Legislature(2001 - 2002)
02/28/2002 01:37 PM Senate L&C
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ALASKA STATE LEGISLATURE
SENATE LABOR & COMMERCE COMMITTEE
February 28, 2002
1:37 p.m.
MEMBERS PRESENT
Senator Ben Stevens, Chair
Senator Alan Austerman
Senator Loren Leman
Senator John Torgerson
Senator Bettye Davis
MEMBERS ABSENT
All Members Present
COMMITTEE CALENDAR
SENATE BILL NO. 274
"An Act relating to issuance of a locum tenens permit for a
physician or osteopath; and providing for an effective date."
MOVED CSSB 274(L&C) OUT OF COMMITTEE
SB 31 - PENALTIES: OSHA VIOLATIONS CAUSING DEATH
HEARD AND HELD
PREVIOUS COMMITTEE ACTION
SB 274 - See Labor and Commerce minutes dated 2/12/02.
SB 31 - No previous action to record.
WITNESS REGISTER
Senator Olson
State Capitol Bldg.
Juneau AK 99811
POSITION STATEMENT: Sponsor of SB 274.
Ms. Anne Henry, Legislative Liaison
Division of Mental Health and Developmental Disabilities
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supported SB 274.
Ms. Catherine Reardon, Director
Division of Occupational Licensing
Department of Community and Economic Development
P.O. Box 110806
Juneau AK 99811
POSITION STATEMENT: Commented on SB 274.
Dr. Robert D. Schultz, M.D.
P.O. Box 240368
Douglas AK 99825
POSITION STATEMENT: Supported SB 274.
Dr. Nick Kletti, Medical Director
Alaska Psychiatric Institute (API)
Ph: 269-715
POSITION STATEMENT: Supported SB 274.
Ms. Susan Humphrey Barnett, Assistant Administrator
Providence Health System
POSITION STATEMENT: Supported SB 274.
Mr. Karl Sanford, Assistant Administrator
Fairbanks Memorial Hospital
1650 Cowles St.
Fairbanks AK 99701
POSITION STATEMENT: Supported SB 274.
Mr. Rich Mastriano, Director
Division of Labor Standards and Safety
Department of Labor & Workforce
Development
PO Box 107021
Anchorage, AK 99510-7021
POSITION STATEMENT: Supported CSSB 31(L&C).
Mr. Dick Cattanaeu, Executive Director
Associated General Contractors
POSITION STATEMENT: Opposed SB 31.
ACTION NARRATIVE
TAPE 02-9, SIDE A
Number 001
SB 274-PHYSICIANS' LOCUM TENENS PERMITS
CHAIRMAN BEN STEVENS called the Senate Labor & Commerce Committee
meeting to order at 1:37 p.m. and announced SB 274 to be up for
consideration.
SENATOR OLSON, sponsor of SB 274, said he would address version
F. Section 1 that says a Member of the State Medical Board or
its designee may grant a temporary permit to practice medicine to
a visiting physician or osteopath for two new situations.
Subsection (a)(2) allows for the temporary hire of a physician or
osteopath by a licensed doctor for the purpose of valuation for
permanent employment. Subsection (a)(3) allows a hospital or
mental health facility to temporarily fill a staff vacancy
through a locum tenens permit while seeking permanent employment
of a licensed physician or osteopath.
Section 2 changes the initial duration of a permit from 60 days
to 90 consecutive days. It can be extended for an additional 60
days if the permittee completes an application for licensure and
pays the associated fee. An individual's exercise of a locum
tenens permit is limited in the aggregate to 240 days in any 24
consecutive months.
Section 3 allows the board to further extend a permit if there is
a medical necessity to protect public health and safety.
SENATOR TORGERSON asked if the Medical Board supported this.
SENATOR OLSON said talks with Jim Jordan, Executive Director,
Alaska State Medical Association, HESS, API, and the State
Medical Board have resulted in a consensus on section 2.
SENATOR TORGERSON moved to adopt the CS to SB 274, Lauterbach.
There were no objections and it was so ordered.
MS. ANNE HENRY, Division of Mental Health, supported SB 274 and
said she would answer questions.
MS. CATHERINE REARDON, Director, Division of Occupational
Licensing, said her division staffs the Medical Board. She said
the different parties were able to get together and almost reach
consensus on this issue. The only item in dispute at this point
is section 3. The Medical Board does not want section 3 in the
law, but the other parties do want it. It gives the Medical Board
the ability to extend locum tenens licenses beyond the 90 days
(plus 60 more days, if you apply for a permit), if the Board or
its designee determines that the extension is necessary in order
to provide essential medical services for the protection of
public health and safety. The Board maintained their objection to
section 3 because they are uncomfortable with open-ended amounts
of time in which people can continue working under a locums and
section 3 leaves it up to the Board's discretion, but they don't
want it. This is simply a difference in philosophy between the
different parties.
DR. ROBERT SCHULTZ said he has been a psychiatrist practicing in
Alaska for 16 years and has had plenty of opportunity to come up
against the circumstances of unstaffed mental health centers and
understaffing at API. He felt very strongly that improving their
staffing would greatly help the state.
He has often seen people who couldn't get into the understaffed
hospitals end up getting hospitalized and getting an outpatient
visit as an inpatient, which costs the state a great deal of
money. Also, people having access to staff in a timely fashion
means their medications get adjusted and rearranged so that they
don't need hospitalization. He supported SB 274.
MR. NICK KLETTI, Medical Director, API, supported SB 274,
including section 3. He said:
We are in the fortunate position currently of having a
full-time medical staff - all of our doctors here being
full-time employees, but API traditionally has gone
through some periods where it's been difficult to
recruit doctors who come up to Alaska first of all and,
secondly, to work with a population that is
hospitalized here…It is greatly to the hospital's
advantage to have full-time psychiatrists or a
physician and not to have locum tenens. In fact, it's
looked at by regulatory agencies as also greatly
desirable to have full-time physicians. Unfortunately,
we're put in the position where often when there are
vacancies, which many rural states have, because it's
difficult to attract physicians to rural states. Of
either providing less than optimal care using temporary
physicians or having no care at all for those patients
and given that choice, I would rather go with a locum
tenens physician - even in an on-going fashion - even
if the license has to be renewed because of patient
care concerns in an on-going way without limitation.
With Occupational Licensing overseeing that and of
course all the credentialing matters a hospital would
have to go through to make sure a physician is doing
her job properly and safely. But I am in very strong
support of this bill. I think this will greatly help
Alaskans and the health care here.
MS. SUSAN HUMPHRY BARNETT, Assistant Administrator, Providence
Health System, supported CSSB 274. She said Providence Health
System runs a community mental health center on Kodiak Island.
They have had fairly continuous coverage, but it is very
difficult to recruit psychiatrists in rural Alaska and there are
times when there is no recourse, but to use locum tenens. She
understands that the Medical Board opposes section 3, but it
really needs to be there, because if you can't recruit a
permanent person, you at least have coverage for people who
really need this type of care. Other specialties have recruiting
difficulties - for instance the Anchorage area has a shortage of
internal medicine physicians and pediatric surgeons and
neurologists. She concluded saying they very strongly support the
committee substitute.
MR. KARL SANDFORD, Assistant Administrator, Fairbanks Memorial
Hospital, supported the CSSB 274, particularly section 3. He said
it costs a lot of money to bring a locum tenens physician to
Alaska and it is not in our best interest overall to have that
turn over every one or two months. "Therefore, I would like to
have the opportunity, if need be, to extend a locum tenens
position if possible."
MR. SANFORD said there is a national shortage in many areas of
physicians and expecting it to be resolved in a two to three
month period is unreasonable.
CHAIRMAN STEVENS asked Ms. Reardon to explain what was meant by
the Board's designee in section 3.
MS. REARDON explained that the Board they could designate someone
to serve this function. Generally, the physician they designate
is the executive administrator of the Medical Board, but they
might decide to designate a single board member.
CHAIRMAN STEVENS asked if the board wanted to testify or was she
delivering their position.
MS. REARDON said she was delivering their position.
SENATOR LEMAN moved to pass CSSB 274(L&C) from committee with
individual recommendations. There were no objections and it was
so ordered.
SB 31-PENALTIES: OSHA VIOLATIONS CAUSING DEATH
CHAIRMAN STEVENS announced SB 31 to be up for consideration.
MR. RICH MASTRIANO, Director, Division of Labor Standards and
Safety, supported CSSB 31.
SENATOR LEMAN moved to adopt the committee substitute to SB 31,
Lauterbach\C as the working document.
SENATOR TORGERSON objected to hear the changes.
MR. MASTRIANO replied that the changes in section 1 are that the
original bill did not have total civil penalties of $25,000 for
any violation and %50,000 for a willful or repeat violation.
Changes in Section 1(4) say, "not subject to reduction by
negotiation or settlement unless expressly approved in writing by
the Commissioner of Labor and Workforce Development and the
Attorney General."
SENATOR LEMAN asked who wanted this CS.
CHAIRMAN STEVENS replied that this came from the department.
SENATOR TORGERSON asked why they subjected violations in the
committee substitute to AS 18.60.010 - .105 and not (a)(b) and
(c), which is in the original version.
MR. MASTRIANO responded that those subsection describe what
serious, willful and repeat violations are. "Basically, the
existing law allows for a mandatory reduction in those penalties
under (h)…"
CHAIRMAN STEVENS said there were three components to section 1 in
the original bill, but in the committee substitute there are four
components. He asked which section was added.
MR. MASTRIANO replied that on page 2, they added, "(1) inclusive
of all final civil penalties under this section for all
violations connected with the death of the employee;". There
would be a total of $25,000 inclusive of all civil penalties.
CHAIRMAN STEVENS asked what the existing statute was on that now.
MR. MASTRIANO replied that now for a serious violation - up to
$7,000, which can be reduced for size, good faith and history of
the employer.
CHAIRMAN STEVENS remarked that it says $7,000 per day.
MR. MASTRIANO said that was for failure to correct a problem, but
ordinarily it is corrected within that time frame, unless they
ask for an extension on abatement.
CHAIRMAN STEVENS asked why the department wanted to change the
current statute and was it similar to OSHA regulation now.
MR. MASTRIANO replied that it is similar to OSHA regulation. The
department is mandated to reduce the penalty by size and history
- and if it's willful, they don't give a good faith reduction.
Their proposed CS would eliminate the department from
automatically reducing the penalties, leaving it to the
commissioner and the attorney general. This is more stringent
that OSHA requirements.
MR. MASTRIANO said they are required to adopt a number of
guidelines by reference. "If we change anything, we have to
change it and be more stringent than the OSHA requirement."
CHAIRMAN STEVENS asked how many cases per year did this apply to.
MR. MASTRIANO said that last year there were 18 fatalities in
various industries, but he added that they don't cover the
fishing industry (U.S. Department of Labor covers the fishing
industry). They cover shore-based processing, construction
industries and general industry.
CHAIRMAN STEVENS asked who determines that the employer willfully
violated the standards.
MR. MASTRIANO said the OSHA enforcement officer who works for the
state will write a citation and at that point there is an
investigation. Currently, when a citation is given to an employer
with less than 25 employees, for instance, that citation is
automatically reduced by 60% (from a serious maximum of $7,000).
If this is his first violation, he will get a good faith
reduction of up to 20%, which results in an 80% total reduction.
If he has no previous history with the department, he gets an
additional 10%. So a $7,000 fine can be reduced by 90%. It can be
reduced even further in a settlement. "A fatality could be
reduced to $750."
CHAIRMAN STEVENS asked if this would have any impact on the
settlement of the individual's estate.
MR. MASTRIANO replied no.
SENATOR AUSTERMAN asked of the 18 deaths were the total that
applied to this bill.
MR. MASTRIANO said there were a total of 23, but for willful or
violations of the standards that caused the death there were 18
total.
SENATOR AUSTERMAN asked if these standards were stronger than
federal law.
MR. MASTRIANO replied they would be, because the federal law
mandates that they reduce the penalty.
SENATOR AUSTERMAN asked him to explain why the department wants
stricter regulations than OSHA.
MR. MASTRIANO replied:
I think when someone loses their life in a work related
accident and it's a result of a willful or serious
violation on the part of the employer, to reduce that
penalty for the employer failing to comply with the law
to $750 or $1,500 - what value do you place on a
worker? We think that there should be something that
gets the employer's attention.
SENATOR AUSTERMAN commented, "Irregardless of how they do it in
the rest of the United States."
CHAIRMAN STEVENS asked what percent of states under OSHA have
more stringent requirements than OSHA.
MR. MASTRIANO replied that this bill is modeled after Minnesota
where it's been in effect for two years. That is the only state
he is aware of having a more stringent requirement.
MR. DICK CATTANAEU, Executive Director, Associated General
Contractors, opposed SB 31. They did not understand why the bill
was needed.
I am not aware of any companies that are serial
murderers - that have repeated incidents of killing
people and that's what it's saying. We need to penalize
the company so they don't do it again…A fatality on a
job is extremely harmful to a company. And it's not
just the $750 you may get fined or the $7,000. There
are going to be other OSHA fines associated with that
and workers' compensation claims and some civil suites
as well. You can't put a price on a person's life and
we're not trying to do that. We just don't see a need
for this. We're concerned about the bill when it says,
"not less than."
SENATOR LEMAN asked if he had seen the committee substitute or
did he not like either bill.
MR. CATTANAEU said they didn't like either version even after
meeting with the department this summer and having the reason
explained to them. He reiterated that he was worried about
language saying "not less than" and the idea that companies are
repeat offenders. He said this statute includes airplane
accidents and things like that.
SENATOR TORGERSON said he agreed with him on his fundamental
figures. He asked if he would be okay with increasing the $7,000
to another number, not putting the minimum in and leaving it
subject to (h), which says the commissioner shall give due
consideration to the size of the business of the employer being
charged, the gravity of the violation, the good faith of the
employer and the history of previous violations.
MR. CATTANAEU replied that he agreed that $7,000 was
insufficient, but by itself, it wouldn't stop someone. He
reiterated, if someone dies on the job, there would be other
violations.
CHAIRMAN STEVENS asked if he was aware of any other states
working on this issue.
MR. CATTANAEU said that he didn't know of any others than
Minnesota.
SENATOR DAVIS asked if Minnesota was the only state that had
adopted this.
MR. MASTRIANO replied yes and added that there is one employer
this last year that has killed more than one person. The way the
committee substitute is written right now, the total fine for a
fatality would be the $25,000 or the $50,000, if it were willful.
SENATOR LEMAN moved to withdraw his motion to adopt the committee
substitute. There were no objections and it was so ordered.
CHAIRMAN STEVENS announced that they would hold the bill for
further work and adjourned the meeting at 2:15 p.m.
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