Legislature(2019 - 2020)BELTZ 105 (TSBldg)
03/14/2019 01:30 PM LABOR & COMMERCE
Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE SENATE LABOR AND COMMERCE STANDING COMMITTEE March 14, 2019 1:31 p.m. MEMBERS PRESENT Senator Lora Reinbold, Chair Senator Mia Costello, Vice Chair Senator Click Bishop Senator Chris Birch Senator Elvi Gray-Jackson MEMBERS ABSENT All members present COMMITTEE CALENDAR CONFIRMATION HEARING(S): Board of Dental Examiners Dr. Jonathan P. Woller - Fairbanks CONFIRMATION ADVANCED Board of Veterinary Examiners Dr. Scott Flamme - Fairbanks CONFIRMATION ADVANCED Board of Nursing Emily Henry - Anchorage CONFIRMATION ADVANCED Workers' Compensation Board Kimberly Ziegler - Cordova Bradly S. Austin - Juneau Diane M. Thompson - Anchorage Sara Faulkner - Homer CONFIRMATIONS ADVANCED Alaska Labor Relations Agency Dennis Moen - Anchorage CONFIRMATION ADVANCED SENATE BILL NO. 44 "An Act relating to the prescription of drugs by a physician assistant without physical examination." HEARD AND HELD PREVIOUS COMMITTEE ACTION BILL: SB 44 SHORT TITLE: TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS SPONSOR(s): SENATOR(s) GIESSEL BY REQUEST 02/04/19 (S) READ THE FIRST TIME - REFERRALS 02/04/19 (S) L&C 03/14/19 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg) WITNESS REGISTER DR. JONATHAN P. WOLLER, Appointee Board of Dental Examiners Division of Corporations, Business, and Professional Licensing Department of Commerce, Community and Economic Development Fairbanks, Alaska POSITION STATEMENT: Testified as appointee to the Board of Dental Examiners. EMILY HENRY, Appointee Board of Nursing Division of Corporations, Business, and Professional Licensing Department of Commerce, Community and Economic Development Anchorage, Alaska POSITION STATEMENT: Testified as appointee to the Board of Nursing. KIMBERLY C. ZIEGLER, Appointee Workers' Compensation Board Division of Corporations, Business, and Professional Licensing Department of Commerce, Community and Economic Development Anchorage, Alaska POSITION STATEMENT: Testified as appointee to the Workers' Compensation Board. BRADLEY S. AUSTIN, Appointee Workers' Compensation Board Department of Labor and Workforce Development (DOLWD) Juneau, Alaska POSITION STATEMENT: Testified as appointee to the Workers' Compensation Board. DIANE M. THOMPSON, Appointee Workers' Compensation Board Department of Labor and Workforce Development (DOLWD) Anchorage, Alaska POSITION STATEMENT: Testified as appointee to the Workers' Compensation Board. SARA FAULKNER, Appointee Workers' Compensation Board Department of Labor and Workforce Development (DOLWD) Homer, Alaska POSITION STATEMENT: Testified as appointee to the Workers' Compensation Board. DR. SCOTT FLAMME, DVM, Appointee Board of Veterinary Examiners Division of Corporations, Business, and Professional Licensing Department of Commerce, Community and Economic Development Fairbanks, Alaska POSITION STATEMENT: Testified as appointee to the Board of Veterinary Examiners. DENNIS MOEN, Appointee Alaska Labor Relations Agency Department of Labor and Workforce Development (DOLWD) Anchorage, Alaska POSITION STATEMENT: Testified as appointee to the Labor Relations Agency. SENATOR CATHY GIESSEL Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Testified as sponsor of SB 44. JANE CONWAY, Staff Senator Cathy Giessel Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Provided a sectional analysis of SB 44. CHERISE HUG, Physician Assistant Orion Behavioral Health Eagle River, Alaska POSITION STATEMENT: Testified in support of SB 44. SHIGONE BEIGHLE, Physician Assistant Orion Behavioral Health Anchorage, Alaska POSITION STATEMENT: Testified in support of SB 44. ACTION NARRATIVE 1:31:13 PM CHAIR LORA REINBOLD called the Senate Labor and Commerce Standing Committee meeting to order at 1:31 p.m. Present at the call to order were Senators Gray-Jackson, Costello, Birch and Chair Reinbold. Senator Bishop arrived shortly thereafter. ^CONFIRMATION HEARING(S): CONFIRMATION HEARING(S): Board of Dental Examiners Board of Veterinary Examiners Board of Nursing Workers' Compensation Board Alaska Labor Relations Agency 1:31:42 PM CHAIR REINBOLD announced that the first order of business would be Confirmation Hearings for the Board of Dental Examiners, the Board of Veterinary Examiners, the Board of Nursing, the Workers' Compensation Board, and the Alaska Labor Relations Agency. 1:32:43 PM JONATHAN P. WOLLER, DMD, Appointee, Board of Dental Examiners, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Fairbanks clarified that his father is Timothy Woller and they work together in the same dental offices. He said that he was born and raised in Fairbanks. He holds an undergraduate degree in physiological sciences from the University of Arizona. He earned his Doctor of Dental Medicine (DDM) from the University of Louisville in 2004. He said that he has continuously practiced dentistry since 2004. During 2004-2007 he practiced medicine in Minneapolis, Minnesota, at a nonprofit organization that served immigrant and underserved children. He returned to Fairbanks in 2007 and entered into private practice with his father. In 2010, he purchased his father's business, which he currently operates. He said that he firmly believes in public service and has served in voluntary positions with the Alaska Dental Society, the American Dental Association, and twice has provided services via the Alaska Mission of Mercy. He said he views serving on the Board of Dental Examiners as a means for him to give back to the state. He offered his belief that dental professionals have a duty to hold themselves to the highest ethical, moral, and clinical standards. Helping dental providers will help to ensure that all Alaskans are in good hands when they seek the services of licensed dentists and dental hygienists. He has served on the executive council and on committees for the Alaska Dental Society. He would like the profession to have clear and fair legislation that reflects the values expected of the dental community. He said he looks forward to serving all Alaskans beyond his own patient population. 1:35:55 PM CHAIR REINBOLD opened public testimony and after ascertaining no one wished to testify, closed public testimony on the confirmation hearing for Dr. Jonathan P. Woller, appointee to the Board of Dental Examiners. 1:37:15 PM EMILY HENRY, Appointee, Board of Nursing, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Anchorage, stated she is thrilled to be a part of the team of nurses at the Providence Extended Care where she has worked since 2018. She said that she is originally from Delaware and graduated from Delaware Technical Community College in 2001. She later worked as a home care nurse and continued to take courses. She later had an opportunity to work in Alaska. She said she is excited to promote and uphold the standards in nursing care. She believes in compassion for residents. She has participated in organizations, including the Future Farmers of America (FFA) in Delaware and conservation organizations, including the Rocky Mountain Elk Foundation, the National Rifle Association (NRA) and the National Wild Turkey Federation. 1:40:17 PM CHAIR REINBOLD opened public testimony and after ascertaining no one wished to testify, closed public testimony on the confirmation hearing for Emily Henry, appointee to the Board of Nursing. She noted that Ms. Henry participated in the FFA. MS. HENRY responded that she has been part of the FFA since she was a girl. She said she hopes to promote healthy lifestyles for better health. 1:41:44 PM KIMBERLY C. ZIEGLER, Appointee, Workers' Compensation Board, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Anchorage, stated she has worked in the construction industry in training and apprenticeship. She currently works in the seafood industry at Copper River Seafoods. She is interested to serve on the Workers' Compensation Board (WCB) because public service is integral to personal and professional growth. After viewing workers' compensation from the employers' side, she is interested in seeing it from another side of the process. She said she hope to work on policy issues to improve the workers' compensation system in Alaska. 1:43:19 PM CHAIR REINBOLD mentioned that the legislature will be considering workers' compensation bills. 1:43:43 PM SENATOR BIRCH asked how many employees work at Copper River Seafoods and if she has experienced any issues. MS. ZIEGLER responded that during the off-season, Copper River Seafood employs 120 fulltime employees and beginning in May the company employs up to 900 seasonal employees. She covers 40-50 workers' compensation claims each year, and in some years up to 70 claims. She said that the seafood industry is a very dangerous profession with significant workers' compensation usage. She said that she is interested in helping address these issues. 1:44:59 PM CHAIR REINBOLD acknowledged that commercial fishing is one of the highest risk jobs. 1:45:36 PM BRADLEY S. AUSTIN, Appointee, Workers' Compensation Board, Department of Labor and Workforce Development (DOLWD), Juneau, stated he works with the Plumbers and Pipefitters, Local Union 262. He serves on the joint apprenticeship training committee and is the training coordinator and instructor for their apprentices. He said his family moved to Alaska in 1970 and that his dad worked as a plumber. He attended Juneau-Douglas High School and owned his own plumbing contractor business. He also has worked for local shops in Juneau. He said that he holds a certificate for industrial training and holds an associate degree in industrial training. He was appointed to the labor seat of the Workers' Compensation Board (WCB) in 2010, that this will be his fourth appointment to the WCB. He characterized the WCB as an important board and serving on the board gives him a chance to give back to Alaska. The board provides three functions. First, the board is involved in hearings, often including complicated medical or legal matters. Second, the board develops regulations, he said. Finally, the board approves companies that apply for self-insurance through workers' compensation. Two members serve Southeast Alaska. He serves in the labor seat, another board member serves in the industry seat, and they have a hearing officer. 1:48:10 PM SENATOR COSTELLO said about a third of the WCB members are new. She asked how he will mentor new members. MR. AUSTIN responded that the WCB members work well together and he hopes that he will be able to mentor new members. In further response, he elaborated that the WCB holds two hearings a month. He said that new members must be prepared to read lengthy settlement agreements and spend considerable time preparing for meetings since it is an active board. SENATOR BIRCH said that Mr. Austin has a tremendous resume. He asked if he has seen safety practices improve or change during the 40 years he has served in his profession. He further asked about the types of on the job injuries he has encountered. MR. AUSTIN acknowledged that safety records have improved greatly over time. His organization and trade unions have instituted safety programs for apprentices and journeymen. He mentioned that North Slope employees also go through extensive safety training programs. The trend has been to provide enhanced safety programs to lower the number of injuries, he said. 1:53:05 PM SENATOR BISHOP said the Workers' Compensation Board falls under the Department of Labor and Workforce Development. From his perspective as the former commissioner of the DOLWD, he acknowledged that a lot of work is involved for this board. The department started a focused campaign to assist employers on the importance of workplace safety. He said that workers' compensation continues to be a tenuous conversation and it is hard to make improvements in the industry. The Department of Labor and Workforce Development (DOLWD) Worker Safety Account receives a 2.75 percent stipend from workers' compensation insurance premiums. Last year, the legislature passed a bill to address the multiplier, because workplace accidents were reduced to the point that the Division of Insurance needed a bill to increase it. "We're moving the needle in the right way and thanks, Brad, for reapplying," he said. CHAIR REINBOLD expressed hope that Mr. Austin would weigh in on workers' compensation bills coming before the committee. 1:55:46 PM DIANE M. THOMPSON, Appointee, Workers' Compensation Board, Department of Labor and Workforce Development (DOLWD), Anchorage, stated she has lived in Anchorage since 1981 and has worked in the restaurant business for over 30 years. She currently is the owner/manager for Firetap Ale House in South Anchorage and she previously has owned Humpy's Great Alaskan Alehouse, which she sold in 2000. She serves as the president of the Alaska Hospitality Retailer's Association (AHRA), which represents the entire hospitality industry in the state. The AHRA currently has about 200 members, she said. She has handled all the workers' compensation claims for her restaurants, so she understands the system. She currently employs about 70 workers. She said that she is interested in observing the other side of the workers' compensation equation. However, her restaurants have not had many workers' compensation claims. She recalled that she has had three claims in 10 years, mostly for cut fingers, which was addressed by providing employees with better gloves. 1:59:35 PM SARA FAULKNER, Appointee, Workers' Compensation Board, Department of Labor and Workforce Development (DOLWD), Homer, stated she has lived in Alaska since 1980. She stated that she and her husband have owned and operated Lands End in Homer for over 30 years. During that time, they also owned Van Gilder Hotel in Seward and Kenai Landing in Kenai. She said she would like to serve on the Workers' Compensation Board to address employee safety and health, which are priorities for her businesses. She would like to learn more about workers' compensation issues and use her knowledge and experience to help others. Secondly, since medical costs have skyrocketed, she would like to help control the workers' compensation program and ultimately reduce workers' compensation insurance rates and costs. She hoped she would be a good board member. She said she will bring her broad experience across many industries. She also has experience with workers' compensation audits and claims. She is also good with numbers and is a good listener. She said that she will do her best to properly execute the workers' compensation laws of Alaska. SENATOR BISHOP said she has a well-rounded background. He said he liked that she started her career as a bull cook working on a neighbor's NANA camp in Deadhorse. He said she will be a good fit for the board. 2:02:12 PM CHAIR REINBOLD opened public testimony and after ascertaining no one wished to testify, closed public testimony on the confirmation hearings for Kimberly Ziegler, Bradly S. Austin, Diane M. Thompson, Sara Faulkner, appointees to the Workers' Compensation Board. 2:02:59 PM SCOTT FLAMME, DVM; Appointee, Board of Veterinary Examiners, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), Fairbanks, stated he has been a veterinarian in Fairbanks for 17 years. He grew up on a farm and has multiple experiences serving on boards. He worked for Pfizer Animal Health as student advisor. He said that veterinary practices have changed dramatically in recent years due to technology. In part, due to these technology changes, veterinarians have experienced increased legal responsibilities, especially in terms of recordkeeping and the use of online technology. He said that he is well versed in "tech" and would like to serve on a state board. Most veterinarians are hard-working individuals and he works hard, he said. SENATOR BISHOP offered his belief that Mr. Flamme is the "right guy for the job" at this time. He said he was floored that Mr. Flamme has time to serve on the board, but that the state can use him. 2:05:23 PM CHAIR REINBOLD opened public testimony and after ascertaining no one wished to testify, closed public testimony on the confirmation hearing for Scott Flamme, appointee to the Board of Veterinary Examiners. 2:05:56 PM DENNIS MOEN, Appointee, Alaska Labor Relations Agency, Department of Labor and Workforce Development (DOLWD), Anchorage, stated that he came to Alaska in the mid-70s, and that he has lived in Fairbanks, Anchorage, and in Southeast Alaska. He has over 40 years of experience with public employees, including working as a public employee and managing public employees for the Department of Transportation and Public Facilities (DOTPF), and as a business manager for Public Employees, Local 71, he said. He has experience in contract negotiations, contract interpretation, conflict resolution, letters of agreement, grievance resolutions, arbitration, and employee training and safety. He recently retired on March 1 and would like to continue to serve Alaskans as a member of the board. 2:07:18 PM SENATOR BISHOP said Mr. Moen is qualified and acknowledged his focus has been on safety and health. He said that he really appreciated the leadership on the "Kids Don't Float" program, which is a good program. 2:08:24 PM SENATOR GRAY-JACKSON said she knows Mr. Moen. She thanked him for his years of service as an employee who has represented so many public service employees that provide many services for members' constituents. She said he brings a lot of workers' compensation experience to the board. 2:09:27 PM CHAIR REINBOLD opened public testimony and after ascertaining no one wished to testify, closed public testimony on the confirmation hearing for Dennis Moen, appointee to the Alaska Labor Relations Agency. 2:09:58 PM At-ease. 2:10:40 PM CHAIR REINBOLD reconvened the meeting. She stated that in accordance with AS 39.05.080, the Senate Labor and Commerce Standing Committee reviewed the following and recommends the appointments be forwarded to a joint session for consideration: Board of Dental Examiners Dr. Jonathan P. Woller - Fairbanks Board of Veterinary Examiners Dr. Scott Flamme - Fairbanks Board of Nursing Emily Henry - Anchorage Workers' Compensation Board Kimberly Ziegler - Cordova Bradly S. Austin - Juneau Diane M. Thompson - Anchorage Sara Faulkner - Homer Alaska Labor Relations Agency Dennis Moen - Anchorage Signing the reports 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. 2:11:24 PM At-ease. SB 44-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS 2:13:02 PM CHAIR REINBOLD reconvened the meeting. She announced that the final order of business would be SENATE BILL NO. 44, "An Act relating to the prescription of drugs by a physician assistant without physical examination." 2:13:05 PM SENATOR COSTELLO clarified the original version of SB 44 was before the committee. Senator Bishop objected for discussion purposes. 2:13:15 PM SENATOR CATHY GIESSEL, Alaska State Legislature, Juneau, stated that this bill relates to telehealth and physician assistants. She said that while she is a health care professional, she is not a physician assistant (PA) and derives no benefit from the bill. She described this bill as a "clean up bill" that will increase access to care throughout Alaska. She paraphrased from her sponsor statement for SB 44, which read: The 2016 Medicaid Reform bill (Senate Bill 74) provided for the use of telehealth by revising Alaska statutes to require the Alaska Board of Medicine to adopt regulations and guidelines for physicians rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.64.364. 2:14:19 PM Consequently, the omission of PAs from the Medicaid Reform bill has led to them being subject to limitations on the use of telemedicine. Specifically, the Medical Board released guidelines stating that physician assistants could not treat a patient via telemedicine without first conducting an in-person examination personally, or with a collaborating physician or other practitioner in the same group practice. 2:14:54 PM SENATOR GIESSEL said that physician assistants (PAs) have been prohibited from practicing telemedicine. She explained that physician assistants are a type of clinician that developed during the Vietnam War. These were medics who went to Vietnam and had to practice very high-level medical care. Actually, they replaced doctors in the war field. They came back to the US with these skills. Physicians realized that these medics were highly skilled. She referred to a document in members' packets labeled "AAPA." The American Academy of Physician Assistants (AAPA) discusses the education and experience of physician assistants. PAs are required to have 27 continuous months of education, including classroom education in medical sciences, and to perform rotations in medical and surgical disciplines, family medicine, internal medicine, general surgery, pediatrics, and obstetrics. These medical professionals must have at least 2,000 hours of clinical practice in various settings and almost all physician assistant programs are master's degree programs. In fact, it will be required by the year 2020. After graduation, they must pass the physician assistant national certifying exam and be licensed by the state. Every two years they must complete 100 hours of continuing medical education and every ten years they must take an exam to recertify. She characterized these physician assistants as medical professionals with substantive education. 2:17:02 PM SENATOR GIESSEL referred to medical board guidelines for collaborating physicians and physician assistants in members' packets. She said that physician assistants (PAs) must practice under the supervision of a collaborating physician. They must have an active collaborative plan, which describes the nature of the relationship, the scope of practice, where they will be practicing, and what controlled substances they can prescribe. Physician assistants have the authority and ability to apply to the Drug Enforcement Administration to obtain authorization to prescribe controlled substances. They may or may not choose to do so, but if they do, their collaborating physicians oversee the prescribing authority. 2:18:12 PM SENATOR GIESSEL related the controlled substances physician assistants are authorized to prescribe, including schedule II through schedule V drugs. She offered to provide the document, but basically explained that schedule II includes drugs such as oxycodone and morphine, schedule III includes drugs such as codeine, schedule IV includes drugs such as Darvon, and Schedule V includes drugs such as Robitussin with codeine. 2:19:01 PM SENATOR GIESSEL explained that the bill would expand telemedicine to physician assistants (PAs). She continued to review her sponsor statement, as follows: SB 44 amends the law, aligning with the intent of the Medicaid Reform bill, to clarify that physician assistants can provide telemedicine in the same manner as physicians. Under SB 44, the physician assistant would be subject to the same statutory oversight as physicians regarding the practice of telemedicine, as well as the same disciplinary sanctions when appropriate Senate Bill 44 will increase patient access to care, particularly for rural and medically-underserved areas. The bill will allow PAs to use telemedicine, extending the reach of medicine to underserved areas. This is particularly important in Alaska, with vast geographical challenges and limited access to vital healthcare. She referred to HRSA document in members' packets. Alaska is a health professional shortage area. 2:20:40 PM SENATOR BIRCH asked for further clarification on whether this would cover nursing and nurse practitioners. SENATOR GIESSEL said that nurse practitioners have independent practice in Alaska and can open their own clinics and have no limitations on prescriptive authority. They can obtain Drug Enforcement Administration (DEA) numbers that allow them to prescribe controlled substances, which has been in place since 1983. They often practice with physician assistants (PA) and often perform the same work, but PAs are under the state medical board and require supervision. 2:21:44 PM SENATOR COSTELLO appreciated the history of PAs. She watched a Vietnam War documentary and can see many individuals came back from that war with an arsenal of experience in the field. She said "patient" is replaced with "person" However, on page 3, line 13 of the bill relates to the term "physician-patient relationship." She asked whether the term "patient" is defined in statute or if it is a commonly-understood term. SENATOR GIESSEL said that law uses the term "person" and "patient" as medical terminology and often refers to them as clients. She characterized it as a term of art whereas person is a legal term. However, physician-patient relationship in used in other places in the medical statutes. 2:23:32 PM JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State Legislature, Juneau, paraphrased the sectional analysis, which read as follows: Senate Bill 44 Sectional Analysis (vsn U) Telehealth: Physician Assistants; Drugs Section 1: Amends AS 08.64.101(a)(6) by requiring the board to adopt regulations for a physician assistant practicing telehealth under AS 08.64.364, and that the regulations must use a recognized national model for standards of telehealth care. Section 2: Amends AS 08.64.364(a) by saying that disciplinary action cannot be directed toward a physician assistant for prescribing drugs via telehealth if the drugs are not controlled substances, if follow up care can be provided from its medical group, and if consent has been given by the patient for care and sharing of records to the primary care provider. Section 3: Amends AS 08.64.364(b) by saying that a physician assistant may administer botulinum toxin (Botox) if they meet all the requirements set out in 08.64.364 and is supervised by an appropriate licensed health care provider Section 4: Amends AS 08.64.364(c) by renumbering and adds that a physician or physician assistant may not prescribe, dispense or administer a prescription drug via an Internet questionnaire or email message without having a prior patient/doctor relationship. 2:25:47 PM SENATOR COSTELLO said that it seems that the guidelines that were written by the board just need to be updated to include PAs. she asked whether the sponsor has considered adding an immediate effective date. MS. CONWAY said that this bill would become effective after the governor signs the bill. 2:26:21 PM SENATOR BIRCH asked whether administering Botox is a change. SENATOR GIESSEL answered that Botox requires the presence of a licensed health care provider who is authorized to administer that medication. This is current law for physicians and the bill adds PAs. Currently, physicians can prescribe, dispense, and administer a controlled substance or botulinum toxin when an appropriate licensed health care provider is present with the person. This language is listed separately because these are heavy duty medications being administered. 2:27:43 PM CHAIR REINBOLD opened public testimony on SB 44. 2:29:38 PM CHERISE HUG, Physician Assistant (PA), Orion Behavioral Health Network, Eagle River, stated she is a PA in Anchorage and works in child and adolescent psychiatry. About half of her time is spent in person and the other half is spent providing telemedicine to remote communities throughout the state. She said PAs are allowed to provide telemedicine, but they cannot prescribe medications without having a face-to-face relationship. She said this has created a burden and difficulty for patients in rural communities to access care. She said that the delay can be detrimental to families. Currently, if she provides an initial evaluation via telemedicine, she cannot start any medication. This causes delays and hinders patient care. It requires patients to travel and adds significant travel costs to patient care. 2:31:33 PM SENATOR BIRCH asked for her experience with audio or video transmission and if it is an effective means of providing care. MS. HUG answered that she uses an Internet-based service that has a video connection. She said they have good cameras, but it depends on what patients have at their end. She explained that the quality of the video tends to be pretty good. She said that she often works with other clinics and patients can go to a community health office for the telehealth appointment. SENATOR BIRCH asked how patients receive their prescriptions. DR. HUG answered that patients use mailout pharmacy services via Walgreens and Southcentral Foundation. The patient's provider ships the medication directly to the patient. 2:34:19 PM SHIGONE BEIGHLE, Physician Assistant (PA), Orion Behavioral Health Network, Anchorage, echoed Ms. Hug's testimony. She stated that about 50 percent of her patients are pediatric psychiatric patients in rural communities. She was raised in a rural community of 500 in Aniak. She said that at age 13 she lost three peers to suicide. Her school had a population of 50 between 7th-12th grades. She said that the loss of three students in one year was significant. She said that Alaska has the highest rate of teen suicide and Alaska Natives and rural communities have the highest rates. She said that her organization provides care via telehealth to children throughout the state, including Barrow and King Cove. This service provides opportunities she wished had been available to depressed teens during her high school years. She related a patient experience, in which a child under the age of 10 had three depressive stints at North Star Behavioral Health (North Star) with limited out-patient care and delayed access stabilization and care. Although North Star provided the initial care, the child will face delays for stabilized care and maintenance if she cannot not write prescriptions until she meets face-to-face with the child. She said that in these situations, the parents and medical staff are already dealing with an unstable child or a child in need. She said adding travel is expensive and adds undue burdens for those working to help children in crisis. She said that she got into the field of medicine and psychiatry because of the great need in Alaska and her desire to serve the rural population. She expressed gratitude for the services that her organization provides and the telehealth services it provides. She expressed concern that medical professionals see patients and then cannot do anything, which is detrimental to patients. She said, "Maybe not being seen and doing nothing is almost the same." 2:37:20 PM CHAIR REINBOLD recalled a friend's experience at a hospital emergency room, with very high costs for services. She hoped that telemedicine would help reduce costs. She hoped to further discuss emergency room costs and the trauma psychiatric patients experience in those situations. 2:38:56 PM CHAIR REINBOLD held public testimony open on SB 44. 2:39:19 PM SENATOR GIESSEL referred to six letters of support from physician assistants in rural Alaska that are in members' packets. [SB 44 was held in committee.] 2:39:47 PM CHAIR REINBOLD reviewed upcoming committee announcements. 2:40:20 PM There being no further business to come before the committee, Chair Reinbold adjourned the Senate Labor and Commerce Standing Committee meeting at 2:40 p.m.