Legislature(2017 - 2018)BUTROVICH 205
03/13/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB53 | |
| SB91 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 91 | TELECONFERENCED | |
| *+ | SB 53 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 13, 2017
1:31 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Peter Micciche
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 53
"An Act relating to insurance coverage for contraceptives and
related services; relating to medical assistance coverage for
contraceptives and related services; and providing for an
effective date."
- HEARD & HELD
SENATE BILL NO. 91
"An Act extending the governor's declaration of disaster
emergency to address the opioid epidemic; and providing for an
effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 53
SHORT TITLE: INSURANCE COVERAGE FOR CONTRACEPTIVES
SPONSOR(s): GARDNER
02/10/17 (S) READ THE FIRST TIME - REFERRALS
02/10/17 (S) HSS, L&C
03/13/17 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 91
SHORT TITLE: EXTEND DISASTER EMERGENCY: OPIOID EPIDEMIC
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/10/17 (S) READ THE FIRST TIME - REFERRALS
03/10/17 (S) HSS
03/13/17 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
SENATOR BERTA GARDNER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 53, provided an overview.
JONATHON CHURCH, Staff
Senator Gardner
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided a sectional overview of SB 53.
MEGAN WALLACE, Attorney
Legislative Affairs Agency
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Addressed questions regarding SB 53.
DR. JAY BUTLER, Chief Medical Officer
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Provided an overview of SB 91.
STACY KRALY, Chief Assistant Attorney General
Alaska Department of Law
Juneau, Alaska
POSITION STATEMENT: Addressed bill-drafting questions regarding
SB 91.
ANDREW JONES, Section Chief, Emergency Programs: Health
Emergency Response Operations, EMS and Trauma
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions regarding SB 91 and the
administering of overdose kits.
KARA NELSON, co-founder
Juneau Recovery Community Organization
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 91.
MICHAEL CARSON, Vice President
MyHouse Mat-Su
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 91.
MIKE COONS, representing self
Palmer, Alaska
POSITION STATEMENT: Testified in opposition of SB 91.
JOHN GREEN, representing himself
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 91.
ACTION NARRATIVE
1:31:58 PM
CHAIR DAVID WILSON 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 Begich, von Imhof, Giessel,
Micciche, and Chair Wilson.
SB 53-INSURANCE COVERAGE FOR CONTRACEPTIVES
1:32:37 PM
CHAIR WILSON announced the consideration of SB 53.
1:32:43 PM
SENATOR BERTA GARDNER, Alaska State Legislature, Juneau, Alaska,
provided a sponsor's statement on SB 53 as follows:
SB 53 is, we believe, a cost-saving measure that will
help improve the lives of women in families. What it
does simply is it requires that health-care insurers
in the state of Alaska allow for coverage of a 12-
month supply of contraceptives, self-administered
hormonal-contraceptive patches at one time.
Some of you may be aware that prescription
contraceptives require that a woman return to her
provider or to a pharmacy for refills sometimes in one
month, sometimes in three-month increments.
Contraceptives have been used for a long time and are
known to be safe we think should be available in 12-
month increments.
Many women in Alaska don't have the ability to
consistently get to their providers for appointments
either because of work, location, or school. One-in-
four women report missing a pill because they couldn't
get the refill pack in time. Ensuring consistent
access to birth control gives individuals better
ability to control when and whether they have
children, it gives them more career and educational
opportunities and reduces the likelihood that they end
up needing government assistance. With perfect use,
hormonal birth control has a success rate of about 95
percent.
The data that we have that we are relying on comes
from 2010 that says, "In Alaska 48 percent of all
pregnancies were unintended; of those pregnancies, 60
percent resulted in birth, 26 percent in abortion, and
the remainder were miscarriages. Unintended
pregnancies have a drastic impact on the wellbeing of
Alaskan women and families, and are associated with
adverse maternal and child health outcomes, and along
with health concerns, unintended pregnancies are major
cost drivers to Alaska's public-health programs. In
2010, public-funded unintended pregnancies cost Alaska
almost $43 million.
When contraceptives are more readily available, Alaska
will see a reduction in the number of unintended
pregnancies and abortions which will ultimately result
in a cost savings to the state.
1:35:39 PM
JONATHON CHURCH, Staff, Senator Gardner, Alaska State
Legislature, Juneau, Alaska, provided supportive data on SB 53
as follows:
One of the studies in your packet followed 84,000
women in California who were given various supplies of
contraceptives: one-month supply, three months, and
one year. Researches of that study found that women
given a one-year supply saw a 30-percent reduction in
the odds of having conceived a pregnancy as well as a
46-percent reduction in the odds of having an
abortion. Had the remainder of the women in the study
been given a one-year supply, an estimated 1300
publicly funded births and 300 abortions would have
been avoided.
We have heard some concerns about the issue of pill
waste due to improper storage or possible illegal
selling. According to the CDC, oral contraceptives
have a shelf life of three to five years depending on
the manufacturer; this timeline can be diminished due
to humidity or temperature, but we believe that women
that opt for a 12-month supply of birth control and
who are regular users of oral contraceptives know how
to store their medications.
The study from California also found that women who
were dispensed the one-year supply of oral
contraceptives wasted on average one cycle. Wasting
one cycle is rather insignificant compared to the cost
of clinic and pharmacy visits as well as the cost of
unintended pregnancies. In the unlikely event that
women do start selling-off hormonal birth control,
there are already criminal statutes in place to deal
with that behavior. Senate Bill 53 would also make
birth control more readily available therefore
decreasing the need for any sort of black market.
MR. CHURCH provided a sectional analysis on SB 53 as follows:
Section 1:
Amends AS 21.42 by adding a new section, AS 21.42.427. AS
21.42.427 requires a health care insurer, in the group or
individual market, that provides coverage for prescription
contraceptives to provide reimbursement for dispensing
prescription contraceptives for a 12- month period. AS
21.42.427(b)-(g) contains other related compliances and coverage
provisions. Also provides provision for allowing for a religious
organization that is not required to provide contraceptives
under the Affordable Care Act would also be exempt from having
to provide contraceptives.
Section 2:
Amends AS 47.07.065 by adding new subsections (b)-(d), which
require the Department of Health and Social Services to pay for
prescription contraceptives intended to last for a 12-month
period for eligible recipients of medical assistance, if
prescribed to and requested by the recipient, as well as pay for
specified related services.
Section 3:
Requires the Department of Health and Social Services to amend
and submit for federal approval a state plan for medical
assistance coverage consistent with sec. 2 of this act.
Section 4:
Provides that sec. 2 of this Act takes effect only if the
provisions of sec. 2 of this Act receive federal approval.
Section 5:
Provides that if sec. 2 of the Act takes effect, it takes effect
the day after the commissioner of the Department of Health and
Social Services makes certification of federal approval under
secs. 3 and 4 of the act.
Section 6:
Except for sec. 5 of this act, provides for a January 1, 2018
effective date.
1:39:09 PM
MR. CHURCH addressed fiscal notes and an issue on coverage as
follows:
There are three-fiscal notes currently attached to the
bill. Two-fiscal notes noted from the Department of
Health and Social Services, and one zero-fiscal note
from the Division of Insurance.
One issue that came up recently is that the bill as
written would not cover the Alaska Care Plan which
covers 45 percent of state employees; this is due to
the location of the definition of health-care insurer
in Title 21. Since the Division of Insurance does not
regulate self-insured employers such as the state, we
would need to place the definition outside of Title 21
and at that time the Division of Administration will
have a fiscal note associated with the bill, but we do
not know what the fiscal impact will be at this time.
SENATOR BEGICH asked him to verify that the bill simply extends
the time period for contraceptives.
MR. CHURCH answered correct, 12 months instead of monthly or 3-
month visits.
SENATOR BEGICH assumed that the negative-fiscal notes are due to
data in the bill's report that the bill should lead to a drop in
unintended pregnancies and unintended abortions.
MR. CHURCH concurred with Senator Begich.
SENATOR GIESSEL noted that the bill contained more than
contraceptives and asked for an elaboration.
MR. CHURCH replied that the first portion of the bill addresses
the coverage for contraceptives that is required by the
Affordable Care Act and puts the requirements in statute, so the
coverage continues if changes occur.
SENATOR GIESSEL stated that she thought the bill strictly
addressed prescriptive contraceptives.
MR. CHURCH replied as follows:
Ultimately with the current requirements these are
already required by the federal government so there
would be no, I would say, practical change minus the
ability to prescribe the hormonal birth controls
beyond the one or three months.
1:42:26 PM
SENATOR VON IMHOF quoted section 1 in SB 53, lines 12-14 as
follows:
Provide coverage for prescription contraceptives;
voluntary sterilization procedures; and consultations,
examinations, procedures, and medical services that
are necessary to prescribe, dispense, insert, deliver,
distribute, administer, or remove the drugs, devices,
and other products or services provided under this
paragraph.
She asked if voluntary sterilization procedures were already in
the bill or being added in a new section.
MR. CHURCH explained that voluntary sterilization procedures
would be added to state statute. He assumed that the procedure
was covered by the Affordable Care Act. He noted that Megan
Wallace with Legislative Legal was available to speak more
accurately to the bill.
SENATOR VON IMHOF asked to confirm that the bill is not
necessarily about just adding 12 months of contraceptives. She
opined that voluntary sterilization gets into surgery and is
very expensive.
SENATOR GARDNER noted that the bill's intention is not to
increase coverage, but to simply say for the hormonal
contraceptives that people should be able to get them in a 12-
month supply.
SENATOR VON IMHOF asked to confirm that SB 53 is saying that
voluntary sterilization is included.
SENATOR GARDNER reiterated that her intention is for the 12-
month supply and asked that the bill's drafter address the
committee.
1:44:42 PM
At ease.
1:45:40 PM
CHAIR WILSON called the committee back to order.
SENATOR VON IMHOF repeated her inquiry regarding voluntary
sterilization procedures versus the sponsor's intent of just
covering 12 months of oral contraceptives.
1:46:15 PM
MEGAN WALLACE, Attorney, Legislative Affairs Agency, Alaska
State Legislature, Juneau, Alaska, addressed bill-drafting
questions regarding SB 53 as follows:
Section 1 starting on page 1, line 9, requires that
any insurance plan offered in the state have to
provide coverage for a, b and c, which is prescription
contraceptives, the voluntary sterilization
procedures, and the consultation, examination,
procedures, and medical services that are necessary
for those services; in addition to that, the bill
requires that a health-care insurer reimburse for 12
months of birth control.
Yes, the bill does two things: it requires the
sterilization and consultation and procedures and
other services necessary to have birth control or
other contraceptives prescribed and those procedures
necessary to carry out those prescriptions covered and
then in addition requires essentially a 12-month
supply of contraceptives where requested.
SENATOR VON IMHOF asked to clarify if the verbiage being added
is new or is already covered by the Alaska Care Plan.
MS. WALLACE replied as follows:
I cannot speak to what the plan already covers, I
don't possess that information, so that would be a
question for the administration in terms of whether
they can confirm that these coverages are already
available under this specific plan. All I can advise
is that the bill requires that all health-insurance
plans provide the coverage in both item-1 on page 1,
[lines 10-14], and then item-2 which is on page 2,
line 2-6; it requires both 1 and 2 being included in
all plans offered in the state if this bill becomes
law.
1:48:58 PM
SENATOR MICCICHE noted that AS 21.42.420 has coverage for
prescription drugs and asked why a separate section under AS
21.42.420 was not considered that simply says, "Birth control
pills and hormonal contraceptive patches will be extended for
360 days versus the 90 days that is currently allowed under the
section." He asked why an entire subsection was created that
included other services.
MS. WALLACE replied as follows:
The bill does more than provide prescription drug
coverage, so it was essentially a drafting decision to
set this requirement out in their own subsection
because as I was just articulating the bill requires
coverage for certain procedures, consultations,
examinations, and then in addition to that there's
restrictions on the coverage provided under this
section that don't apply to the prescription drug
coverage under AS 21.42.420.
SENATOR GARDNER specified as follows:
Our intent is not to add any new coverage as not to
change co-pays, but simply to have prescription,
hormonal, self-administered contraceptives to be
available at a 12-month plan and why it was drafted
differently I don't know. I should know, but I don't.
SENATOR BEGICH asked Ms. Wallace why the bill was drafted in a
way that was not what the sponsor of the legislation requested.
1:51:44 PM
MS. WALLACE replied as follows:
I was directed to draft the bill that is in front of
us and if there was a miss communication between our
office and Senator Gardner, the sponsor, I'd be happy
to provide her with a new version that clarified that
intent, but essentially it was my understanding that
we provided the bill that was requested.
SENATOR BEGICH asked Senator Gardner if the bill does what she
intended it to do.
SENATOR GARDNER replied apparently not and conceded that the
bill goes further.
1:52:40 PM
CHAIR WILSON announced that the committee will hear public
testimony.
1:52:57 PM
At ease.
1:54:52 PM
CHAIR WILSON called the committee back to order. He announced
that SB 53 will be held awaiting a committee substitute (CS).
1:55:50 PM
At ease.
SB 91-EXTEND DISASTER EMERGENCY: OPIOID EPIDEMIC
1:56:58 PM
CHAIR WILSON announced the consideration of SB 91.
1:57:17 PM
DR. JAY BUTLER, Chief Medical Officer, Department of Health and
Social Services (DHSS), Juneau, Alaska, provided an overview of
SB 91 as follows:
In late 2016, DHSS competed for and was awarded a
five-year grant by the Federal Substance Abuse and
Mental Health Services Administration to support an
opioid overdose prevention program that included the
distribution of Naloxone, a drug that can be
lifesaving when administered to someone who has
stopped breathing due to an opioid overdose.
The grant funds have been used to acquire the nasal
spray form of the drug that is part of a rescue kit
distributed through Alaska Project HOPE, "HOPE"
standing for, "harm reduction overdose prevention and
education." We worked with law enforcement in terms of
how they might be able to best carry the kits to best
administer them if needed during an emergency
situation.
Project HOPE has prioritized partnerships with staff
of organizations that do not have medical direction,
meaning that they would have someone who could issue a
prescription for the drug and those who are most
likely to be present when an overdose occurs such as
for certain first responders and persons involved in
recovery support.
To provide the kits under a standing-medical order,
the department explored a number of options. We were
advised by the attorney general's office that the best
option would be for the state-medical officer to issue
a standing order and the authority for the standing
order would require a disaster declaration. Governor
Walker issued the declaration on February 14 with an
anticipated legislative concurrent resolution that
would extend the declaration for longer than the 30-
day deration defined by Alaska statute.
No state funds are required to support Project HOPE.
Since the declaration, 12 organizations have already
received the training including some that have
received training-the-trainer training and are able to
provide the kits and nearly 800 kits have been
dispensed so far. This past Thursday we returned that
the opinion of Legislative Legal is that a bill is
required to extend the declaration and to continue the
distribution of the kits under the standing order.
2:00:15 PM
DR. BUTLER addressed the sectional analysis of SB 91 as follows:
Section 1:
Includes the findings of the extent of the public-health threat.
Acknowledges and describes the governor's disaster declaration,
and the need for legislation to extend the declaration.
Section 2:
Extends the February 14, 2017 disaster declaration for 1 year to
February 14, 2018.
Section 3:
Makes the effective date retroactive to March 15, 2017 when the
current disaster declaration expires.
SENATOR MICCICHE asserted that he is an active supporter of
dealing the state's opioid crisis. He asked for an explanation
of the emergency declaration's criteria under federal law. He
inquired if the emergency declaration was actually appropriate.
2:01:36 PM
STACY KRALY, Chief Assistant Attorney General, Alaska Department
of Law, Juneau, Alaska, addressed the emergency declaration from
SB 91 as follows:
This is a state emergency declaration, not a federal
declaration. Under current state statute there is a
mechanism under the public-health authorizations under
Title 18 and also under the Military and Veterans
Affair statutory authorizations under Title 26 that
provides for the issuance of a declaration of an
emergency.
If you look in particular under AS 18.15.390 which are
the powers of the department in a public-health
disaster, the department can work with the Department
of Military and Veterans Affairs to initiate a public-
health emergency under the auspices and authorities
that Military and Veterans Affairs as under AS
26.23.020; so they kind of work in conjunction with
each other generally and under emergency declaration
are done for flooding, that's the most recent one that
happened, ice jams and flooding and that sort of thing
so there would be an emergency declaration through the
Department of Veterans and Military Affairs that would
provide the department authorization to provide
certain services and funding in many cases to address
this emergency, an earthquake or something like that.
What has also happened though is that the Legislature
through the public health statutes, like I said under
Title 18, has given the department the authority to
use the mechanisms of a disaster declaration for
purposes of a public-health emergency and that is what
we have done under this context; so they work together
a little bit different. We use the same framework and
format under the emergency declaration for the
Veterans and Military Affairs, but it is used for a
public health emergency which is what we've done in
this context.
SENATOR MICCICHE asked if the federal grants that are funding
the program requires a disaster declaration.
2:04:19 PM
MS. KRALY answered no. She continued as follows:
What we were very clear in the emergency declaration
when we crafted it for the governor's office is that
there were going to be no additional funds that were
going to be administered generally when an emergency
happens like I was explaining previously; say the
flood, there's a need for an expenditure, some
financial outlay by the Legislature to help address
the emergency. This grant was applied for and was
received long before this declaration was received, so
there's no addition fiscal outlay or request being
made as a result of this declaration.
CHAIR WILSON stated the following:
Our offices looked into this a little bit and working
with the department and the state as well and first we
want to thank the governor for raising awareness to
this issue. We all want here to save lives and we
understand, but I do want to put this in perspective,
if we will have a conversation to make sure we have
clearness upon what is needed and what is being asked
for.
CHAIR WILSON asked if Alaska has already received the $4
million.
DR. BUTLER answered yes.
CHAIR WILSON asked him to verify that the declaration is not
needed for the expenditure of the $4 million.
DR. BUTLER answered correct.
CHAIR WILSON summarized as follows:
Really what is being asked for is that the medical
director could have these special privileges to help
dispense Naloxone throughout the Alaska communities
and this would allow him to do that both allow this
position to do that for the one year until the end
date of this declaration.
2:06:11 PM
DR. BUTLER answered correct.
CHAIR WILSON asked if a bill could be drafted rather than an
emergency declaration.
DR. BUTLER answered that he supported any means in addressing
opioid overdose prevention.
CHAIR WILSON noted that Dr. Butler had the emergency declaration
privilege within the 30 days. He asked if SB 91 extends the
privilege for 30 days or would the bill be a stop-gap if the
Legislature does not act within the 30-day timeframe.
DR. BUTLER answered as follows:
The current disaster declaration will expire on March
15, so if there is a gap period it means we would stop
the dispensing of the kit until we can get a
resolution for this issue.
SENATOR VON IMHOF asked him to verify that the state received
the federal Substance Abuse and Mental Health Services
Administration (SAMHSA) grant of $4.1 million.
DR. BUTLER answered correct.
SENATOR VON IMHOF assumed that the program's success required as
many caregivers as possible to have access to the kits in order
to deliver Naloxone.
DR. BUTLER specified that the persons who may be administering
Naloxone did not have to be a health-care provider.
2:08:21 PM
SENATOR VON IMHOF asked to confirm that Naloxone requires a
doctor's approval of some sort in order to administer, something
that is not always time efficient and not always possible in
emergency situations.
DR. BUTLER answered correct.
SENATOR VON IMHOF stated that one way to circumvent the doctor's
approval is by claiming an emergency disaster. She asked if
circumventing approval by a doctor was the intent of the
emergency disaster declaration.
DR. BUTLER specified that the disaster declaration allows the
standing order to be created to be able to provide that pre-
existing prescriptive authority so that the kits could be
available to people who are most likely to be present.
SENATOR VON IMHOF asked him to verify that a blanket authority
would be extended to the on-the-ground health-care providers
that are in the emergency situation
DR. BUTLER answered correct.
SENATOR VON IMHOF replied that she understood the reasoning
behind getting 800 kits out and distributed as quickly as
possible without having the cumbersome aspect of having an
individual doctor's approval each time. She stated that the
question remained if an emergency declaration is required versus
the statute process. She asked Dr. Butler if he would support
extending the declaration 30 days to buy time for the committee
to write up a statute for a 1-year authority period.
2:10:08 PM
DR. BUTLER reiterated that he supported however the authority
can be established to distribute the kits. He pointed out that
the funding is for five years and asked if the prescriptive
authority can be considered for a longer period.
SENATOR GIESSEL quoted the statute that cited the declaration of
disaster under AS 26.23.020 and commented as follows:
"This emergency declaration allows the allocation of
medicine or supplies to address the emergency;" it is
only for 30 days, it is a standing order as Dr. Butler
has pointed out. The medication in the overdose kit is
a prescription medication, consequently he, as the
state's medical officer, can write a blanket
prescription allowing the training of personnel, of
citizens in the proper use of these, it's a nasal
spray, but it does require the prescription. To extend
this only for 30 days does not really address the
problem and the state medical director has provided us
with some information about the size of this problem
and it will take more than just another 30 days to
address it properly.
SENATOR BEGICH asked to confirm that the legislation would do
what Senator Giessel referenced in statute.
SENATOR GIESSEL answered yes.
2:12:54 PM
CHAIR WILSON asked Dr. Butler to explain the numbers that are
referenced in the bill on page 1, lines 9-13.
DR. BUTLER confirmed that heroin-associated deaths more than
quadrupled from 2009 to 2015, from 7 deaths to 38 deaths in
2015.
CHAIR WILSON noted that in 2014 approximately 500 doses of
Naloxone was given out. He asked Dr. Butler if he knew how many
kits are planned to be administered for the first year.
DR. BUTLER replied that the goal is to distribute 5,000 kits.
2:16:32 PM
CHAIR WILSON noted constituency concerns that wide availability
of Naloxone may have a negative impact on society as a "Get out
of death for free card." He asked if there is concern that the
$4 million will just be used for Naloxone rather than putting
funds further upstream to get to people before they use opioids.
DR. BUTLER specified that Naloxone can save a life, but does not
cure the addiction. He concurred that Naloxone is not the only
approach to address the opioid epidemic. He set forth that
access to treatment and the stigma often associated with
addiction must also be addressed. He added that how pain is
being managed with opioids is another area that must be
assessed.
2:20:51 PM
SENATOR MICCICHE asked how other states are dealing with the
opioid epidemic.
DR. BUTLER replied that like Alaska, other states are also
taking a multi-faceted approach that includes allowing the state
medical officer to issue a standing order, address drug
monitoring programs, continued medical education to providers on
pain management and addiction, and limiting the number of opioid
pills that can be dispensed.
SENATOR MICCICHE asked if there is a "good samaritan" law that
covers someone administering Naloxone.
2:24:06 PM
MS. KRALY replied that she would take a look at the general
"good samaritan" laws of the statutes and provide a more
thorough answer of how those would apply.
CHAIR WILSON asked if training certificates will be provided to
show that a person was well trained for administering Naloxone.
He opined that certification would apply to "good samaritan"
laws that a person was trained within the authority of what they
do.
DR. BUTLER explained that the kits have pre-packaged Naloxone
nasal spray to simplify administering the drug. He detailed that
training is fairly simple and provided a step-by-step process
for administering Naloxone.
SENATOR MICCICHE asked if the state was in the right place
"mechanically" in training for administering Naloxone.
2:28:05 PM
ANDREW JONES, Section Chief, Emergency Programs: Health
Emergency Response Operations, EMS and Trauma, Division of
Public Health, Department of Health and Social Services,
Anchorage, Alaska, announced his availability to address how the
overdose kits are administered.
CHAIR WILSON asked Mr. Jones to address Senator Micciche's
inquiry on Naloxone.
MR. JONES explained that Health Emergency Response Operations,
Emergency Medical Services (EMS) and the Trauma System have a
comprehensive and customized training program to meet the needs
of Alaskans. He detailed that training is hands-on, one-on-one
that is similar to CPR training. He noted that individuals that
receive training get a card to show that they were trained. He
revealed that training-on-training has an application process
and the thorough training takes a few hours to complete.
He explained that the intent of the program was to compliment SB
23 and one of the parts of the bill says, "An employer or
volunteer of the overdose program with training can administer
the lifesaving drug." He said the intent was for the state to
create an umbrella-program with a goal to get the kits into the
hands of the non-profits, the peer-recovery groups, the people
who are in connection with individuals who are either going
through recovery or may actually be using on a day-to-day basis.
He addressed Senator Micciche regarding a disaster declaration
and specified that the two things that are always analyzed and
asked is: loss of life, and loss of property. He said the $4
million federal grant will assist with getting the medication
out in an efficient and quick manner to save lives.
2:30:36 PM
CHAIR WILSON asked if DHSS would come back in 2018 after the
declaration is done and ask the Legislature to issue the medical
director's position the same clearance to authorize dispensing.
He asked if responding to the request would be best done through
a bill process or continue a year-to-year process.
DR. BUTLER opined that the most efficient response would be the
bill process.
SENATOR VON IMHOF said she was pleased the state received the $4
million SAMHSA grant; however, she posed that using a
declaration of disaster emergency to implement the program opens
the door to potential risk of open-ended funding in the future.
She noted that legal opinion was sought and pointed out that
there is a risk. She said as a person sitting on the Senate
Finance Committee, she acknowledged the risk and asserted that
she would like to explore an alternative option if the same
thing can be accomplished.
2:33:27 PM
DR. BUTLER reiterated that his objective is to maintain the
program and save lives in whatever way that is optimal.
MS. KRALY explained that the emergency declaration that was
signed by Governor Walker was very narrowly crafted to
specifically address the concerns that Senator von Imhof raised.
She revealed that an emergency declaration was the quickest way
to get the kits into Alaska's communities.
2:36:42 PM
SENATOR GIESSEL noted that the Mat-Su has an opioid response
team, a community group that has come together to address the
issue in the Mat-Su Valley. She disclosed that Anchorage is
forming a similar group. She asked Mr. Jones if he knows if a
response team is formulating in Fairbanks.
MR. JONES answered that a Fairbanks has a collation as well as
numerous collations throughout the state. He said the intent is
to provide tools and capabilities to empower communities for a
long-term response.
SENATOR GIESSEL asked Mr. Jones what Naloxone's side effects are
and the result if the drug is mistakenly administered to someone
that is not having an opioid overdose.
MR. JONES answered that the side effects are minimal, unless the
person is allergic specifically to Naloxone, a situation that
has very few cases of occurrence in the U.S. He said most of the
times what ends up happening if an individual is overdosing and
it is not an opioid, the person probably will not wakeup and
that's when CPR is administered.
SENATOR GIESSEL asked Mr. Jones if he knew much about the
state's "good samaritan" laws in reference to liability for
Naloxone.
2:39:21 PM
MR. JONES revealed that one of the statutes as a result of last
year's legislation from SB 23 addressed liability and gross
negligence. He explained that gross negligence would occur if a
person had an overdose kit but did not administer Naloxone. He
added that administering CPR is covered under the "good
samaritan" law, as long as gross negligence is not applied.
SENATOR GIESSEL asked Dr. Butler if he could elaborate on
Naloxone's side effects and liability related to the "good
samaritan" law.
DR. BUTLER concurred with Mr. Jones that nothing will happen to
a person that is administered Naloxone if the individual is not
experiencing an opioid overdose. He detailed that the person
will not wake up, but 9-1-1 should be called and CPR
administered by someone that is trained.
2:41:17 PM
CHAIR WILSON opened public testimony.
2:41:47 PM
KARA NELSON, representing self, Juneau Recovery Community
Organization, Juneau, Alaska, testified in support of SB 91. She
said the opioid epidemic is an emergency and people are dying.
She asserted that Naloxone is needed. She revealed that she has
been trained in administering Naloxone and has done so in
overdose situations.
2:44:55 PM
MICHAEL CARSON, Vice President, MyHouse Mat-Su, Wasilla, Alaska,
testified in support of SB 91. He noted that he is also the
chairman of the Mat-Su Opioid Task Force. He detailed that
MyHouse is one of the non-profits that would benefit from the
wide distribution of Naloxone kits. He concurred that the
state's heroine increase has, "Gone up through the roof."
2:48:27 PM
MIKE COONS, representing self, Palmer, Alaska, testified in
opposition of SB 91. He revealed that he was a paramedic for 22
years. He opined that distributing Naloxone will be a failure
and may even add to increased deaths of opioids by enabling
addicts. He said he objected to the use of federal funds to pay
for the $4.1 million grant to the state for disaster relief.
CHAIR WILSON clarified that the $4.1 million comes from a SAMHSA
grant.
MR. COONS replied that the grant still comes from taxpayer
dollars.
2:51:27 PM
JOHN GREEN, representing himself, Wasilla, Alaska, testified in
support of SB 91. He revealed that his daughter died from a
heroin addiction. He set forth that recovery resources should be
made available in order to save lives.
2:54:12 PM
CHAIR WILSON closed public testimony.
He asked Dr. Butler about the "after effect." He remarked that
the possible side effects from receiving Naloxone was
overlooked. He asked Dr. Butler if an individual's state of mind
and behavior is affected from Naloxone.
DR. BUTLER replied that Naloxone does not cure addiction. He
emphasized that addiction is a chronic health condition that
requires management. He noted that the community coalitions play
an important role in addiction recovery.
CHAIR WILSON asked Dr. Butler to address the effects of what
happens to a person right after receiving Naloxone.
2:56:55 PM
DR. BUTLER replied that the effects are dependent on the
situation.
CHAIR WILSON inquired if there is a risk of the person being
aggressive after being administered Naloxone. He asked if the
effects from Naloxone and the risks are being covered in
training.
DR. BUTLER explained that the acute effects that are experienced
by the person who receives the Naloxone is going to be driven
somewhat by the dose and strength of the opioid. He added that
the amount of Naloxone administered is important to get someone
to start breathing again, but to avoid going into acute
withdrawal. He pointed out that acute withdrawal is very
unpleasant with the possibility for vomiting.
SENATOR BEGICH noted that typically a "findings section" is not
included in legislation and recommended that the section be
eliminated from the bill.
2:59:59 PM
CHAIR WILSON detailed that his intent is to introduce a
committee substitute at the next committee meeting. He said he
hoped to get the bill out of committee as soon as possible so
that the work of DHSS is not hindered. He commented on the bill
as follows:
I don't think anyone here in the committee doesn't
think that every life is valuable to be saved and we
thank the administration for putting this forth and
this plan together. I think that we've all had our own
experiences with this issue one way or another, but we
just want to make sure that we are looking at this as
a whole. It is my viewpoint that we are addressing not
just down-the-river, but we can go further upstream as
possible.
CHAIR WILSON held SB 91 in committee for future consideration.
3:01:15 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Committee at 3:01 p.m.