Legislature(2021 - 2022)BUTROVICH 205
03/22/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB124 | |
| Presentation(s): the State of Alaska's Health | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 124 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 22, 2022
1:33 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 124
"An Act relating to admission to and detention at a subacute
mental health facility; establishing a definition for 'subacute
mental health facility'; establishing a definition for 'crisis
residential center'; relating to the definitions for 'crisis
stabilization center'; relating to the administration of
psychotropic medication in a crisis situation; relating to
licensed facilities; and providing for an effective date."
- HEARD & HELD
PRESENTATION(S): THE STATE OF ALASKA'S HEALTH
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 124
SHORT TITLE: MENTAL HEALTH FACILITIES & MEDS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
04/12/21 (S) READ THE FIRST TIME - REFERRALS
04/12/21 (S) HSS, FIN
04/27/21 (S) HSS AT 1:30 PM BUTROVICH 205
04/27/21 (S) Heard & Held
04/27/21 (S) MINUTE(HSS)
04/29/21 (S) HSS AT 1:30 PM BUTROVICH 205
04/29/21 (S) -- MEETING CANCELED --
05/04/21 (S) HSS AT 1:30 PM BUTROVICH 205
05/04/21 (S) Heard & Held
05/04/21 (S) MINUTE(HSS)
05/05/21 (S) JUD REFERRAL ADDED AFTER HSS
05/06/21 (S) HSS AT 1:30 PM BUTROVICH 205
05/06/21 (S) <Bill Hearing Canceled>
03/08/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/08/22 (S) Heard & Held
03/08/22 (S) MINUTE(HSS)
03/15/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/15/22 (S) Heard & Held
03/15/22 (S) MINUTE(HSS)
03/17/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/17/22 (S) Heard & Held
03/17/22 (S) MINUTE(HSS)
03/22/22 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
NANCY MEADE, General Counsel
Office of the Administrative Director
Alaska Court System
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 124.
STEVEN BOOKMAN, Senior Assistant Attorney General
Human Services Section
Civil Division
Department of Law
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 124.
DR. ANNE ZINK, Chief Medical Officer
Department of Health and Social Services (DHSS)
Anchorage, Alaska.
POSITION STATEMENT: Presented a PowerPoint on the State of
Alaska's Health and answered questions on the Crisis Now model.
ACTION NARRATIVE
1:33:29 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:33 p.m. Present at the
call to order were Senators Reinbold, Costello, Hughes, and
Chair Wilson. Senator Begich arrived shortly thereafter.
SB 124-MENTAL HEALTH FACILITIES & MEDS
1:34:17 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 124
"An Act relating to admission to and detention at a subacute
mental health facility; establishing a definition for 'subacute
mental health facility'; establishing a definition for 'crisis
residential center'; relating to the definitions for 'crisis
stabilization center'; relating to the administration of
psychotropic medication in a crisis situation; relating to
licensed facilities; and providing for an effective date."
He noted that the committee started the amendment process last
Thursday and stopped on Amendment 13.
1:35:16 PM
At ease
1:35:32 PM
CHAIR WILSON reconvened the meeting.
CHAIR WILSON acknowledged that Senator Begich had joined the
meeting.
1:35:40 PM
SENATOR HUGHES moved that the committee rescind its action [to
adopt] Amendment 10.1 to SB 124.
1:35:46 PM
CHAIR WILSON objected for discussion purposes.
1:35:50 PM
At ease
1:36:25 PM
CHAIR WILSON reconvened the meeting.
1:36:27 PM
SENATOR HUGHES explained that she held discussions with the
department. The amendment applied to voluntary commitments but
must also apply to involuntary ones. She said she serves on the
next committee of referral, the Senate Judiciary Committee, and
would address her concerns in that committee as the amendment
does not meet the intended objective.
1:36:55 PM
CHAIR WILSON withdrew his objection; he found no further
objection, and the action [to adopt] Amendment 10.1 was
rescinded.
1:37:14 PM
SENATOR REINBOLD moved to adopt Amendment 13, work order 32-
GS1730\B.2.
32-GS1730\B.2
Dunmire
3/14/22
AMENDMENT 13
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 3, following line 24:
Insert a new bill section to read:
"* Sec. 11. AS 47.30.700 is amended by adding a new
subsection to read:
(c) When a crisis stabilization center, crisis
residential center, evaluation facility, or treatment
facility admits a respondent under this section, the
crisis stabilization center, crisis residential
center, evaluation facility, or treatment facility
shall, unless the petition was filed by an immediate
family member of the respondent, immediately notify
the respondent's immediate family, or, if the
respondent is a minor, a parent or guardian of the
minor, that the respondent has been admitted."
Renumber the following bill sections accordingly.
Page 4, line 17:
Delete "a new subsection"
Insert "new subsections"
Page 4, following line 21:
Insert a new subsection to read:
"(d) When a crisis stabilization center, crisis
residential center, evaluation facility, or treatment
facility admits a person under this section, the
crisis stabilization center, crisis residential
center, evaluation facility, or treatment facility
shall immediately notify the person's immediate
family, or, if the person is a minor, a parent or
guardian of the person, that the person has been
admitted."
Page 13, lines 1 - 2:
Delete "secs. 1 - 27"
Insert "secs. 1 - 28"
Page 13, lines 27 - 28:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 29:
Delete "sec. 23"
Insert "sec. 24"
Page 14, line 7:
Delete "Section 28"
Insert "Section 29"
1:37:17 PM
CHAIR WILSON objected for purposes of discussion.
1:37:25 PM
At ease
1:39:38 PM
CHAIR WILSON reconvened the meeting.
1:39:39 PM
SENATOR REINBOLD stated that Amendment 13 would require
immediate notification of a family member when an individual is
admitted to a crisis stabilization center, crisis residential
center, evaluation facility, or treatment facility.
1:40:05 PM
SENATOR BEGICH said he understood the intent, but his concern
was to ensure that the contact with family was safe, and that
might not happen if Amendment 13 were to pass,. He suggested
that the amendment could be considered in the Senate Judiciary
Committee. He maintained his objection.
1:41:15 PM
SENATOR COSTELLO wondered if adding the language or guardian
on lines 8 and 22, after "family" would address his concern.
1:41:54 PM
SENATOR HUGHES stated that she would work on the language in the
Senate Judiciary Committee to ensure that parents and guardians
were notified and that Senator Begichs safety concern was also
addressed.
SENATOR REINBOLD said her concern was for immediate family
members who did not know where the person was being admitted.
She suggested the committee conceptually amend Amendment 13
today and the next committee of referral could address how to
avoid notifying family members in abusive situations.
1:44:39 PM
SENATOR BEGICH said he had contemplated Senator Costello's
suggestion, which he understood would add respondents
immediate family or guardian." He offered to withdraw his
objection if she agreed to offer the amendment.
SENATOR COSTELLO offered to make a conceptual amendment.
1:45:00 PM
CHAIR WILSON asked Ms. Meade to comment on Amendment 13.
1:45:36 PM
NANCY MEADE, General Counsel, Office of the Administrative
Director, Alaska Court System, Anchorage, Alaska, stated that
she reviewed Amendment 13 and did not find any technical issues.
1:45:54 PM
SENATOR COSTELLO moved Conceptual Amendment 1 to Amendment 13.
Page 1, line 8:
Insert "or guardian" following "family"
Page 1 line 22:
Insert "or guardian" following "family"
SENATOR COSTELLO stated that it would read "immediate family or
guardian" in both instances.
1:46:31 PM
CHAIR WILSON objected for purposes of discussion.
1:46:36 PM
CHAIR WILSON offered his view that Conceptual Amendment 1 to
Amendment 13 would not address the issue of notifying an
immediate family member that the admitted person would not want
notified. He related the notification could be a brother,
sister, grandmother, mother, or another family member.
SENATOR BEGICH agreed. He felt comfortable that Senator Hughes
would work on language in the next committee of referral.
CHAIR WILSON remarked that generally, he did not prefer to have
another committee address an unfinished amendment. He asked the
will of the committee.
1:47:43 PM
SENATOR REINBOLD asked if this relates to the full amendment.
CHAIR WILSON answered that Conceptual Amendment 1 to Amendment
13 was before the committee.
1:48:02 PM
CHAIR WILSON stated the committee would take a roll call vote on
Conceptual Amendment 1 to Amendment 13.
1:48:04 PM
SENATOR HUGHES stated she understood that Chair Wilson was
uncomfortable that the issue was unfinished. She committed to
work on the issue in the next committee of referral. She offered
support for Conceptual Amendment 1 to ensure that notification
to the immediate family occurs.
1:48:30 PM
At ease
1:49:01 PM
CHAIR WILSON reconvened the meeting and asked for a roll call
vote.
1:49:13 PM
A roll call vote was taken. Senators Begich, Hughes, Costello,
and Reinbold voted in favor of adopting Conceptual Amendment 1
to Amendment 13, and Senator Wilson voted against it. Therefore,
Conceptual Amendment 1 to Amendment 13 was adopted on a 4:1
vote.
CHAIR WILSON announced that Conceptual Amendment 1 to Amendment
13 was adopted on a vote of 4 yeas and 1 nay.
1:49:43 PM
SENATOR REINBOLD opined that parental consent should be required
for admission to the crisis care facilities, not just
notification. She said it was easier to modify and adjust the
notification language once it is in the bill. She urged members
to vote yes.
1:50:24 PM
CHAIR WILSON stated that some patients do not always want family
members informed of their medical conditions, especially when
they are not minors. He offered his belief that this was a
significant concern.
1:50:48 PM
SENATOR HUGHES offered to address this issue and Senator
Begich's concern that a family member could be abusing the
person. She offered to review both of those issues in the Senate
Judiciary Committee.
1:51:10 PM
SENATOR BEGICH commented that he would have opposed Amendment 13
if Senator Hughes hadnt indicated she would work on these
issues in the Senate Judiciary Committee.
1:51:28 PM
CHAIR WILSON removed his objection; he found no further
objection, and Amendment 13, as amended, was adopted.
1:51:43 PM
SENATOR REINBOLD moved to adopt Amendment 14, work order 32-
GS1730\B.4.
32-GS1730\B.4
Dunmire/Foote
3/14/22
AMENDMENT 14
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 7, line 30, following "if":
Insert "the respondent is"
Page 8, line 1:
Delete all material and insert:
"(2) if the respondent is a minor,
(A) the minor has the rights identified
in AS 47.30.700 - 47.30.815;
(B) psychotropic medication may not be
administered to the minor unless a parent or
legal guardian has given permission to the crisis
stabilization center or crisis residential center
to administer the psychotropic medication; and
(C) a parent or legal guardian has the
right to be fully informed of possible side
effects of a proposed psychotropic medication."
1:51:46 PM
CHAIR WILSON objected for discussion purposes.
1:51:48 PM
SENATOR REINBOLD explained that Amendment 14 would ensure that
parental or guardian permission is required before administering
psychotropic drugs to a minor in a crisis care facility. She
stated her belief that informed consent is a critical right.
1:53:04 PM
SENATOR HUGHES said she was unsure whether Senator Reinbold was
present during a prior discussion about the need for medical
personnel to give medication during life-threatening situations,
such as a person experiencing a heart attack. In those
instances, medical personnel might not have time to get a
parent, guardian, or other family member's permission before
administering drugs or providing procedures. She noted that
minor athletes could have heart attacks. She related a scenario
where a minor was endangering their life or others when admitted
to crisis stabilization centers. She asked Senator Reinbold if
she was suggesting that the center would have to get permission
from a parent or legal guardian before saving the child's life.
SENATOR REINBOLD recalled a discussion about the language in
Amendment 3. She recognized that the court system stated that
"serious" did not need to be added, but a psychiatrist she spoke
to disagreed because it required a higher standard. She offered
his view that the committee should revisit the amendment. She
offered her belief that a parent or guardian should be involved
when psychotropic drugs are administered because of the risk of
side effects. She said she would want a parent or guardian
involved when administering psychotropic drugs during a life-
threatening situation.
1:55:39 PM
SENATOR HUGHES agreed that some psychotropic drugs were not
administered in life-threatening situations. For instance, she
understood that lithium was used for routine behavioral health,
which a crisis stabilization center would prescribe. She offered
her view that consent could be required unless the minor's life
was endangered. She asked whether the sponsor would be willing
to consider an exception for emergency situations in which the
minor's life was at risk.
1:57:04 PM
SENATOR REINBOLD said she was open to having an exception for
life endangerment.
1:57:32 PM
At ease
1:58:10 PM
CHAIR WILSON reconvened the meeting.
1:58:11 PM
SENATOR BEGICH asked whether these rights were already covered
in law.
1:58:49 PM
STEVEN BOOKMAN, Senior Assistant Attorney General, Human
Services Section, Civil Division, Department of Law, Anchorage,
Alaska, agreed that law addresses this in AS 25.20.025,
Examination and treatment of minors. It essentially says that
parents make decisions about minors. It lists instances in which
a parent cannot be contacted or, if contacted, is unwilling to
grant or withhold consent that a minor can consent to treatment.
He stated that the concerns voiced earlier about crisis
medication, where the alternative was to tie someone down, and
non-crisis medication intended to improve a general condition,
was an important distinction. He offered his view that this was
addressed in the existing statute.
1:59:49 PM
SENATOR BEGICH stated his belief that it was covered.
1:59:58 PM
CHAIR WILSON agreed.
2:00:11 PM
SENATOR REINBOLD commented that was what she had thought. She
stated that the bill amends AS 47, not AS 25 and that these are
new residential centers. She said she was told that AS 25 would
not apply to them. She stated that Amendment 14 would make it
clear that the rights in Article 10 apply to the minors in these
new facilities.
2:00:55 PM
SENATOR HUGHES asked whether Legislative Legal Services said AS
25 would not apply.
SENATOR REINBOLD answered that her information came from a
patient advocacy group concerned about the new subacute
facilities. She stated that Amendment 14 would ensure that
Article 10 rights also apply to minors.
CHAIR WILSON stated that Mr. Bookman clarified that AS 25 does
apply. He noted that the court administrator nodded her
agreement that Title 25 would apply to SB 124.
2:02:06 PM
SENATOR HUGHES asked for assurance that AS 25 would separate the
life-threatening situations from medication given to soothe the
patient, such that consent from a parent or guardian would not
be necessary.
2:02:40 PM
MR. BOOKMAN answered that he believed it would do so. He stated
that AS 25.20.025 covers medical treatment generally. He
indicated that regarding crisis medication, the intent of SB 124
is to incorporate the standard currently used in evaluation
centers. Under AS 47.30.838, a crisis medication may be used
only if there's a crisis or an impending crisis requiring
immediate use of the medication to preserve life or prevent
significant physical harm. He offered his belief that a mood
stabilizer or something that is soothing would not be permitted
because that medication would not be necessary to prevent an
impending or actual crisis. The crisis medication would need to
have an immediate effect. It would not be permissible under AS
47.30.838.
2:04:08 PM
SENATOR HUGHES stated that it made sense that AS 25 would apply
to situations where a child is rushed to an emergency room for
treatment. Although she supports the concept of Amendment 14,
she does not support the amendment. She offered to follow up
with Legislative Legal Services for assurances that AS 25 does
apply and that parental consent would be required in non-
emergency situations. If not, she offered to raise the issue in
the Senate Judiciary Committee.
2:05:03 PM
SENATOR REINBOLD asked whether parental and minor rights in AS
47.37.815 apply to the new facilities.
MR. BOOKMAN answered yes. He explained that the minor would have
rights as any patient would. He clarified that the new crisis
stabilization centers, and crisis residential centers would not
have the ability to involuntarily prescribe non-crisis
medication. It is not an issue for minors because the only way a
minor at one of these centers could receive long-term medication
would be with the parent or guardian's permission. He explained
that the existing statute would allow for a limited exception if
the parents were unavailable and the minor was mature enough to
consent.
2:06:38 PM
SENATOR REINBOLD offered her view that Amendment 14 was critical
because psychotropic medication can cause nightmares, increased
saliva, swelling of the face, lips, tongue, or throat, thoughts
of suicide, or other harmful side effects. She offered her
support for informed consent, parental involvement, and an
advocate or legal guardian.
2:07:42 PM
CHAIR WILSON maintained his objection.
2:07:45 PM
A roll call vote was taken. Senator Reinbold voted in favor of
Amendment 14, and Senators Hughes, Costello, Begich, and Wilson
voted against it. Therefore, Amendment 14 failed on a 1:4 vote.
2:08:05 PM
CHAIR WILSON announced that Amendment 14 failed on a vote of 1
yea and 4 nays.
2:08:18 PM
CHAIR WILSON held SB 124 in committee.
2:08:24 PM
At ease
^PRESENTATION(S): THE STATE OF ALASKA'S HEALTH
PRESENTATION(S): THE STATE OF ALASKA'S HEALTH
2:11:16 PM
CHAIR WILSON reconvened the meeting and announced the
presentation on the State of Alaska's Health.
2:11:58 PM
At ease
2:12:16 PM
CHAIR WILSON reconvened the meeting.
2:12:20 PM
ANNE ZINK, MD; Chief Medical Officer, Department of Health and
Social Services (DHSS), Anchorage, Alaska, stated that she would
present a high-level overview of the State of Alaska's
health. She paraphrased her prepared testimony, which read:
[Original punctuation provided.]
The goal of this presentation is to provide you with
data and foundational knowledge so that the
legislative branch, the executive branch, and the
public can work together to improve the health and
well-being of Alaskans.
As the Chief Medical Officer for the State of Alaska,
I oversee the Division of Public Health, I serve as
the clinical liaison across state departments, and I
work with clinicians throughout the State and directly
care for patients in the Emergency Department.
2:13:07 PM
The health of Alaskans is greater than DHSS, or any
one Department or organization. It involves many state
and federal agencies as well as thousands of health
care providers, community and tribal leaders who
work tirelessly day in and day out.
The cost of health care and what the State pays goes
beyond Medicaid it includes the State Retiree Plan,
the Department of Corrections, the State employee
health plan, not to mention the myriad of grants and
contracts.
This presentation today is for you and for everyone
working to improve the lives of Alaskans.
The goal of the presentation was to provide the
committee with data and foundational knowledge so the
legislative branch, executive branch, and the public
could work together to improve Alaskans health and
well-being.
2:13:52 PM
DR. ZINK reviewed slide 2, consisting of puzzle pieces listing
health factors. The slide stated that behind every decision,
every policy, every report, there is a person. She paraphrased
her prepared testimony, which read:
[Original punctuation provided.]
Early in my career, one of my mentors told me always
do what is right for the patient, and remember the
rest is noise.
That advice has guided me, as a physician and now in
my service to the State.
The scope of health care is broad and complex, but we
must always remain focused on the people we serve
the individuals behind the puzzle pieces.
And health care is more than seeing a doctor. Studies
show that up to 80% of a person's health is determined
by factors outside of traditional health care,
including behavioral factors such as tobacco use or
physical activity, as well as social, economic and
community factors such as having a job, housing,
access to food, transportation, or even community
connectiveness can contribute heavily to outcomes such
as the length and quality of life.
This is why everything from access to local trails, to
integrating behavioral health services, matter in a
person's overall health.
2:14:37 PM
DR. ZINK reviewed slide 3, Life Expectancy Trends, which
consisted of two graphs depicting national trends. She said the
figure on the left-hand side showed the life expectancy from
1880 to 2019, which increased over time except for disruptions,
such as the 1918 pandemic, WWI and WWII. She highlighted that in
recent years the life expectancy had flattened and was beginning
to decrease. She noted that this was due primarily attributed to
overdose and suicide. The COVID-19 pandemic is not shown on the
slide, but if it were, it would show a continued decline in life
expectancy. Historically the most significant transformation in
life expectancy came from a better understanding of infectious
diseases by providing clean water and sewer to protect health.
This continues to be a struggle throughout the world and in
Alaska. She noted that 32 communities lack functioning water and
sewer.
DR. ZINK stated that the next health care transformation came in
the 21st Century based on advancements in diagnostic and
therapeutic medicine, including antibiotics, vaccines, and lab
work. She indicated that despite advances, infectious diseases
have persisted, and health care costs have continued to rise.
She noted that not everyone has the same access to care or has
improved outcomes.
DR. ZINK directed attention to the graph on the right-hand side
of slide 3, which showed a comparison of life expectancy versus
health expenditures for other countries compared to the US. She
paraphrased her prepared testimony, which read:
[Original punctuation provided.]
2:16:14 PM
Looking at the graph on the right comparing what the
US spends on health care per capita and life
expectancy over time to other developed countries, the
big outlier in the group is the US, which has the
highest health expenditures per capita but lags behind
other developed countries in life expectancy, and this
difference has accelerated over time. The reasons for
this are multifactorial, hotly debated and complex to
change, but important to think about in terms of how
we spend our dollars towards health.
The health of the population and the amount of money
we spend on health care directly impacts everything
from military readiness to the ability to educate our
children and we know healthy economies are built with
healthy people.
For example, when employers spend more money on
healthcare, less money is available for innovation or
other investments. Or for schools when a large
portion of the budget must pay for health benefits for
employees and retirees, that translates into less
overall funding, and larger class sizes for students.
The goal is to use each dollar as wisely as possible
to improve health outcomes of Alaskans. The least
expensive patients are those who are physically and
mentally healthy. What has become increasingly clear
is that the next major impact on the life expectancy
and the cost of care will come less from novel medical
discoveries, but more from the way health care
delivery is structured.
It will take providers, patients, the public, and
policy makers working together to make this meaningful
change.
2:17:59 PM
DR. ZINK turned to slide 4, Your New Health Care System, which
depicted a flowchart of services. She paraphrased her prepared
testimony, which read:
[Original punctuation provided.]
So how do we move forward? How do we work together to
promote and protect the health and well-being of
Alaskans?
First, we must look at how our systems align.
This map is not a meme. It was made during the
creation of the Affordable Care Act to outlines out
how different parts of the federal government are
involved in providing health care to Americans. It is
overwhelming, but powerful to spend time looking at
all the connections which speaks to the complexity of
health care delivery.
It's also worth noting that this map only applies to
federal complexity, and does not address connections
between state government, local municipalities, Tribal
health care, and other federal health care like
Veterans Affairs and the Department of Defense, or the
other health factors we spoke of earlier like housing,
transportation, employment, education and more.
Soon it can feel like this 2D graph is insufficient.
We need a 3D matrix.
2:18:46 PM
DR. ZINK reviewed slide 5, which consisted of an aerial
photograph of Unalaska. She paraphrased her prepared testimony,
which read:
[Original punctuation provided.]
And adding to this complexity is the uniqueness of
Alaska including our large size, vast geography,
diverse cultures, and transportation constraints, with
most of our state off road system.
Our geography and our uniqueness can be our advantage.
The distances and cost in Alaska force us to think
about health care delivery differently. For example,
take a patient with head trauma. In other states,
patients like this are often admitted to the ICU for
monitoring. But here, because of our distance
constraints, we have taken a closer look at this
practice. Alaska's trauma committee created guidelines
that have enabled many patients to stay in their
communities safely. This approach reduces costs and
supports patients, without compromising care.
Our geography and historical background have also led
to unique partnerships. In Alaska public health and
health care are Tribal health, school health,
industrial health, and military health. Our limited
resources and distances foster relationships not seen
at all at all, or to the same degree, in other states.
2:19:46 PM
And Health Care is delivered differently. In many
rural communities the only health care is the tribal
health care system, providing robust and comprehensive
care to both native and non-native beneficiaries in
some of the hardest to reach regions in our state.
Hospital have had to design their hele-pads for
military Blackhawk helicopters because they may be
bringing in the next trauma victim, or vaccination
efforts aboard deep-sea fish processing vessels to
keep the crew active, working and healthy.
Alaska has a chance to be a leader in health care
reform that is focused on the improved outcomes for
the whole person at reduce cost if we use our
geography and our partnerships to our collective
advantage.
2:20:34 PM
DR. ZINK reviewed slide 6, a collage highlighting services and
slogans the department provides to Alaskans. She paraphrased her
prepared testimony, which read:
[Original punctuation provided.]
And that is the goal within the Department of Health
and Social Services.
As you know well, the work done by the current
department of DHSS is broad, diverse, and serves
Alaskans at all stages of life. By simplifying health
care delivery, braiding funding, and aligning care, we
can provide better care for less cost, and that was a
big driver behind the split of the Department of
Health and Social Services, which goes into effect
July 1st.
With the Department of Family and Community Services,
the focus will be on providing direct care services in
24/7 facilities, as well as communities.
With the Department of Health, the focus will be on
data-driven strategies to connect prevention to health
care payment, delivery, and long-term services, in the
most effective way possible.
2:21:18 PM
DR. ZINK reviewed slide 7, Health Care and Public Health, which
depicted a three-bucket model. She paraphrased her prepared
testimony, which read:
[Original punctuation provided.]
At this point you may be asking yourself: how do we
accelerate to this transition?
I find this "three buckets" model helpful to look at
how public health and health care complement each
other and overlap to create whole person and whole
community care, which is key to moving forward.
Let's take diabetes for example. In the traditional
health care setting, a provider may test for diabetes,
provide medication for their disease, and offer
education and training on how to live as healthy a
life as possible.
Meanwhile, the public health system helps support
additional education, as well as community-based
lifestyle programs to improve access to healthy foods
and increase physical activity. Public Health also
sets up tools to help patients and providers track and
manage diabetes and works with policy makers to ensure
treatments such as insulin are accessible and
affordable.
2:22:11 PM
The shadowed area shows where the two systems overlap.
Together, these systems support the patient, but more
importantly they work to prevent other individuals
from developing the disease. When systems are
integrated, the patient does not notice that these
buckets are separate, AND there are fewer patients
overall.
That is the beauty and the challenge - when a system
works well, the user doesn't even recognize there is a
system. I flew here this morning and spent my time
reflecting on the beauty and wonder of Alaska, not
worrying if they hundreds of systems involved to make
my flight safe, enjoyable and on time would work and
the same should be true for patients needing care.
And when we are able to invest in public heath, we
reduce the overall burden of disease. We now expect
our children to grow to adults. Our TB wards have
been converted to universities, our orphanages from
infectious disease into hospitals, our expectation is
for health, not bracing for premature death.
2:23:05 PM
As a state and a nation, we are familiar with bucket
#1 the delivery of health care - and do a great job
with it. The health care in Alaska and the U.S. is
generally incredible high quality, but it comes a high
cost without always the expected benefit.
But it is bucket #2 health care services outside
the traditional clinical setting and bucket #3
interventions that reach a whole population where
our collective focus can help provide savings and
improve outcomes. The braiding is these buckets was a
big driver of the 1115 waiver.
What is clear, we must not go back on efforts made
over the last center to improve the public's health,
as it will cost us dearly, both financially and with
the lives of our neighbors, friends and loved ones.
2:23:58 PM
DR. ZINK reviewed slide 8, The Role of Public Health. She
paraphrased her prepared testimony, which read:
[Original punctuation provided.]
Now let's look a bit closer at what public health is
and what it does.
Public health has transformed substantially over time,
and each development has built on what came before.
In the field of public health, we commonly talk about
this evolution as Public Health versions 1.0, 2.0 and
3.0.
In Alaska, Public Health 1.0 included public health
nurses who diagnosed and treated diseases like
tuberculosis alongside the creation of Community
Health Aides, providing clinical care to those who
didn't have it, and trying to fill in gaps in health
care. Other parts of this stage included improving
sanitation, food and water safety, ensuring vaccines
and treatments were available to the general
population.
2:24:39 PM
In 1965, Medicaid and Medicare were created,
essentially to provide a way to pay for health care
for the elderly and the poor in other words, to
provide payment for Public Health 1.0. Today, over
200,000 Alaskans are covered by Medicaid and Medicare.
However, there were still gaps apparent even with
greater access to health care, and public health
transformed to 2.0 with a systematic approach to
address risk factors, prevent and address chronic
diseases, and address emerging threats such as
HIV/AIDS.
Then, Public Health 3.0 expanded beyond traditional
programs and services to work collectively with
partners to address health concerns and empower
individuals to be their most healthy and well selves.
The pandemic has further challenged the role of public
health, highlighting unresolved gaps in care and the
need for improved informatics and information sharing.
Our next steps will be to improve the way we gather
and share data to better coordinate health care
delivery, collectively move towards prevention, and to
ensure systems are in place to support every Alaskan
with diverse needs.
2:25:50 PM
DR. ZINK reviewed slide 9, Cost and Life Expectancy, which
consisted of a line graph. She paraphrased her prepared
testimony, which read:
[Original punctuation provided.]
But how about the cost?
This is a fascinating look at health care expenditures
per state compared to life expectancy. It is a bit
old, made by the Alaska Department of Administration
with data through 2014, but you can see Alaska and
North Dakota standing out as some of the states with
highest health care cost in the country, but also
above average life expectancy. West Virginia and the
District of Columbia stand out as high cost, yet lower
than average life expectancy. States that are
achieving higher life expectancy at lower costs
include Hawaii, California, Colorado, and Arizona.
2:26:28 PM
What I also find interesting is that more money in
health care does not translate to higher life
expectancy when we look across states; in fact, the
inverse appears to be true.
Rural states also tend to spend more on health care
than more urban states, but there are numerous
exceptions.
2:26:46 PM
DR. ZINK reviewed slide 10, Health Care Reform Quadruple Aim.
She paraphrased her prepared testimony, which read:
[Original punctuation provided.]
In addition to the three buckets and the various
versions of Public Health, another framework that is
helpful for this discussion is the quadruple aim of
health care reform. Often used by hospital systems,
this framework provides four goals that combined
together improve care and reduce costs.
Starting with the patient's experience the goal is to
improve public access to health data and services,
empowering Alaskans to make healthy life choices.
Then, building into population health, focusing on
measuring health factors and health outcomes for
entire communities, providing tools and connections to
health systems, and connecting public health and
health care.
Next is cost. We reduce costs by aligning how health
care is paid for, and by investing more money in
prevention. Examples include chronic disease
prevention programs, the use of telehealth or digital
platforms, and programs that expand care within
community settings. In addition, tools like an all-
payer claims database will help bring transparency to
healthcare costs.
2:27:50 PM
Critical to all this work is the health care team,
both direct and indirect. We can support the health
care team through reducing administrative burden, loan
repayment, workforce recruitment and retention, and
clinical support tools.
When all four of these aims are working smoothly
together, we achieve better results.
2:28:17 PM
DR. ZINK reviewed slide 11, Causes of Death in Alaska, which
consisted of two bar charts. She paraphrased her prepared
testimony, which read:
[Original punctuation provided.]
So now let's look at some data on where Alaska stands
and how we compare to the rest of the United States on
specific health issues.
On the left you see leading causes of premature death
in 2020 for Alaska compared to the US. This is
different than overall causes of death.
In 2020, the biggest causes of premature death in
Alaska and the U.S. were due to unintentional injury,
cancer and heart disease.
Here's where we are different: Alaska stands out in
having about twice the amount of premature death
caused by suicide and liver disease compared to the
U.S., as noted in red.
Differences can be due to multiple factors, but a big
one is our health behaviors. To look at how these
behaviors contribute to premature death in Alaska, we
did an analysis of the reasons behind these deaths.
This is shown on the right.
2:29:06 PM
Looking at leading causes of over 20,000 deaths, 59%
were potentially preventable at a younger age.
We then looked upstream and identified deaths
attributable to specific risk factors. The leading
risk factors contributing to premature death were
obesity, being overweight, or physically inactive, as
well as smoking tobacco.
2:29:32 PM
DR. ZINK reviewed slide 12, Suicide Prevention, which consisted
of two bar charts and a line graph showing the number of annual
suicide attempts and mortality rates.
As we talked about in the past slide, looking at
Alaska compared to the US, Alaska had about 2 times
the amount of premature death caused by suicide and
liver disease, so let's dive into one of those topics
a bit and talk about suicide.
Our state has struggled with having some of the
highest rates of suicide in the nation, often ranking
as the most suicides per capita, and currently ranking
second in the nation behind Wyoming.
In general, suicides have had an outsized impact on
youth. In 2019, suicide was the leading cause of
death for youth and young adults, ages 15-24. This
was the only age group in our state where suicide was
the leading cause of death.
Nationally, if you look at the graph at the bottom
left, suicides between 1975-2015 for 15-19 year-olds,
the highest for boys was in the early 1990s. It came
down, but is now steadily increasing for both boys and
girls in the more recent years.
It was great to see in 2020 in Alaska, we had a
decrease in the number of adolescents who died by
suicide, and a slight decrease in suicides in the
State overall. However, we have seen an increase in
suicide attempts. In 2021, there was a significant
increase in suicide attempts for 11-14 year-olds, with
rates higher than any other prior year. We have also
seen increases in suicide attempts for people ages 60
and older.
Fortunately, although we have seen increases in the
overall number and rates of suicide attempts, this did
not translate into higher suicide rates. An important
thing to remember when we look at data around suicide
attempts is that 9 out of 10 people who survive a
suicide attempt DO NOT go on to die by suicide later.
2:31:20 PM
Alaska's data demonstrates a similar pattern to what
we are seeing nationally. In December 2021, the U.S.
Surgeon General issued an advisory to highlight the
urgent need to address the national youth mental
health crisis.
DHSS has allocated additional resources and funding to
support mental health and suicide prevention. This
includes specific training such as the Zero Suicide
framework for both behavioral health and primary care
providers, youth and young adult suicide prevention
media campaigns, expanding the Alaska Careline, and
partnering with entities such as the Department of
Education and the Office of Children's Services.
2:32:05 PM
DR. ZINK reviewed slide 13, Drug Overdose Deaths Continue to
Rise, consisting of a bar chart showing the overdose death rate
for all drugs and opioids in Alaska compared to the US. She
paraphrased her prepared testimony, which read:
[Original punctuation provided.]
Now let's dive into another top leading cause of
premature death: Unintentional injuries. This category
includes drug overdoses that are considered
unintentional poisonings, motor vehicle crashes, and
unintentional falls.
In 2020, both Alaska and the US as a whole saw our
worst drug overdose death rates yet. Based on
preliminary data from 2021, in Alaska, the drug
overdose death rate increased by over half from 2020.
The drug overdose death rate is driven fentanyl, a
synthetic opioid that is 50 times more potent than
heroin. 74% of opioid overdose deaths in Alaska
involved fentanyl in 2021.
In 2018 you see a dip in Alaska compared to the U.S.
This was attributed to increased screening for those
at risk, referral for treatment, linkage to care, and
treatment availability, prescription drug monitoring
programs and regulations, and widespread messaging and
distribution of naloxone through DHSS's Project Hope.
2:32:53 PM
It's important to note that other drugs play a role as
well. Methamphetamine- and other psychostimulant-
involved overdose deaths continue to rise due to their
increasing purity and potency. Approximately two-
thirds of overdose deaths involve more than two
substances -- excluding alcohol.
Many of the overdose deaths in Alaska are
unintentional, due to people not realizing that
fentanyl may be in other drugs or counterfeit
prescription medications.
Just this week, we saw 6 deaths in the Mat-Su and at
least 17 overdose emergencies thought to be due to a
lethal batch of heroin, resulting in a Narcotics Alert
to be issued by Mat-Su law enforcement.
2:33:38 PM
DR. ZINK reviewed slide 14, Charting a path forward, which
depicted a sea filled with icebergs. She asked how Alaska could
move forward and how to take the myriad of data points and chart
a path through this complex world of health care delivery to
improve outcomes for Alaskans.
2:33:50 PM
DR. ZINK reviewed slide 15, The River and the Bridge. She
paraphrased her prepared testimony, which read:
[Original punctuation provided.]
To answer that question, I am going to begin with a
story that you may have heard before.
Imagine a large river where you see someone downing,
so you race in and pull them out, only to see another
person struggling in the river. You look up and see
hundreds of people trying frantically to save all the
drowning people who have fallen into the river. As
everyone along the shore tries to rescue as many
people as possible, you look up and see a seemingly
never-ending stream of people downing, so you begin to
run upstream. One of other rescuers hollers, "Where
are you going? There are so many people that need help
here." To which you reply, "I'm going upstream to find
out why so many people are falling into the river."
2:34:30 PM
DR. ZINK noted that this rings particularly true for her as an
emergency physician who found herself more and more involved in
public health to try to figure out how to move upstream. She
continued:
Upstream you find a broken bridge that people keep
falling off of, into the water. By fixing the bridge,
more people cross the river without falling in, which
requires much less effort than pulling people out of
the river later.
For every dollar we spend on health care, we spend
about 3 cents on prevention, 6-10 cents on primary
care and 87-91 cents on acute and specialty care.
When we look at other countries with longer life
expectancies at a lower cost per capita, they all get
there in slightly different ways, but constantly they
have methods for paying or incentivizing upstream
prevention.
The other advantage to moving ups stream and investing
in systems of care is makes us more resilient when new
challenges are presented: earthquakes, ice storms,
pandemics. Preparedness is prevention.
2:35:32 PM
DR. ZINK reviewed slide 16, Moving Upstream, consisting of a
diagram of health factors and a photograph of two rural
Alaskans. She paraphrased her prepared testimony, which read:
[Original punctuation provided.]
There are a multitude of factors that cause poor
health, which is not only costly to individuals, but
is a shared burden to our communities. In 2020, our
Alaska hospitals billed $1.0 billion for emergency
department visits and $4.4 billion for hospital stays.
As an emergency room doctor, I can tell you that care
can be life saving, and not all illness can be
prevented. But by focusing on the health outcomes and
moving upstream to find fix the proverbial broken
bridges, we can save lives and save money.
Today, I want to highlight three key efforts that I
think we can all get behind to move upstream.
The first is Healthy Alaskans, the State's Health
Improvement Plan. It is co-led by DHSS and the Alaska
Native Tribal Health Consortium. The mission of
Healthy Alaskans is to provide a framework and foster
partnerships to optimize health for all Alaskans and
their communities. This is our roadmap for upstream
improvements, with communities, health care entities,
Tribes, and other stakeholders working together.
Healthy Alaskans sets goals every 10 years.
2:36:46 PM
DR. ZINK reviewed slide 17, Healthy Alaskan 2020 successes,
which listed eight successes.
1. Reduced cancer mortality rate
2. Reduced percentage of adolescents who recently
used tobacco products
3. Reduced percentage of adults who are overweight
4. Increased percentage of adolescents who have 3 or
more adults from whom they could seek help
5. Reduced percentage of adults who recently engaged
in binge drinking
6. Reduced percentage of adolescents who recently
engaged in binge drinking
7. Decreased percentage of adults who report not
affording a doctor in last year
8. Increased percentage of population ages 18-24 with
a high school diploma
2:36:45 PM
DR. ZINK paraphrased her prepared testimony, which read:
[Original punctuation provided.]
Often I get asked, does this really work? Can the
goals established in our state's health improvement
plan be achieved? Yes, but by working together, we
can do even more.
Looking back on the 2020 goals, 8 of them were
accomplished including: reducing cancer mortality
rate, the percentage of adolescents who recently used
tobacco products and the percentage of adults who are
overweight.
We saw:
• More youth reporting that they had 3 or more
adults they could seek help from, which reduces
the impact of adverse childhood experiences
• A decrease in the percentage of adults and
adolescents who recently engaged in binge
drinking
• An increase in the percentage of adults who could
afford a doctor
• An increase in the number of young adults with a
high school diploma.
2:37:30 PM
All of those are great success stories.
Let's take a closer look at three examples:
Reduction in Cancer Mortality (#1):
This was achieved through various efforts including:
• The Alaska Comprehensive Cancer Control Plan
(2021-2025)
• The Alaska Cancer Partnership
• Ladies First: Alaska Breast and Cervical Cancer
Early Detection
• Promoting primary prevention. In other words,
making the healthy choice the easy choice to stop
cancer before it starts by being active, eating
well and avoiding tobacco, to name a few
examples.
Binge Drinking Reduction (#5, #6):
Efforts aimed at improving these goals include these
programs and campaigns:
- Healthy Voices, Healthy Choices Alaska
- Be [You] Campaign (teens)
- ANTHC Substance Misuse Prevention Program
-
Tobacco Use Reduction (#2):
These inventions have helped with this goal:
- Tobacco Quit Line
- Smokefree Alaska Bill (2018)
- DHSS Tobacco Prevention and Control Program,
Strategic Plan
2:38:03 PM
DR. ZINK highlighted two items on the list related to efforts to
reduce adult and adolescent binge drinking from the Healthy
Voices, Healthy Choices Coalition campaign, and the Alaska
Native Tribal Health Consortium's Substance Misuse and
Prevention Program.
DR. ZINK noted that the reduced percentage of adolescents who
recently used tobacco products involved help with the Tobacco
Quit Line, a legislative partnership with Smoke Free Alaska in
2018, and the department's Tobacco Prevention and Control
Strategic Plan.
2:38:35 PM
DR. ZINK reviewed slide 18, Healthy Alaskans 2030 goals. She
paraphrased her prepared testimony, which read:
[Original punctuation provided.]
What does 2030 look like? You can see from those three
examples of success, one of the common ingredients is
collaboration with diverse partners.
Healthy Alaskan's Goals are chosen, as they are
finite, measurable, and actionable so that we have a
common framework and common objectives. We can get
lost on the mired of system, diseases and
interventions this slide deck was once over 100
sides on what was important to share with you all for
the State of Alaska's health - but paring it down, and
collective working on a few key challenges we can do
more together.
2:39:12 PM
I have provided copies of Healthy Alaskans 2030 for
you all, including the goals and metrics used by the
plan.
Healthy Alaskans regularly monitors each goal and
shares progress via annual scorecards. It also
maintains a list of evidence-based strategies and
actions to help reach the targets for each objective.
And we invite you as policy makers, as well as the
public, health providers, patients and the press to
take a look these objectives and join us in making a
Healthier Alaska.
2:39:56 PM
DR. ZINK reviewed slide 19, Healthy You in 2022. She paraphrased
her prepared testimony, which read:
[Original punctuation provided.]
A side effort has been taken on by DHSS to bring extra
attention to Healthy Alaskans 2030 the Healthy You
in 2022 campaign.
The past few of years with the pandemic has been very
long, hard, and for many devastating both physical
and mental and was the reason for this renewed effort
on focusing on the basics of health.
The campaign draws from the work of various
departments and programs to help Alaskans to focus on
being physically and mentally well. The first quarter
is focused on movement and play, the second quarter is
on mental health and well-being, the third quarter is
healthy eating and sleep, and the last quarter is
healthy habits.
We invite you all and every Alaskan to help build
a Healthy You in 2022. You can find more on the
microsite HealthyYou.Alaska.gov
2:40:47 PM
DR. ZINK reviewed slide 20, Data Modernization. She paraphrased
her prepared testimony, which read:
[Original punctuation provided.]
A second area I want to highlight is Data
Modernization. Often, we think of IT as Information
Technology, but more and more it is really Innovation
Technology. It is hard to change that which can not be
seen or measured.
Early in the pandemic, we enlisted the help of
national guard members to enter one lab result into
three different systems. It was clear, the lack of IT
infrastructure capabilities hampered not only our
response here in Alaska, but across the country.
2:41:18 PM
Improved data can help community leaders know what
health challenges affect their community and target
their efforts; health care providers see the more
complete picture of the health of their patient; and
patients have better access to their own records
empowering their health.
There are many large efforts happening at a state and
national level on data modernization. Within the
Department of Health, we have brought on a new Chief
Health Data Officer to help lead all of these efforts.
Key to this transformation is creating a governance
structure, and road map for the numerous data systems,
and technologies both within the State and community,
to improve the health of Alaskans.
This, however, will be an area that will need
collective time and attention to achieve the desired
outcomes.
Through improved data modernization that provides
reliable, understandable, and relevant data to the
public at their fingertips, Alaskans can and will
achieve more. Improved data modernization is more
cost-efficient, more secure, and allows for real-time
decision-making to better support health care
providers and individuals.
2:42:24 PM
DR. ZINK reviewed slide 21, Health Care Workforce Support. She
paraphrased her prepared testimony, which read:
[Original punctuation provided.]
The third, or last thing, I wanted to highlight today
are the people who serve Alaskans in health care, both
directly and indirectly such as much of public health.
Alaska's health care workforce has always been limited
and the pandemic has made it even worse. For the first
time in 2020, we saw a decrease in Alaska Health Care
employment, leaving more work, during the pandemic, to
fewer people. We will not be able to improve the
continuum of care, without a robust workforce.
2:42:56 PM
Administrative burdens, malpractice risk, limited
training and recruitment, limited clinical supports,
physical violence, and the emotional exhaustion of the
work, leave providers burnt out, leaving the
profession and sadly committing suicide at twice the
national rate.
It is important to remember that burn out is not the
failure of the person, but a failure of the system.
In 2020 in the US, 82% of healthcare workers reported
emotional exhaustion, 55% reported questioning their
career path, and 45% of nurses said they did not have
adequate emotional support. We see similar result of
the public health workforce with people leaving this
critical profession at unprecedented rates.
Though collaboration with key partners, and by
addressing the bottle necks and barriers across the
health care ecosystem, we can grow and support
Alaska's health care workers, the backbone and heart
of care in Alaska.
2:43:55 PM
DR. ZINK reviewed slide 22, Moving Forward. She paraphrased her
prepared testimony, which read:
[Original punctuation provided.]
The focus on moving upstream is not new to us in the
State of Alaska. We are constantly focused on finding
the root of improved health and this critical work
continues in many forms.
Whether we are using layered prevention identify and
end a GI outbreak related to contaminated food, or
changes to Medicaid delivery, by working together
upstream, we can collectively keep Alaskans healthier
and we can use our resources more effectively.
2:44:23 PM
The Department of Health and Social Services continues
to move forward with our partners to ensure that
systems are working for Alaskans, instead of Alaskans
just working within systems. We are more prepared and
more resilient to the myriad of challenges we may face
from tsunamis to budget cuts, infectious disease to
forging aggression when we are healthy and well and
have systems, that like our democracy is by the
people, and truly for the people of this great state.
This slide shows some of the milestones along this
journey.
The 1115 Medicaid Demonstration Waiver is a great
example of upstream prevention. This waiver serves as
the vehicle to redesign, build, and expand the
Medicaid payment for behavioral health system to
support at-risk children and families, and use data-
driven, integrated systems of care to improve the
outcomes for Alaskans suffering from mental illness,
substance use disorder, and more.
This work then fits with in the work of the "Crisis
Now model" which builds on three key systems:
1. "Someone to Talk to" (a crisis call center that
coordinates in real time) which is being built with the
ongoing efforts of 988. Beginning July 16, this new
three-digit dialing will connect people in crisis, or
loved ones worried about their family, to support and
resources.
2. "Someone to Respond" (24/7 mobile crisis teams to
respond to a crisis in-person), and
3. "Place to go" (23-hour and short-term stabilization,
offering a safe and supportive behavioral health crisis
placement for those who cannot be stabilized by call
center staff or mobile crisis team response). Juneau is
going to open the first 23-hour stabilization center in
Alaska.
2:46:14 PM
This Crisis Now model helps to support people in need,
reduces the burden on law enforcement who often
responds to mental health crises, and gets patients
care more quickly and in the least restrictive way
possible, reducing ED visits and inpatient psychiatric
admissions.
2:46:28 PM
Those are just a few examples of the upstream work
that will help us achieve the goal of healthier
Alaskans and reduced health care costs. This is a
journey we're all on together and I look forward to
working with the Legislature and all of our partners
to achieve these goals. Your support and work has been
critical to these successes so far and will continue
to be critical in the months and years to come.
2:46:50 PM
DR. ZINK thanked members. She stated that together the
department and the legislature could provide better care at a
lower cost to Alaskans by building on the efforts of Healthy
Alaskans 2030, improving data modernization, supporting the
health care workforce, and finding ways to pay for prevention.
DR. ZINK stated that she was grateful for the legislature's
efforts and the Chair's willingness to host this first-ever
State of Alaska's Health presentation. She said she looks
forward to collectively improving care for all Alaskans.
2:47:21 PM
SENATOR BEGICH directed attention to slide 13 to the drug
overdose deaths. He noted that a slow increase followed a
significant decline in 2017-2018. He indicated he was studying
the efficacy of treatment programs. He said he recognized the
impact of NARCAN, although the drug is dispensed anonymously, so
it cannot be tracked. He wondered if the increase was a
reflection of reductions or the effectiveness of treatment
grants. He asked what tool would decrease the death rate and
whether it would be increased grant programs.
DR. ZINK offered her view that it was going up for many reasons,
so it would take time to understand it better. She stated that
many people in the field were concerned by the dramatic increase
in overdose deaths related to fentanyl. She explained that
fentanyl is 50 times more powerful than heroin and that many
people may think they are taking a prescription drug like Norco,
hydrocodone, or oxycontin, which they have previously taken.
However, the drug is a counterfeit pill laced with fentanyl. She
said one medication is lethal. She said the two to four
milligram (mg) dose of NARCAN, naloxone, is not enough to
overcome the level of fentanyl in the victim. Thus, the
department is working on an 8 mg dose, plus distributing
fentanyl patches so people can test their drug for the presence
of fentanyl. She acknowledged that more could be done to help
prevent people from using opioid drugs and reduce reliance on
the drugs.
2:50:18 PM
SENATOR BEGICH wondered what specific funding the legislature
could provide to support the work being done to address the
fentanyl issue. He indicated that he lost a nephew to fentanyl
use.
DR. ZINK said the work in the field involves the Department of
Public Safety and the Department of Health and Social Service's
Divisions of Behavioral Health and Public Health. She offered to
research and report to the committee on specific funding needs.
2:51:39 PM
SENATOR REINBOLD referred to the Crisis Now model. She noted she
had constituents who expressed concern about the perceived
mistreatment of disabled psychiatric patients, including Access
Alaska and Faith Myers. One constituent was a Russian who
alleged he was held in a psychiatric facility for political
reasons. She asked what the Crisis Now model was and what
assurances the legislature had that these abuses would not
occur.
2:53:34 PM
DR. ZINK acknowledged that as an emergency medicine physician,
she had observed daily the ways the current system is failing
patients. She said she understood that members would receive
letters expressing concern or frustration. She recalled that
people literally wore through their paper scrubs awaiting a
psychiatric evaluation and treatment.
2:53:55 PM
DR. ZINK explained that the Crisis Now model was a collective
effort to improve care. The Crisis Now model would provide the
person seeking mental health assistance with 1) someone to call,
2) someone to respond, and 3) a place to go. She elaborated on
the planned mental health care improvements. First, people can
currently call Alaska Care, but the federal government has been
working to create a 988 number specifically for mental health
assistance and additional resources, rather than just calling
911. Second, law enforcement spends significant time trying to
stabilize someone in crisis. Crisis Now would provide Mobile
Crisis teams trained in mental health to respond to a person in
crisis, helping them get needed support and resources, so they
don't end up in an emergency room (ER). Currently, law
enforcement picks up the person in crisis and takes them to the
ER, waiting for a behavioral health clinician to assess them.
The ER is bright and loud and not a therapeutic environment for
patients. Third, Crisis Now would provide short-term 23-hour
crisis stabilization centers. Someone's wife may have left them,
or the person may have experienced another acute event that made
them suicidal or violent. However, being able to go to a place
to talk, cool off, or get access to medication can help.
Sometimes people need to sober up, and they are more able to
make decisions or connect to family and loved ones.
2:56:14 PM
DR. ZINK stated that ensuring the system works requires everyone
to be involved, trying to understand the system and the process,
reviewing data, and getting feedback from constituents to ensure
that Crisis Now serves the people.
2:56:41 PM
SENATOR REINBOLD wondered how to ensure that people won't be
abused. She asked whether the department supports an All-Payer
Claims database. She further asked for an update on the
hospital's Federal Emergency Management Agency (FEMA) workers.
DR. ZINK responded that ensuring abuse doesn't occur would
require constant monitoring. She offered her view that it makes
sense in Alaska to have an All-Payer Claims Database for
improved transparency in overall healthcare costs. Providers see
patients with numerous payer sources, so reducing the
administrative burden makes sense, but it is challenging. She
offered her view that FEMA workers were finished, that the
contracts ended. She noted that many took full-time jobs in
Alaska.
2:57:45 PM
SENATOR HUGHES recalled that Senator Begich had questions about
drug overdoses. She stated that she received an update on the
Set Free Alaska pilot project, designed to help people with
addiction problems become productive citizens. She reported that
it was going well, and once data was collected, it was possible
to replicate it throughout the state. She referred to slide 9.
She noted that Alaska was on the high end for health care
expenditures based on 2014 data. She anticipated that Alaska's
expenditures would be even higher now. She encouraged the
department to consider preventive and primary care costs to move
Alaska forward. She recalled that Alaska spends 80-90 percent on
specialty acute care, which needs to be addressed. She noted
that Director Wing-Heier reported to the Senate Labor and
Commerce Committee that some people pay a deductible as high as
$15,000. She surmised that many people are not receiving the
care they need. She emphasized the need to reduce health care
costs.
3:00:09 PM
DR. ZINK responded that cost of care was a huge limiting factor,
and people won't seek care for serious injuries or health issues
because of the deductible costs.
3:00:33 PM
CHAIR WILSON suggested members send their questions to his
office and he would forward them to the department.
SENATOR REINBOLD said she had a list of 13 questions to submit.
3:02:40 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 124 Testimony 3.21.22.pdf |
SHSS 3/22/2022 1:30:00 PM |
SB 124 |
| SB 124 Amendments Considered 1-12 3.17.22.pdf |
SHSS 3/17/2022 1:30:00 PM SHSS 3/22/2022 1:30:00 PM |
SB 124 |
| SB 124 Amend. 1-39 3.17.22.pdf |
SHSS 3/17/2022 1:30:00 PM SHSS 3/22/2022 1:30:00 PM SHSS 3/29/2022 1:30:00 PM SHSS 4/7/2022 1:30:00 PM |
SB 124 |
| SB 124 CS Work Draft V. B.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/17/2022 1:30:00 PM SHSS 3/22/2022 1:30:00 PM |
SB 124 |
| SHSS- State of Health Presentation 3.22.22 .pdf |
SHSS 3/22/2022 1:30:00 PM |
|
| SB 124 Testimony 3.22.22.pdf |
SHSS 3/22/2022 1:30:00 PM |
SB 124 |
| SB 124 Ammend. Consider 13&14 3.22.22.pdf |
SHSS 3/22/2022 1:30:00 PM |
SB 124 |
| StateHealthImprovementPlan.HealthyAlaskans2030_Final.Revised-_02012022.pdf |
SHSS 3/22/2022 1:30:00 PM |