislative Affairs Chair, Alaska
Physicians and Surgeons, testified in support of SB 144. He
spoke of the benefits he and his family and friends have
received from the state vaccination program. He said a letter of
support would be forthcoming.
2:04:21 PM
RANDI SWEET, United Way of Anchorage, testified in support of SB
144. She encouraged a long-term funding resolution for the state
vaccination program. She described vaccinations as critical to
both adults' and children's health. She referred to the
constitutional mandate that the legislature provide for the
promotion and protection of public health, which SB 144 would
do.
2:05:52 PM
MARY SULLIVAN, Alaska Primary Care Association, testified in
support of SB 144. She spoke of the negative effects on
community health centers if vaccinations are not increased.
2:07:40 PM
WARD HURLBURT, M.D., Director and Chief Medical Officer,
Division of Public Health, Department of Health and Social
Services (DHSS), testified on SB 144. He said DHSS is in favor
of the bill, but requires a minimal fiscal note. He spoke of his
experience in Dillingham when there were no vaccinations. He
shared that Alaska currently rates at number 42 among states in
immunization programs. Half of the children in Alaska qualify
for federally funded vaccination programs. About 25 percent have
coverage through private insurance. The bill targets the 25
percent that do not qualify for federal funding and have no
insurance.
DR. HURLBURT related that from a public health standpoint,
without an immunization rate of 80 percent, there is no "herd
immunity", which means there is a risk to the whole population.
Alaska has the highest percentage of "parental hesitancy" at 9
percent. The department is working on that issue. He gave credit
to the health care workers in Talkeetna, a challenging
community, for their efforts to increase the immunization rate.
CHAIR DAVIS commented that a fiscal note was forthcoming from
DHSS.
2:11:56 PM
CHUCK WHEELER, Nome, testifying on his own behalf, spoke in
support of SB 144. He said the state was notified in 2008 of the
funding cuts and last year he was aware of federal funding cuts.
He noted that immunization costs keep escalating and the funding
keeps decreasing. He shared statistics of high disease rates in
Northwest Alaska. Vaccinations are not available in Nome. The
uninsured cannot afford vaccinations. He supported vaccinations
as a needed prevention program.
2:15:18 PM
GEORGE BROWN, M.D., testified in support of SB 144. He inquired
about medical costs per child of the whooping cough vaccine, as
opposed to the cost of the outbreak of whooping cough in
Southeast Alaska in 2007-8. He said the vaccine costs about
$2.40. He asked about the cost of the H1N1 influenza
vaccination, versus the cost of the epidemic in 2009-10. He said
the cost of the vaccine was about $3.20. He reported that the
cost savings for the measles, mumps, and rubella vaccination was
$16 for every dollar invested. He noted that the child
vaccination program in Washington State consists of a pooling of
federal, private, and state funds to assure that all children
receive all recommended immunizations.
2:18:20 PM
CHAIR DAVIS said she was familiar with Washington State's
program and suggested pooling might be a good method of
providing an immunization program for Alaska. She said the task
at hand is to fund Alaska's program for this year. She
emphasized that SB 144 was a very important bill.
SENATOR EGAN referred to page 3, subsection (f)(1), and asked
why meningococcal and human papillomavirus vaccines were
exempted.
DR. HURLBURT responded that the two vaccines were not included
because they are very costly and the cost benefit ratio is not
as good. For most other vaccines, the savings in medical costs
is about $8 per child for every dollar spent. The goal of the
legislation is to make the program affordable and provide the
best protection, first for the children, and then for adults who
don't have other coverage.
SENATOR EGAN wondered why this issue couldn't be addressed long
term, rather than temporarily.
SENATOR GIESSEL stated that the reason the bill only goes
through 2015 is because the plan is to research other state
immunization programs in order to come up with a long-term
program for Alaska.
DR. HURLBURT spoke of models found in Washington and New
Hampshire. There are cost and supply advantages for a state to
purchase all immunizations in order to create a universal
program. Alaska is attempting to have a universal program.
2:23:55 PM
SENATOR DYSON said he thought the bill could move from
committee.
SENATOR DAVIS said she would prefer to have a fiscal note first.
She added that another issue which merits attention is the "opt
out" choice parents have.
SENATOR MEYER questioned how to address the 9 percent of parents
who are reluctant to have their children immunized.
DR. HURLBURT said he thought education was the solution to
dispelling false information about immunizations. He referred to
a British study which promoted a misconception that vaccinations
caused autism. There is also the issue that a two-year-old needs
about 15 shots over the first couple years, which bothers
parents. Cost is also a concern. Public health nurses and school
requirements are part of the solution. Mississippi has a law
that requires a provider's note to excuse a child from receiving
vaccinations.
SENATOR MEYER asked what the average rate of parental hesitancy
was.
DR. HURLBURT explained that 9 percent is the number of parents
who opt out of having their children immunized. Alaska's
immunization rate is currently 60 percent. Alaska Native
children have an immunization rate of 90 percent.
CHAIR DAVIS held SB 144 in committee.
2:30:18 PM
There being no further business to come before the committee,
Chair Davis adjourned the Senate Health and Social Services
Standing Committee meeting at 2:30 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB172 Bill.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB172 Sponsor Statement.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB172 Legal Memo 1.jpg |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB172 Legal Memo 2.jpg |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB172 Legal Memo 3.jpg |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB172 Legal Memo 4.jpg |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB172 Legislative Research Memo 1.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB172 Ltr to Senator Davis from Sen. Dyson.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 172 |
| SB144 Bill.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 144 |
| SB 144 Sponsor Statement.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 144 |
| SB 144 Sectional Analysis.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 144 |
| SB 144 Proposed Participants.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 144 |
| SB 144 Epidemiology Bulletin 2 1062010.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 144 |
| SB 144 Epidemiology Bulletin 1 10192011.pdf |
SHSS 1/30/2012 1:30:00 PM |
SB 144 |