03/14/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB57 | |
| Confirmation Hearing(s) | |
| SB181 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 57 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 181 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 14, 2024
3:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator James Kaufman, Vice Chair
Senator Forrest Dunbar
Senator Cathy Giessel
MEMBERS ABSENT
Senator Löki Tobin
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
State Medical Board
David Paulson - Anchorage
- CONFIRMATION ADVANCED
HOUSE BILL NO. 57
"An Act relating to review organizations and permitting an
emergency medical services provider to establish a review
organization; and relating to patient records."
- HEARD & HELD
SENATE BILL NO. 181
"An Act relating to placement of a child in need of aid;
relating to adoption; and providing for an effective date."
- MOVED CSSB 181(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 57
SHORT TITLE: EMERGENCY MED. SVCS: REVIEW ORGANIZATIONS
SPONSOR(s): REPRESENTATIVE(s) WRIGHT
02/03/23 (H) READ THE FIRST TIME - REFERRALS
02/03/23 (H) L&C, HSS
02/17/23 (H) L&C AT 3:15 PM BARNES 124
02/17/23 (H) Heard & Held
02/17/23 (H) MINUTE(L&C)
03/03/23 (H) L&C AT 3:15 PM BARNES 124
03/03/23 (H) Moved HB 57 Out of Committee
03/03/23 (H) MINUTE(L&C)
03/06/23 (H) L&C RPT 4DP 1NR
03/06/23 (H) DP: SADDLER, PRAX, RUFFRIDGE, SUMNER
03/06/23 (H) NR: CARRICK
03/21/23 (H) HSS AT 3:00 PM DAVIS 106
03/21/23 (H) Heard & Held
03/21/23 (H) MINUTE(HSS)
03/28/23 (H) HSS AT 3:00 PM DAVIS 106
03/28/23 (H) Moved HB 57 Out of Committee
03/28/23 (H) MINUTE(HSS)
03/29/23 (H) HSS RPT 5DP
03/29/23 (H) DP: RUFFRIDGE, SUMNER, FIELDS, MINA,
PRAX
05/09/23 (H) TRANSMITTED TO (S)
05/09/23 (H) VERSION: HB 57
05/10/23 (S) READ THE FIRST TIME - REFERRALS
05/10/23 (S) L&C, HSS
02/12/24 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/12/24 (S) Heard & Held
02/12/24 (S) MINUTE(L&C)
02/21/24 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/21/24 (S) Moved HB 57 Out of Committee
02/21/24 (S) MINUTE(L&C)
02/23/24 (S) L&C RPT 4DP
02/23/24 (S) DP: BJORKMAN, DUNBAR, GRAY-JACKSON,
MERRICK
03/14/24 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 181
SHORT TITLE: CHILD PLACEMENT; DILIGENT SEARCH
SPONSOR(s): SENATOR(s) BJORKMAN
01/16/24 (S) READ THE FIRST TIME - REFERRALS
01/16/24 (S) HSS
02/15/24 (S) HSS AT 3:30 PM BUTROVICH 205
02/15/24 (S) Heard & Held
02/15/24 (S) MINUTE(HSS)
02/29/24 (S) HSS AT 3:30 PM BUTROVICH 205
02/29/24 (S) Heard & Held
02/29/24 (S) MINUTE(HSS)
03/14/24 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
REPRESENTATIVE STANLEY WRIGHT, District 22
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 57.
RACHEL GUNN, Staff
Representative Stanley Wright
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT:
BRIAN WEBB, representing self
Anchorage, Alaska
POSITION STATEMENT: Invited testimony for HB 57.
DAVID PAULSON, M.D., Appointee
State Medical Board
Anchorage, Alaska
POSITION STATEMENT: Testified as the governor's appointee to the
State Medical Board.
SENATOR JESSE BJORKMAN, District D
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 181.
LAURA ACHEE, Staff
Senator Jesse Bjorkman
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided an overview of SB 181 and an
explanation of the proposed amendment.
ACTION NARRATIVE
3:32:58 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 3:32 p.m. Present at the
call to order were Senators Giessel, Dunbar, Kaufman, and Chair
Wilson
HB 57-EMERGENCY MED. SVCS: REVIEW ORGANIZATIONS
3:33:50 PM
CHAIR WILSON announced the consideration of HOUSE BILL NO. 57
"An Act relating to review organizations and permitting an
emergency medical services provider to establish a review
organization; and relating to patient records."
3:34:14 PM
REPRESENTATIVE STANLEY WRIGHT, District 22, Alaska State
Legislature, Juneau, Alaska, Sponsor of HB 57 stated the bill
corrects an inequity affecting emergency medical services (EMS)
in Alaska by extending quality assurance program protections to
EMS workers, which fixed healthcare facilities have had for
years. He noted that several states have already recognized the
need for such protections for EMS systems. Alaska's EMS system,
especially in rural areas, relies heavily on volunteers,
including medical directors who are often physicians ensuring
communities have access to state-certified emergency services.
He emphasized a discrepancy where these physicians have quality
assurance protections in their primary roles at clinics and
hospitals but lose those protections when serving as EMS medical
directors, threatening the health and safety of Alaskans and the
sustainability of rural EMS systems.
3:36:05 PM
RACHEL GUNN, Staff, Representative Stanley Wright, Alaska State
Legislature, Juneau, Alaska, said EMS represents a vital
intersection of transportation, safety, medical, and public
health disciplines, with emergency physicians playing a critical
role. She explained that these physicians extend their expertise
beyond hospital walls, guiding EMTs and paramedics through
medical control, issuing treatment orders, and establishing
prehospital protocols to direct patient care before hospital
arrival. EMS professionals, including Emergency Trauma
Technicians (ETTs), Mobile Intensive Care Technicians (TMTs),
paramedics, and medical directors, engage in critical self-
reflection to assess what went well, what could improve, and
factors contributing to poor outcomes. She emphasized that while
peer review boards and quality assurance programs encourage
continuous evaluation, the legal protections for hospital-based
medical directors do not extend to EMS review processes. She
argued that HB 57 is necessary to protect peer review
discussions from legal exploitation, ensuring that EMS
professionals can openly discuss improvements without fear of
litigation, which is crucial for continuous EMS advancement and
safety.
3:38:13 PM
MS. GUNN provided the following sectional analysis for HB 57:
[Original punctuation provided.]
SECTIONAL ANALYSIS
HB 57
Emergency Medical Services Quality
Assurance Program Protections
SECTIONAL ANALYSIS HB 57 Emergency Medical Services
Quality Assurance Program Protections
Section I:
Amends AS 18.23.070(1) to Include EMT's, dispatchers,
and paramedics in the definition of "health care
provider" for the purpose of peer review protection.
Section II:
Amends the definition of "healthcare provider" in AS
18.23.070(3) to include EMS agencies and employees who
are conducting peer review activities.
Section III:
AS 18.23.070(5) is amended to include emergency
medical services agencies and employees under the
definition of a "review organization"
3:39:17 PM
CHAIR WILSON announced invited testimony on HB 57.
3:39:28 PM
BRIAN WEBB, representing self, Anchorage, Alaska, stated SB 57
aims to address the omission of EMS in the original statute by
extending the same protections that fixed healthcare facilities
have to Alaska EMS services. He explained that Alaska EMS
requests an amendment to AS 18.23.070 to broaden the definitions
of covered entities, as the current wording does not include EMS
personnel or activities. He noted that EMS providers are aware
that what is discussed or documented in review processes is
legally discoverable, leading to hesitation in sharing
information, which hinders education and patient care
improvements. The lack of protections impacts EMS retention,
with valuable volunteers, clinicians, and critical medical
directors leaving the system due to the absence of legal
safeguards. He emphasized that rural towns in Alaska rely on
volunteer medical directors, who have legal protections in their
day jobs but not when volunteering, making HB 57 crucial. He
cited a tenfold increase in EMS medical director litigation
since COVID-19, mostly related to administrative duties, and
noted that other states, including California, Arizona, Florida,
and Washington, have already enacted similar protections.
3:43:00 PM
MS. GUNN stated Dr. Livengood was on a medical emergency but
provided a written testimony.
3:43:11 PM
CHAIR WILSON opened public testimony on HB 57; finding none, he
closed public testimony.
3:43:41 PM
SENATOR KAUFMAN opined that HB 57 is sensible as it provides
protection and opens communication channels to include EMS
personnel in discussions about continuous improvement and
quality management.
3:44:22 PM
REPRESENTATIVE WRIGHT thanked the committee for hearing HB 57.
3:44:41 PM
CHAIR WILSON held HB 57 in committee.
^CONFIRMATION HEARING(S)
CONFIRMATION HEARING(S)
STATE MEDICAL BOARD
3:44:48 PM
CHAIR WILSON announced the consideration of governor appointee
Dr. David Paulson to the State Medical Board.
3:45:23 PM
DAVID PAULSON, M.D., Appointee, State Medical Board, Anchorage,
Alaska, provided a brief overview of his work on the State
Medical Board, including quality control of candidates applying
for licenses in Alaska and assisting with investigations. He
mentioned his participation in board actions and noted that this
was his first experience serving on a board. He expressed his
interest in continuing to serve and protect Alaskans.
3:46:29 PM
SENATOR GIESSEL asked Dr. Paulson to share his philosophy on
pain medication and management. She specifically requested his
perspective as a neurosurgeon on the use of opioids, either
before and after surgery.
DR. PAULSON replied that preoperatively, it is important for him
to have patients reduce their pain medication to the lowest
possible amount. He collaborates with other medical
professionals to assess patients and typically asks them to
decrease their pain medication by half. He stated that
postoperatively, beyond two weeks, he is not involved in pain
management, as it is handled by a pain specialist.
SENATOR GIESSEL apologized and clarified that she should have
disclosed her background as a board-certified family practice
nurse practitioner, which was the reason for her question on
pain management.
3:47:46 PM
SENATOR DUNBAR asked what the "hot" topics or pressing issues
are expected to be in the coming term.
DR. PAULSON stated that unless the legislature addresses reforms
for physician assistants (PAs) and pharmacy practices, certain
issues need to be clarified. Specifically, he mentioned the need
to sort out pharmacists' authority to write certain
prescriptions and increasing autonomy for PAs. He noted these
are important questions for the board to address.
3:48:44 PM
CHAIR WILSON asked if he foresees any regulatory difficulty with
the board.
DR. PAULSON asked for further elaboration on the question.
CHAIR WILSON said his question relates to the change in scope of
practice for physician assistants (PAs) and other issues that
might fall under the board's purview. He mentioned that the
Medical Board had a recent change with EMS oversight moving to
the Department of Health and inquired if there are any other
items the board might be considering in the future, seeking
general insights.
3:49:50 PM
DR. PAULSON apologized and stated that nothing comes to mind.
3:50:10 PM
DR. PAULSON thanked the committee for their consideration.
3:50:25 PM
CHAIR WILSON solicited a motion.
3:50:27 PM
SENATOR KAUFMAN moved that the consideration of Dr. David
Paulson, appointee to the State Medical Board, be forwarded to a
Joint Session of the legislature. He reminded members that
signing the report(s) regarding appointments to boards and
commissions in no way reflects individual members' approval or
disapproval of the appointees; the nominations are merely
forwarded to the full legislature for confirmation or rejection.
3:50:42 PM
CHAIR WILSON found no objection.
[In accordance with AS 39.05.080, the Senate Health and Social
Services Standing Committee reviewed the following and
recommends the appointments be forwarded to a joint session for
consideration:
State Medical Board
David Paulson - Anchorage
3:50:54 PM
At ease
SB 181-CHILD PLACEMENT; DILIGENT SEARCH
3:52:50 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 181 "An Act relating to
placement of a child in need of aid; relating to adoption; and
providing for an effective date."
CHAIR WILSON stated that at the committee's last hearing CSSB
181, version Y, was adopted.
3:53:52 PM
CHAIR WILSON solicited a motion.
3:53:46 PM
SENATOR KAUFMAN moved to adopt Amendment 1, work order 33-
LS0348\Y.1, to SB 181.
33-LS0348\Y.1
Bergerud
3/5/24
A M E N D M E N T 1
OFFERED IN THE SENATE
TO: CSSB 181(HSS), Draft Version "Y"
Page 1, line 13:
Delete "has the status of an intervenor for purposes
of that hearing"
Insert "does not become a party to the case"
3:53:49 PM
CHAIR WILSON objected for purposes of discussion.
3:53:59 PM
SENATOR JESSE BJORKMAN, District D, Alaska State Legislature,
Juneau, Alaska, sponsor of SB 181, explained that the need for
Amendment 1 (Y.1) arose due to conflicting opinions between the
drafters of the law and the court system, which is responsible
for implementing it. He stated that it was decided, for the sake
of prudence, that those in charge of implementing and applying
the law should have their perspective prevail.
3:54:41 PM
CHAIR WILSON asked for a brief overview of SB 181.
3:54:44 PM
LAURA ACHEE, Staff, Senator Jesse Bjorkman, Alaska State
Legislature, Juneau, Alaska, provided an overview of SB 181 and
an explanation of the proposed amendment. She stated that the
overall purpose of SB 181 is to amend the state's Child in Need
of Aid law to allow foster parents to request a hearing when
necessary. It also grants courts and the Department of Family
and Community Services more discretion in making placements that
serve the best interests of the child.
3:55:21 PM
At ease
3:55:39 PM
CHAIR WILSON reconvened the meeting.
3:55:42 PM
MS. ACHEE said SB 181 establishes clear statutory requirements
for the Office of Children's Services to conduct family
searches, ensuring timely placement of children with an adult
family member or family friend, if available. In SB 181, version
Y, Section 1, language was added to address concerns from both
the Alaska Court System and the Department of Family and
Community Services. It clarifies that while foster parents may
request a hearing, they are not a party to the case. An
agreement was reached to address the court's concerns, adding
clarity without changing the bill's intent.
3:56:54 PM
SENATOR GIESSEL asked the meaning of "a party to the case."
MS. ACHEE stated her belief that being "a party to the case"
gives a person greater precedence in the case and grants
complete access to files, including private and confidential
information.
3:57:29 PM
SENATOR GIESSEL asked Ms. Achee to incorporate that information
into the sentence being amended and clarify the full meaning of
"a party to the case."
3:57:55 PM
SENATOR GIESSEL interjected to clarify that she was not asking
how the amendment would look in SB 181 but wanted to understand
what the application of being "a party to the case" would mean
in practice.
MS. ACHEE explained her understanding that under the original
statute, a "party" to the case, such as a parent, could request
a hearing. The concern arose that allowing a foster parent to
request a hearing without clarification might lead courts to
interpret this as making foster parents a party to the case,
giving them full access rights to information. The change allows
foster parents to request a hearing, but it makes clear they do
not receive all the rights and access that are given to a party.
3:59:06 PM
CHAIR WILSON removed his objection; finding no further objection
Amendment 1 (Y.1) was adopted.
3:59:14 PM
CHAIR WILSON stated that before the committee is CSSB 181, as
amended.
3:59:26 PM
SENATOR BJORKMAN thanked the committee for their consideration
as SB 181 goes a long way in making sure there are better
outcomes for children facing foster care.
3:59:49 PM
CHAIR WILSON solicited a motion.
3:59:53 PM
SENATOR KAUFMAN moved to report CSSB 181, work order 33-
LS0348\Y, as amended, from committee with individual
recommendations and attached fiscal note(s).
4:00:09 PM
CHAIR WILSON found no further objection and CSSB 181(HSS) was
reported from the Senate Health and Social Services Standing
Committee.
4:00:32 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 4:00 p.m.