Legislature(2019 - 2020)BUTROVICH 205
02/17/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| SB173 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 173 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 17, 2020
1:30 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Mike Shower
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 173
"An Act relating to mobile intensive care paramedics; relating
to duties of the State Medical Board and the Department of
Health and Social Services; and providing for an effective
date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 173
SHORT TITLE: LICENSE MOBILE INTENSIVE CARE PARAMEDICS
SPONSOR(s): SENATOR(s) REVAK
02/03/20 (S) READ THE FIRST TIME - REFERRALS
02/03/20 (S) HSS, L&C
02/17/20 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
SENATOR JOSH REVAK
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Spoke as sponsor of SB 173.
KIM SKIPPER, Staff
Senator Josh Revak
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided the sectional analysis for SB 173.
JILL LEWIS, Deputy Director
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 173.
SONDRA LECLAIR, Section Chief
Rural and Community Health Systems
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 173.
SARA CHAMBERS, Director
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 173.
ALYSIA JONES, Executive Administrator
State Medical Board
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 173.
JULIE ANDERSON, representing self
Haines, Alaska
POSITION STATEMENT: Testified in support of SB 173.
ANDREW PANTISKAS, EMS Officer
Capital City Fire/Rescue
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 173.
BRIAN WEBB, representing self
In room
POSITION STATEMENT: Testified in support of SB 173.
WILMA VINTON, representing self
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of SB 173.
ANJELA JOHNSTON, Chair
EMS Training Committee
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 173.
TIMOTHY PETERSON, M.D., Co-Chair
State EMS Medical Direction Committee
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 173.
EUGENE WISEMAN, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 173.
MIO RHIEN, South Tongass Volunteer Fire Department
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of SB 173.
MICHAEL LEVY, M.D., representing himself
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 173.
ALEX BOYD, Assistant Chief
Director of Training
Anchorage Fire Department
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 173.
MARK JOHNSON, representing self
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 173.
ACTION NARRATIVE
1:30:11 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:30 p.m. Present at the
call to order were Senators von Imhof, Begich, Giessel, and
Chair Wilson. Senator Shower arrived shortly thereafter.
SB 173-LICENSE MOBILE INTENSIVE CARE PARAMEDICS
1:30:32 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 173,
"An Act relating to mobile intensive care paramedics; relating
to duties of the State Medical Board and the Department of
Health and Social Services; and providing for an effective
date."
He stated his intent to hear an initial overview and a sectional
analysis and take public testimony on SB 173.
1:30:58 PM
SENATOR JOSH REVAK, Alaska State Legislature, Juneau, Alaska,
sponsor of SB 173, said this bill seeks to consolidate the
oversight of the emergency medical services (EMS) system under a
single agency. Currently, regulation of the EMS system is split
between the State Medical Board within the [Department of
Commerce, Community and Economic Development (DCCED)] and the
EMS section within the Department of Health and Social Services
(DHSS). This issue arose because paramedics did not exist in
Alaska before 1974. After 1974, the term mobile intensive care
paramedic was created for the new scope of practice in the
Anchorage and Fairbanks fire departments. The emergency medical
system (EMS) within DHSS did not exist in Alaska code until
1981. The responsibility to license and credential the
paramedics was placed under the State Medical Board. In 1984,
the EMS section became fully functional. However, the paramedics
remained under the State Medical Board.
SENATOR REVAK said paramedics provide an essential part of a
comprehensive emergency medical services system. This bill will
transfer paramedic licensure to the Alaska Emergency Medical
Services office, DHSS. The Alaska Emergency Medical Services
office is currently responsible for certifying emergency medical
technicians (EMTs), EMT instructors, EMT training, ground
ambulance, medevac services, paramedic instructors, and
paramedic training. However, paramedics are licensed by the
State Medical Board.
SENATOR REVAK said SB 173 does not change the scope of practice,
license requirements, or fee structure. Medical direction will
be provided by the existing DHSS Chief Medical Officer and the
EMS Medical Directors' Committee, The State Emergency Medical
Services office is well-positioned to support this change with a
staff of six full-time positions, five of whom are required to
have paramedic experience. Existing data systems are able to
incorporate paramedic licensure, making the transfer a seamless
transition. Aligning all EMS services under a single agency
promotes public safety while bringing new efficiencies to the
licensure process.
1:35:00 PM
KIM SKIPPER, Staff, Senator Josh Revak, Alaska State
Legislature, Juneau, Alaska, gave the sectional analysis for SB
173:
Sec. 1 amends 08.64.107, State Medical
Board/Regulation of physician assistants and intensive
care paramedics, to remove regulation of paramedic
licensure from the Medical Board. (See also Sec. 8.)
Sec. 2 amends 08.64.170, License to practice medicine,
podiatry, or osteopathy, allowing paramedics to
practice medicine to render emergency lifesaving
service under "another law" instead of under the
Medical Board's authority. (See also Sec. 6)
Sec. 3 amends 08.64.360, Penalty for practicing
without a license or in violation of chapter, to
remove paramedics. (See also Sec. 10)
Sec. 4 amends 08.64.369, Health care professionals to
report certain injuries, to change paramedics licensed
under the Medical Board to those licensed under DHSS,
for health care providers who must report certain
injuries to the Department of Public Safety.
Sec. 5 amends 12.55.185(11), Sentencing and Probation,
to change paramedics licensed under the Medical Board
to those licensed under DHSS.
Sec. 6 amends 18.08.075, Authority of emergency
medical technician, to allow paramedics to provide
emergency medical care. (See also Sec. 2.)
Sec. 7 amends 18.08.080, Emergency Medical
Services/Regulation, to require DHSS to adopt
regulations establishing standards for paramedic
licenses.
Sec. 8 adds a new subsection 18.08.082(a)(5), Issuance
of certificates; designations, to add regulation of
paramedic licensure to DHSS. (See also Sec. 1.)
Sec. 9 amends 18.08.082(b), Issuance of certificates;
designations, to clarify that DHSS is the central
certifying and licensing agency for all emergency
medical services.
1:36:58 PM
Sec. 10 amends 18.08.084(a), Certificate required, to
prohibit a person from practicing as a paramedic
without a license. (See also Sec. 3.)
Sec. 11 amends 18.08.089, Authority to pronounce
death, to ensure consistent use of the term "mobile
intensive care" paramedic throughout the law.
Sec. 12 adds a new paragraph (14) to 18.08.200,
Emergency Medical Services/Definitions, to add the
definition of "mobile intensive care paramedic". (See
also Sec. 14.)
Sec. 13 amends 37.05.146(c)(77)(F), Definition of
program receipts and non-general fund program
receipts, to add fees for licensure of paramedics to
the list of fees collected by DHSS.
Sec. 14 repeals 08.64.366, Liability for services
rendered by a mobile intensive care paramedic (See
18.08.086, Immunity from liability, under DHSS).
Repeals 08.64.380, Medicine/Definitions to remove (3)
"emergency lifesaving service" and (4) "mobile
intensive care paramedic" (See also Sec. 12).
Sec. 15 amends the uncodified law to provide
transitional authorities:
(a) A current paramedic license issued before January
1, 2021 remains valid until it expires under the
Medical Board, is suspended or revoked, or is
converted to a license under DHSS.
(b) The Department of Commerce, Community and Economic
Development and the Medical Board will transfer to
DHSS on January 1, 2021, files of all pending
paramedic-related records and proceedings,
applications, and disciplinary actions.
(c) Authority for DHSS to adopt regulations which
shall include the conversion of unexpired paramedic
licenses issued under the Medical Board.
Sec. 16 provides an immediate effective date for DHSS
to adopt regulations.
Sec. 17 provides an effective date of January 1, 2021.
CHAIR WILSON called representatives from DHSS to explain how the
transition would work.
1:39:43 PM
JILL LEWIS, Deputy Director, Division of Public Health,
Department of Health and Social Services (DHSS), Juneau, Alaska,
said the Division of Public Health (DPH) has a broad mission to
protect and promote the health of Alaskans, which includes
disease and injury prevention, vital records, and the medical
examiner's services to ensure access to health care, and
preparedness for all hazards. This change is needed to make the
system more efficient. This change has been developed in a
deliberative process involving hundreds of stakeholders
throughout the EMS community.
1:41:40 PM
SONDRA LECLAIR, Section Chief, Rural and Community Health
Systems, Division of Public Health, Department of Health and
Social Services (DHSS), Anchorage, Alaska, said Rural and
Community Health Systems houses the EMS Office. She explained
that the EMS system is comprehensive and multifaceted. Each
component, including EMTs, paramedics, ambulance services, and
others are vital to a well-functioning system.
She began a PowerPoint, "SB 173 License Mobile Intensive Care
Paramedics." She reviewed slide 2, SB 173:
Transfers oversight and licensure of Mobile Intensive
Care Paramedics from the State Medical Board to the
Department of Health and Social Services (DHSS)
effective January 1, 2021.
MS. LECLAIR reviewed slide 3, Aligns a Fragmented System:
square4 Regulation and oversight of the EMS system is
split between the State Medical Board and
Department of Health and Social Services.
square4 Reduces the administrative burden for fire/EMS
services, paramedics who will coordinate with
only one state agency
o Licensure, certification
o Patient care data entry
square4 Increases efficiency and communication with all
EMS provider types
square4 Representation on the Governor's Alaska Council
on Emergency Medical Services
She said it is important to create a seamless line of
communication and representation. Further, if SB 173
becomes law, paramedics will have representation on the
council that creates guidelines and protocols that impact
their daily work.
1:44:50 PM
SENATOR VON IMHOF said licensed occupations typically are
regulated by a board comprised of their peer, such as the Board
of Barbers and Hairdressers. The licensure for paramedics is
being transferred from the State Medical Board to DHSS. She
asked if that is because the paramedics are part of an EMS
system or is it because their peers do not want to oversee the
paramedics.
MS. LEWIS replied the State Medical Board fully supports the
transfer of paramedic licensure in order to better integrate the
system. The EMS office's mission not only will license and
certify elements but will ensure a comprehensive EMS system.
This helps ensure that the entire system is robust, sustainable,
and resilient.
SENATOR VON IMHOF asked whether there would be another request
for another licensed occupation to be wrapped in with EMS.
MS. LEWIS replied she will present a slide to show the EMS
elements the DHSS already regulates. There is just the one link
in the whole system that is not already under the umbrella.
1:47:19 PM
SENATOR GIESSEL asked if emergency room personnel emergency room
doctors would also be moved to DHSS.
MS. LEWIS answered no. She explained that those physicians are
appropriately licensed by the State Medical Board. However,
paramedics align better with the expertise in emergency medicine
and field services.
SENATOR GIESSEL said pages 4-5 of the bill describe the duties
for mobile intensive care paramedics, which includes pain
management, opioid use, and in Section 12, advanced life support
under the direct or indirect supervision of a physician. These
individuals are being licensed to perform very advanced medical
services under the direct or indirect supervision of a
physician. Paramedics are authorized to perform medical
interventions, which is the reason paramedics fall under the
State Medical Board. She asked how that has changed.
MS. LEWIS answered that the direct oversight of a paramedic by a
sponsoring physician will not change under the bill. Currently,
under DHSS regulations, EMTs must have sponsoring physicians
under DHSS regulations. However, many paramedics work under the
medical direction of a physician under the regulations provided
by the DHSS's EMS Office.
SENATOR GIESSEL replied it sounds a lot like the delegation of
authority that is embodied in a registered nurse or advanced
practice registered nurse. However, certified nursing aides and
medical assistants are not being moved to DHSS. She asked for
further clarification on the reason to transfer paramedics from
the State Medical Board.
1:51:32 PM
SENATOR BEGICH asked for clarification about Ms. LeClair's
statement that the EMS does not have records of all the
paramedics and how this bill would address that.
MS. LECLAIR replied EMS uses an automated communication system
designed for oversight and communication with the prehospital
individuals it certifies, including EMTs, and ambulance
services, but paramedics are not included.
SENATOR BEGICH asked if the bill is necessary to coordinate
those systems.
MS. LECLAIR answered that in order to require paramedics to log
in and use the EMS system, paramedics must fall under its
licensure and certification system.
She reviewed slide 4, Protects the public health.
square4 Aligns all emergency medical services under an
agency whose sole purpose is to ensure a
comprehensive statewide EMS system.
square4 Allows for full integration of paramedics into
quality initiatives such as stroke, cardiac
arrest, trauma, telehealth, and community
paramedicine.
square4 Medical direction by the Department of Health and
Social Services' Chief Medical Officer and an EMS
Medical Directors' Committee.
She said the data integration between the two departments is
complex and likely costly if it can be done at all. This bill
would bring all prehospital services under the EMS office. EMS
has six full-time staff to ensure that patients receive quality
care from their EMS providers and to provide support for EMS
providers. When one body provides oversight, it assists in
integration at all levels, she said.
MS. LECLAIR explained that two elements of medical direction
will continue if paramedics are transitioned to DHSS. First, the
physician-sponsorship will not change. Second DHSS has medical
direction at the department and section level. The Chief Medical
Officer provides the overall medical direction for the
department, but DHSS also has an EMS medical director and EMS
Medical Directors' Committee. That committee is comprised of
individuals who specialize in emergency medicine and/or who are
active medical directors of EMS services. This committee
provides oversight and recommendations for standard protocols,
quality initiatives, and scope of practice and ensure there are
liaisons on the training committees, so that training and
medical direction are well aligned at the council level.
1:57:10 PM
MS. LECLAIR referred to slide 5, Regulation of the EMS System.
This slide outlines the organization of the EMS system. EMS
currently has regulatory authority to oversee the elements of
the prehospital emergency medical services. The first four
elements [DHSS Chief Medical Officer, Alaska Council on
Emergency Medical Services, State EMS Medical Director, EMS
Medical Directors' Committee], indicate the medical direction
referred to earlier. Under those four elements are the types of
providers, training, instruction, or services that DHSS
certifies and oversees, including paramedic instructors and
training programs, EMTs and their programs, ambulance services,
and others. However, one element of the prehospital system that
DHSS does not regulate are the paramedic personnel who are under
the State Medical Board. As Ms. Lewis mentioned, DHSS held
extensive discussions with the State Medical Board, and the
board unanimously voted to support the transition of paramedic
oversight to DHSS.
CHAIR WILSON asked to see documentation on that decision.
1:58:47 PM
MS. LECLAIR reviewed slide 6, Continuity During Transition:
square4 Existing licenses are valid until the
registration expires or is converted to a new
license under the Department of Health and Social
Services
square4 Transfer files, records, and proceedings,
including applications and disciplinary actions,
to the Department of Health and Social Services
(DHSS)
MS. LECLAIR reviewed slide 7, SB 173:
square4 No change to current scope of practice, licensure
requirements, or fee structure
square4 600 paramedics licensed in Alaska
square4 Less than 50 new applications annually
square4 Licenses are for two years
square4 No fiscal impact.
MS. LECLAIR reviewed slide 8, Infrastructure in {lace:
She said DHSS has the infrastructure to take on the additional
licensure oversight.
square4 The State EMS Office is well-positioned to
provide the efficiency, organization, and
oversight required to support this change.
square4 The office has the capacity. Taking on paramedics
licensure can be accomplished with existing
resources and does not require additional funding
or staffing.
square4 The office has the expertise. Six full-time
staff, 5 of which are required to have paramedic
experience, with more than 100 years of combined
experience with the emergency medical services
system.
square4 The office has the infrastructure. Existing data
systems and procedures are ready to incorporate
paramedic licensure.
She elaborated on the current system, stating that just under
3,500 EMTs are certified by the EMS system and several hundred
new applications are received each year. The office also has
certifications for instructors, ambulance services, and others
for a total of just under 4,000 who receive certification
through the EMS Office. Paramedics would represent about 17
percent of the current number of providers in the system and
about 8 percent of the new applications received each year. The
EMS database is specifically set up to help the office automate
the licensure and certification process. The office has a full-
time EMS database manager to ensure that it runs smoothly and
that people receive the needed information. Those elements are
in place so the office can absorb the additional impact of
bringing paramedics into the section.
SENATOR GIESSEL said she was struck by this amazing capacity and
astonished to hear that taking on additional licensure would
have no fiscal impact. She related her understanding that the
office must employ an investigator and have an attorney general
to deal with complaints and licensing issues.
2:03:02 PM
MS. LEWIS responded that DHSS has enough staff to absorb the
additional work because licensing paramedics would not represent
a substantial increase in the workload, plus the systems are
fairly efficient. DHSS would not need additional staff or
budgetary authority to receive the fees. The number of
investigations were less than eight per year over a 10-year
period. Lat year there was just one. She anticipated that the
amount of investigative work would be manageable.
CHAIR WILSON asked about the fees collected by the State Medical
Board.
MS. LEWIS answered that DCCED could explain the fee structure,
but DHSS does not anticipate changing the fee structure. She
reported that there are roughly 600 biennially-licensed
paramedics.
CHAIR WILSON asked if paramedics and EMTs pay the same licensure
fee.
MS. LEWIS agreed that EMTs all pay the same amount. The vast
majority of EMTs are volunteers, so DHSS strives to keep fees
reasonable to encourage participation. She pointed out that EMTs
generally pay for their own training and sometimes their own
equipment.
SENATOR GIESSEL asked how much the State Medical Board
subsidizes the cost of paramedic regulation.
MS. LEWIS replied she was not the best person to answer the
question.
SENATOR BEGICH asked if DHSS would collect paramedic fees for
licensure, which was not clearly reflected in the fiscal note.
MS. LEWIS responded that because DHSS keeps the EMTs rate so
low, it subsidizes EMTs with other state and federal funds. The
additional fees for the paramedics will offset some of that cost
without requiring additional staff. DHSS could redirect funds
currently being used to subsidize licensure and certification to
other aspects of the emergency medical system (EMS).
CHAIR WILSON said fiscal notes do not always show true costs of
either increments or decrements. Technically, adding paramedics
would be a decrement, he said.
2:09:16 PM
MS. LEWIS answered that the fiscal note is net zero because the
amount collected by DCCED would be the same amount collected by
DHSS, which is less than $50,000.
SENATOR GIESSEL said she the legislature gets fiscal notes for
small board changes. She said she shares Senator Wilson's
consternation that this bill has zero fiscal note.
MS. LECLAIR reviewed slide 9, In Closing.
square4 Paramedics are an essential part of a comprehensive
medical services system.
square4 Aligning all EMS services under a single agency
promotes public safety while bringing new efficiencies
to the licensure process.
She summarized by stating that Alaska is one of three states
that does not integrate paramedics into the prehospital EMS
system. The EMS unit works regularly with EMS services to assist
paramedics with training and instruction. Bringing prehospital
services providers under one state agency will benefit paramedic
integration and communication and create efficiencies.
2:12:46 PM
SARA CHAMBERS, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), Juneau, Alaska, noted that the
Division of Corporations, Business and Professional Licensing
houses the State Medical Board.
2:13:00 PM
ALYSIA JONES, Executive Administrator, State Medical Board,
Division of Corporations, Business and Professional Licensing,
Department of Commerce, Community and Economic Development
(DCCED), Juneau, Alaska, introduced herself.
CHAIR WILSON said the committee packets do not have documents
that show the State Medical Board is fully supportive of the
transfer.
MS. JONES reported that at its February 6-7 meeting, the State
Medical Board voted unanimously to support the transfer of
paramedics to DHSS as proposed by SB 173.
CHAIR WILSON asked what the benefits of the transfer were from
the perspective of the State Medical Board.
MS. JONES shared that Ms. LeClair gave a presentation at the
board's November meeting. She had provided a 2014 National
Highway Safety Administration report that recommended states
address paramedics being removed from prehospital services. She
recalled that Dr. Clift, who serves on the State Medical Board
said it made sense for the paramedics to be with the other
prehospital services.
SENATOR GIESSEL asked whether Ms. Jones was the new executive
director for the State Medical Board.
MS. JONES replied she was appointed at the end of December 2019.
SENATOR GIESSEL asked how long the members present at the
February 6 and 7, 2020 meeting had served in their terms.
MS. JONES answered that seven current board members were
present. One board member who was appointed on February 4 was
unable to attend. The rest of the board members have been
serving from two to four years.
CHAIR WILSON asked about the number of licensees and the current
fee structure.
2:15:55 PM
MS. CHAMBERS answered that there are about 600 paramedics.
Paramedics pay biennial license fees in the amount of $75. The
initial license fees are slightly higher. This results in
$20,000 to $25,000 in revenue per year for the State Medical
Board. The State Medical Board total revenues during the
biennial renewal year are approximately $2.5 million. She said
there is no evidence that the State Medical Board subsidizes the
activity of the mobile intensive care paramedics. Some boards
actively and overtly help high-level professions pick up the
cost of the lower-level professions, but not in this case. There
are minimal expenses associated with paramedics. The State
Medical Board does not offer the overwhelming support of
training and engagement that DHSS can offers paramedics. A
fraction of one range 14 license examiner processes all
paramedic licenses. Paramedics do not generate a substantial
investigative costs since there have not been any extensive
investigations. Paramedics do not have a seat on the board. With
so much support from the medical director and EMS staff, the
State Medical Board found it makes sense to make this change.
The board considered these questions at its November meeting and
unanimously supported moving paramedic licensure to the DHSS.
She pointed out that this occurred prior to Ms. Jones being
appointed to serve as executive director.
SENATOR VON IMHOF pointed out a letter in the committee packet
further collaborating what Ms. Chambers stated. She said the
committee's concern is to ensure that the state EMS does not
incur unintended cost consequences, that a full fiscal plan has
been thought out, and that it is truly a seamless transition.
MS. CHAMBERS offered to furnish the minutes as an official
record of the State Medical Board's action.
SENATOR BEGICH referred to the unanimous board approval but
noted the membership of the Medical Board has completely
changed. He asked her to assess the new members' viewpoints.
MS. CHAMBERS answered that two members are continuing their
service, but the new members have not yet started their terms
and she was unsure of their positions on this issue.
SENATOR BEGICH pointed out there is an inconsistency with
program receipt amounts. The fiscal note from Public Health
refer to $15,000, but Ms. Chambers said it was $20,000 to
$25,000.
MS. CHAMBERS replied she has worked with Ms. Lewis and Ms.
LeClair. The DCCED contemplates biennial licensure, which
amounts to $40,000 in revenue from paramedic fees; however, she
presents amounts in annual terms for the legislature.
SENATOR BEGICH said the fiscal note refers to $10,000 to $15,000
in general fund program receipts. He would like the committee to
know the exact amount. Even if discrepancies are small, such as
the ones in the fiscal notes for the DHSS and DCCED, the
discrepancy should be resolved.
MS. CHAMBERS replied she would address that for future hearings.
She suggested one reason for the difference could be that the
division does not receive undesignated general funds. All their
expenses are funded through program receipts, but the Division
of Public Health receives undesignated general funds. She said
she would work on articulating the different funding sources.
CHAIR WILSON said that issue will need to be resolved before the
bill is moved from committee.
SENATOR GIESSEL said a statement has been made that the Chief
Medical Officer at DHSS oversees this. The current Chief Medical
Officer is Dr. Zink, an emergency room physician. But the chief
medical officer could also be a pediatrician or a public health
specialist. Section 12 talks about advanced life support, which
encompasses intubation, a wide variety of serious medications,
including the injection of those medications into the heart
muscle itself. These are not minimal activities, she said. This
is one way paramedics are different from emergency medical
technicians. She expressed concern that yet another activity is
being moved to the DHSS, since it is a massive department.
2:27:36 PM
CHAIR WILSON opened public testimony on SB 173.
JULIE ANDERSON, representing self, Haines, Alaska, noted that
she had submitted a letter of support for SB 173 as the co-chair
of the Alaska Council on EMS's Scope of Practice Implementation
Task Force. She started working on the task force in November of
2018. She learned that the state EMS Office is quite
interconnected with national and state entities. The EMS office
has a lot of support from other agencies to provide this
oversight. She has a unique perspective as an individual because
she is licensed as a paramedic and as a registered nurse. As
Senator Revak and Ms. LeClair described, as a paramedic she must
register with the State Medical Board and the EMS office. She
said it can be confusing to know who to turn to for certain
resources. One of the strengths of the nursing profession is
their advocacy allows them to define themselves in a way that
emergency medical services providers cannot. As Senator Revak
explained, paramedics are a young profession. She offered her
belief that the ability to unify and have advocacy from the EMS
is meaningful and important.
MS. ANDERSON said Haines is still waiting for a paramedic to be
licensed who was certified more than nine weeks ago by the
National Registry. She expressed concern that there are multiple
cases of delayed certification through the State Medical Board.
The State EMS Office currently has the infrastructure to process
reciprocity and streamline registration timelines.
2:30:53 PM
ANDREW PANTISKAS, EMS Officer, Capital City Fire/Rescue, Juneau,
Alaska, said he came to Alaska from Washington state five years
ago. He has his certification from the National Registry and
holds a bachelor's degree in paramedicine, but it still took
over four months to get licensed in Alaska. These timeframes can
be shorted and it may be helpful to consider the impacts to
Alaskans who do not have access to a paramedic's during the
three to four months it takes to gain licensure. He currently
manages paramedics and EMTs, who fall under two state entities,
yet 80 percent of their skills are the same. Some of these EMTs
can administer opiates and provide advanced cardiac life
support. He said it is difficult to manage and recertify these
professionals under two separate state agencies. SB 173 will
simplify things and allow more oversight from the state.
2:32:56 PM
BRIAN WEBB, representing self, Anchorage, Alaska, said he first
became an EMT in Anchorage in 1978. He has been licensed,
registered, and certified as a paramedic for over 40 years. When
he began prehospital career in Anchorage, there were fewer than
50 paramedics statewide. Now there are over 600. He is one of
the few paramedics still practicing with institutional
knowledge. Since the Division of EMS did not exist during the
inception of paramedics, the State Medical Board was the only
logical place was to place them. Working to move paramedics from
the State Medical Board to EMS will bring prehospital care under
a single entity. He has been interested in this issue for over
20 years, which includes his years working as an EMS training
coordinator with the regional EMS office in Anchorage.
MR. WEBB said paramedics do not have any peers on the State
Medical Board. Moving paramedics to the DHSS will provide that
peer support and oversight. EMT-2s or EMT-3s in Alaska provide
advanced life support and must have a sponsoring physician. If
EMT-2s or EMT-3s are not in the DHSS, these EMTS do not have a
sponsoring physician to provide day-to-day medical direction.
The EMS Office is staffed by paramedics who are knowledgeable
about the paramedic duties and functions. This move will
increase regulatory oversight, bolster standards of care, and
streamline and simplify their lives. It took him over 24 months
to get licensed in his home state when he returned from his
service in the U.S. Navy, and by then his license had expired.
That adversely impacted him and the process needs to change.
2:35:54 PM
WILMA VINTON, representing self, Fairbanks, Alaska, said she has
been an MICP (mobile intensive care paramedic) since 2007 and an
EMT since 1979. She is an assistant chief of EMS for Steese
Volunteer Fire Department. As an instructor, and past adjunct
faculty for the University of Alaska Fairbanks paramedic
program, she works with EMTs and MICPs on a regular basis to
assist them in acquiring and maintaining their certifications
and licenses. Her full-time job is executive director of
Interior Region EMS Council. This move from the Medical Board to
the State Office of EMS is an excellent way to streamline the
licensing process. Paramedics are an essential part of the EMS
system. She believes it would be a seamless move.
She said EMTs are regularly certified within a week of testing
and at a maximum within 20 days. The EMS Office also certifies
paramedic coordinators and instructors. The licensing process
under the Medical Board can take several months. The board meets
only quarterly to approve licenses. The State Office of EMS does
this daily. Shortening the paramedic certification time will
benefit students, those from the lower 48 seeking certification,
and military leaving the service who wish to practice in Alaska.
MICPs would be managed by an organization that understands their
needs and is part of the EMS system.
2:38:41 PM
ANJELA JOHNSTON, Chair, EMS Training Committee, Juneau, Alaska,
noted that she submitted a letter on behalf of the committee.
She is dual licensed in Alaska as a registered nurse and
paramedic. She has been affiliated with Alaska EMS for just less
than 23 years, and she would echo Julie Anderson's comments. As
Ms. Lewis testified, it was an accident of history that
paramedics were assigned to the Medical Board. Committee members
can do their part to correct this accident and make EMS whole
again in Alaska by advancing the bill. She urged members to
support this bill.
2:40:06 PM
TIMOTHY PETERSON, M.D., Co-Chair, State Medical Directors'
Committee, Juneau, Alaska, said he is the medical director of
Capital City Fire/Rescue. He is involved in and aware of the
training paramedics have. That type of expertise is needed for
oversight of paramedics. The State Medical Board is a hodgepodge
of different medical professions. The Medical Directors'
Committee on which he serves consists of EMS experts from across
Alaska. He would like EMS experts to supervise and license EMS
providers. The National Highway Safety Administration did an
assessment of EMS in the state of Alaska about five years ago.
One of the main recommendations was that these things be put
together like it is everywhere else. When he supervises
paramedics and EMTs through different offices, it is
frustrating.
2:42:10 PM
EUGENE WISEMAN, representing self, Anchorage, Alaska, said he is
in his 10th relicensure cycle as a paramedic. After listening to
the testimony, he agrees with those who spoken before him. The
relationship between paramedics and their physicians are not at
the Medical Board level or Dr. Zink level. His relationship is
with his medical director. That is where the relationship
between EMS and physicians lies, at that lower level. Those
individuals write their protocols and provide the quality
assurance and insurance. That would only be enhanced as the
Medical Directors' Committee is part of DHSS and the EMS Office.
Paramedics should be aligned with the EMS Office to improve the
strength [of relationships] with medical directors. Paramedics
are often the mentors to the EMTs. It hard to give them guidance
because their recertification is in different systems.
2:44:09 PM
MIO RHIEN, South Tongass Volunteer Fire Department, Ketchikan,
Alaska, said he is a paramedic for Guardian Flight. He has been
a paramedic in Alaska for 10 years. He has worked in two other
states. Dr. Peterson's points about consistency of licensure and
oversight are significant. That is one of the things he noticed
when he came to Alaska. This bill moves in the direction of
consistency, which helps to build accountability and keep it.
Relationships with medical directions sometimes feels hampered
because paramedics have no relationship with the State Medical
Board and the board is not as intimately involved with what
paramedics do. This move would make it easier to recruit
paramedics because the certification process would be easier.
2:47:18 PM
MICHAEL LEVY, M.D., representing himself, Anchorage, Alaska,
said he concurred with all that was said before about this
alignment. As the medical director for the state of Alaska
Emergency Programs, he is the physician that oversees the other
physicians and looks at scope of practice, etc. He is also the
President-elect of the National Association of EMS Physicians
and probably has the largest EMS practice in the state of
Alaska. He is the medical director of the Anchorage Fire
Department, the Kenai Peninsula Borough, and organizations on
the North Slope. He has over 100 medics that report to him in
one way or another. Moving medics to DHSS makes a lot of sense
to him because of what he has seen over the years. He reiterates
what Dr. Peterson said. Medical direction is provided at the
level of a subspecialty of medicine. EMS medicine is a clinical
practice. Medical directors provide oversight of medics and
other medical directors as their sole focus and practice these
days. The new alignment will allow medical directors to provide
better quality.
SENATOR VON IMHOF asked if this move will change physician
oversight in any way that could compromise or increase risk.
DR. LEVY replied it would only improve physician oversight. That
is not to say that his colleagues on the Medical Board have not
done a good job but realigning with the house of EMS can only
improve things.
2:51:08 PM
ALEX BOYD, Assistant Chief and Director of Training, Anchorage
Fire Department, Anchorage, Alaska, said consolidation of this
process mimics the current practice in the EMS community. He
said he works closely with EMTs and paramedics on a daily basis.
He said he seconds what Dr. Levy said about how this will only
improve the process.
2:52:40 PM
MARK JOHNSON, representing self, Juneau, Alaska, said he is
retired but serves on some of the committees involved in the EMS
system in the state. He was chief of EMS for more than 25 years
in Alaska. He was there when the paramedic regulations were
adopted by the Medical Board. The Governor's Advisory Council on
EMS, which has members appointed by the governor and oversees
EMS for DHSS, helped write those regulations for the Medical
Board. That was around 1979. Every time those regulations were
updated, the board worked closely with the EMS Office. Many
medical board members that he has known over the years have
asked why the EMS could not just take over this for the state
board. It required a statute change and many other things were
happening in those days. As has been pointed out, the state EMS
program in the vast majority of states does oversee licensure
and certification of paramedics. This is long overdue. There is
consensus among the EMS community that this should be done.
2:54:24 PM
CHAIR WILSON closed public testimony and held SB 173 in
committee.
2:55:37 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee at 2:55 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 173 Letters of Support 2.14.20.pdf |
SHSS 2/17/2020 1:30:00 PM SHSS 2/26/2020 1:30:00 PM |
SB 173 |
| SB 173 Sponsor Statement.pdf |
SHSS 2/17/2020 1:30:00 PM SHSS 2/26/2020 1:30:00 PM SL&C 3/17/2020 1:30:00 PM |
SB 173 |
| SB 173 Sectional Analysis.pdf |
SHSS 2/17/2020 1:30:00 PM SHSS 2/26/2020 1:30:00 PM SL&C 3/17/2020 1:30:00 PM |
SB 173 |
| SB 173 Fact Sheet Feb 2020.pdf |
SHSS 2/17/2020 1:30:00 PM SHSS 2/26/2020 1:30:00 PM SL&C 3/12/2020 1:30:00 PM |
SB 173 |
| SB 173 Letters of Support 2.14.20.pdf |
SHSS 2/17/2020 1:30:00 PM SHSS 2/26/2020 1:30:00 PM |
SB 173 |
| SB 173 Letters of Support 2.17.20.pdf |
SHSS 2/17/2020 1:30:00 PM |
SB 173 |
| SB 173 Fiscal Note DHSS Public Health 2.13.20.pdf |
SHSS 2/17/2020 1:30:00 PM SL&C 3/17/2020 1:30:00 PM |
SB 173 |
| SB 173 Fiscal Note DCCED CBPL 2.10.20.pdf |
SHSS 2/17/2020 1:30:00 PM SHSS 2/26/2020 1:30:00 PM SL&C 3/17/2020 1:30:00 PM |
SB 173 |
| HB 29 Amendment No. 1 A.3.pdf |
SHSS 2/17/2020 1:30:00 PM |
HB 29 |