Legislature(2019 - 2020)BELTZ 105 (TSBldg)
03/12/2020 01:30 PM LABOR & COMMERCE
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ALASKA STATE LEGISLATURE SENATE LABOR AND COMMERCE STANDING COMMITTEE March 12, 2020 1:31 p.m. MEMBERS PRESENT Senator Click Bishop, Chair Senator Gary Stevens, Vice Chair Senator Joshua Revak Senator Elvi Gray-Jackson MEMBERS ABSENT Senator Mia Costello COMMITTEE CALENDAR CONFIRMATION HEARING(S) Board of Barbers and Hairdressers Cheryl Brantley - Anchorage Zera "Blake" Thomas - Chugiak - CONFIRMATIONS ADVANCED Board of Nursing Catherine Hample - Wasilla - CONFIRMATION ADVANCED SPONSOR SUBSTITUTE FOR SENATE BILL NO. 68 "An Act relating to the practice of dental hygiene; establishing an advanced practice permit; prohibiting unfair discrimination under group health insurance against a dental hygienist who holds an advanced practice permit; and relating to medical assistance for dental hygiene services." - MOVED CS SSSB 68(L&C) OUT OF COMMITTEE SENATE BILL NO. 173 "An Act relating to mobile intensive care paramedics; relating to duties of the State Medical Board and the Department of Health and Social Services; and providing for an effective date." - HEARD & HELD PREVIOUS COMMITTEE ACTION BILL: SB 68 SHORT TITLE: DENTAL HYGIENIST ADVANCED PRAC PERMIT SPONSOR(s): SENATOR(s) GIESSEL BY REQUEST 02/21/19 (S) READ THE FIRST TIME - REFERRALS 02/21/19 (S) L&C, FIN 04/03/19 (S) SPONSOR SUBSTITUTE INTRODUCED - REFERRALS 04/03/19 (S) L&C, FIN 03/10/20 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg) 03/10/20 (S) Heard & Held 03/10/20 (S) MINUTE(L&C) 03/12/20 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg) BILL: SB 173 SHORT TITLE: LICENSE MOBILE INTENSIVE CARE PARAMEDICS SPONSOR(s): SENATOR(s) REVAK 02/03/20 (S) READ THE FIRST TIME - REFERRALS 02/03/20 (S) HSS, L&C 02/17/20 (S) HSS AT 1:30 PM BUTROVICH 205 02/17/20 (S) Heard & Held 02/17/20 (S) MINUTE(HSS) 02/26/20 (S) HSS AT 1:30 PM BUTROVICH 205 02/26/20 (S) Moved SB 173 Out of Committee 02/26/20 (S) MINUTE(HSS) 02/28/20 (S) HSS RPT 2DP 3NR 02/28/20 (S) DP: WILSON, VON IMHOF 02/28/20 (S) NR: BEGICH, GIESSEL, SHOWER 03/12/20 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg) WITNESS REGISTER CHERYL BRANTLEY, Appointee Board of Barbers and Hairdressers 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 Barbers and Hairdressers. ZERA "BLAKE" THOMAS, Appointee Board of Barbers and Hairdressers Division of Corporations, Business and Professional Licensing Department of Commerce, Community and Economic Development Chugiak, Alaska POSITION STATEMENT: Testified as appointee to the Board of Barbers and Hairdressers. CATHERINE HAMPLE, RN, Appointee Board of Nursing Division of Corporations, Business and Professional Licensing Department of Commerce, Community and Economic Development Wasilla, Alaska POSITION STATEMENT: Testified as appointee to the Board of Nursing. DUSTIN ELSBERRY, Intern Senator Josh Revak Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Introduced SB 173 on behalf of the sponsor. JILL LEWIS, Deputy Director Division of Public Health Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: During the hearing on SB 173, delivered a PowerPoint: "SB 173 License Mobile Intensive Care Paramedics." BRIAN WEBB, representing self Juneau, Alaska POSITION STATEMENT: Testified in support of SB 173. SARA CHAMBERS, Director Division of Corporations, Business & Professional Licensing Department of Commerce, Community and Economic Development Juneau, Alaska POSITION STATEMENT: Testified in support of SB 173. ALYSIA JONES, Executive Administrator Alaska State Medical Board Division of Corporations, Businesses, and Professional Licensing Department of Commerce, Community and Economic Development Juneau, Alaska POSITION STATEMENT: Testified in support of SB 173. ALEX BOYD, Paramedic and Assistant Chief of Training Anchorage Fire Department Anchorage, Alaska POSITION STATEMENT: Testified in support of SB 173. WILMA VINTON, Executive Director Interior Region Emergency Medical Services Council, Inc.; Assistant Chief of Emergency Medical Services Steese Volunteer Fire Department Fairbanks, Alaska POSITION STATEMENT: Testified in support of SB 173. ANJELA JOHNSTON, Training Coordinator Southeast Region, Alaska Emergency Medical Services Council Division of Public Health Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Testified in support of SB 173. ACTION NARRATIVE 1:31:58 PM CHAIR CLICK BISHOP called the Senate Labor and Commerce Standing Committee meeting to order at 1:31 p.m. Present at call to order were Senators Gray-Jackson, Revak, Stevens, and Chair Bishop. ^CONFIRMATION HEARING(S) CONFIRMATION HEARING(S) Board of Barbers and Hairdressers Board of Nursing 1:32:55 PM CHAIR BISHOP announced the first order of business would be consideration of governor appointees to boards and commissions. He asked each appointee to place their name and affiliation on the record, give a brief introduction, and discuss the reason they want to serve on the board or commission. He advised that public testimony would be taken after all appointees have testified and the names would be forwarded to the full body for consideration. The hearing today was not a recommendation on any subsequent vote. 1:33:33 PM CHERYL BRANTLEY, Appointee, Board of Barbers and Hairdressers, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development, Anchorage, Alaska, stated that she grew up in Kotzebue. She said that she has 13 years of experience working as a licensed hairdresser and six years as a licensed instructor in Alaska. She has also held a cosmetology and instructor's license in Kansas at the Paul Mitchell School. She said that she is passionate about teaching and inspiring new students to elevate their skills as hair stylists. She would like to serve on the board to bring a fresh perspective on today's issues. She brings her desire to serve the people on behalf of hairdressers, barbers, estheticians, nail technicians and tattoo artists. She would like to help the board make fair decisions that will help protect the public. SENATOR STEVENS said his daughter, who is a hairdresser, expressed concern when the board removed the physical exam for hairdressers. He asked her perspective. MS. BRANTLEY said she agrees that the practical test is important and should be put back as a requirement. She related her personal observations and opined that the practical exam can help identify those who need additional training. CHAIR BISHOP thanked her for putting her name forward. 1:36:00 PM ZERA "BLAKE" THOMAS, Appointee, Board of Barbers and Hairdressers, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development, Chugiak, Alaska, stated that he was appointed to serve on the tattooist, body piercer, and permanent cosmetic seat of the board. He started an apprenticeship in 2002, then began his career as a body piercer. After gaining a position in his current studio in 2004, he was promoted into management in 2007. He emphasized he brings objectivity and knowledge of the craft to the board. 1:37:26 PM SENATOR REVAK thanked him for his involvement with Bikers Against Child Abuse. He said their mission is important and they do great work. MR. THOMAS thanked him for the comment then said he has not worked with the group recently, but he intends to become active again. CHAIR BISHOP thanked him for putting his name forward. 1:38:01 PM CATHERINE HAMPLE, RN; Appointee, Board of Nursing, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development, Wasilla, Alaska, stated that she is an adjunct professor at the University of Alaska Anchorage and teaches advanced medical surgical nursing. She said she has been working in nursing since she was 16 years old, working first as a candy striper, then as a licensed practical nurse, and finally as a registered nurse. She obtained several advanced degrees from the University of Phoenix. She has worked in supervisory positions and is now teaching student nurses. She said she would like to serve on the board to monitor safe nursing practice for public protection, but also to promote nursing. 1:39:04 PM CHAIR BISHOP 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 Barbers and Hairdressers Cheryl Brantley - Anchorage Zera "Blake" Thomas - Chugiak Board of Nursing Catherine Hample - Wasilla [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.] 1:39:39 PM At ease SB 68-DENTAL HYGIENIST ADVANCED PRAC PERMIT 1:40:39 PM CHAIR BISHOP reconvened the meeting and announced the consideration of SPONSOR SUBSTITUTE FOR SENATE BILL NO. 68, "An Act relating to the practice of dental hygiene; establishing an advanced practice permit; prohibiting unfair discrimination under group health insurance against a dental hygienist who holds an advanced practice permit; and relating to medical assistance for dental hygiene services." [The committee adopted the committee substitute for SSSB 68, work order 31-LS0224\R, during the first hearing.] CHAIR BISHOP stated that this is the second hearing and public testimony was taken at the last hearing, all of which was favorable. He asked if the sponsor had any comments. SENATOR GIESSEL answered no. 1:41:11 PM SENATOR STEVENS moved to report CSSSSB 68, work order 31- LS0224\R, from committee with individual recommendations and attached fiscal note(s). CHAIR BISHOP found no objection and CSSSSB 68(L&C) was reported from the Senate Labor and Commerce Standing Committee. 1:41:36 PM At ease SB 173-LICENSE MOBILE INTENSIVE CARE PARAMEDICS 1:43:28 PM CHAIR BISHOP announced the consideration of SENATE BILL NO. 173, "An Act relating to mobile intensive care paramedics; relating to duties of the State Medical Board and the Department of Health and Social Services; and providing for an effective date." He stated that this is the first hearing on SB 173 and public testimony has been noticed. 1:43:45 PM SENATOR REVAK, speaking as sponsor, stated that SB 173 will fix an inefficiency in the regulation of paramedics. Regulation of the emergency medical services (EMS) system currently is split between the State Medical Board and the Department of Health and Social Services and this has created several problems. He deferred further introduction to his intern. 1:44:28 PM DUSTIN ELSBERRY, Intern, Senator Josh Revak, Alaska State Legislature, Juneau, Alaska, introduced SB 173, paraphrasing the following sponsor statement: SB 173 consolidates oversight of the emergency medical services system under a single agency. Currently, regulation of the EMS system is split between the State Medical Board and the Department of Health and Social Services. Paramedics are an essential part of a comprehensive emergency medical services system. This bill will transfer paramedic licensure to the department's State Emergency Medical Services Office. The department already has responsibility for certifying emergency medical technicians, EMT instructors, EMT training, ground ambulance, medevac services, and even paramedic instructors, and paramedic training. However, paramedics are licensed by the State Medical Board. This bill does not change the scope of practice, license requirements, or fee schedule for the approximately 600 paramedics licensed in Alaska. Medical direction will be provided by the existing DHSS Chief Medical Officer and the EMS Medical Director's Committee comprised of 11 members specialized in emergency medicine. The bill provides for a smooth transition on January 1, 2021, with an immediate effective date for regulations, provisions to ensure current biennial licenses remain in effect until new regulations are in place, and continuity of license histories with the transfer of files and pending disciplinary cases. The State Emergency Medical Services Office is well- positioned to support this change with a staff of six full-time positions, five of which are required to have paramedic experience. Existing data systems are ready to incorporate paramedic licensure. Aligning all EMS services under a single agency promotes public safety while bringing new efficiencies to the licensure process. 1:47:26 PM SENATOR REVAK summarized that SB 173 will transfer the housing of paramedics from the State Medical Board to the Emergency Medical Services Section (EMS) in the Department of Health and Social Services (DHSS), which is where all other pre-hospital medical care providers are housed. There has been formal support from the State Medical Board to do this. 1:47:54 PM At ease 1:48:02 PM CHAIR BISHOP reconvened the meeting. 1:48:06 PM SENATOR GRAY-JACKSON asked the sponsor if he had conversations with any EMS employees. SENATOR REVAK replied some people will testify today about the negative impacts of the current system. 1:48:43 PM MR. ELSBERRY delivered the sectional analysis for SB 173: Sec. 1 amends 08.64.107, State Medical Board/Regulation of physician assistants and intensive care paramedics, to remove regulation of paramedic licensure from the Medical Board. (See also Sec. 8.) Sec. 2 amends 08.64.170, License to practice medicine, podiatry, or osteopathy, allowing paramedics to practice medicine to render emergency lifesaving service under "another law" instead of under the Medical Board's authority. (See also Sec. 6) Sec. 3 amends 08.64.360, Penalty for practicing without a license or in violation of chapter, to remove paramedics. (See also Sec. 10) Sec. 4 amends 08.64.369, Health care professionals to report certain injuries, to change paramedics licensed under the Medical Board to those licensed under DHSS, for health care providers who must report certain injuries to the Department of Public Safety. Sec. 5 amends 12.55.185(11), Sentencing and Probation, to change paramedics licensed under the Medical Board to those licensed under DHSS. Sec. 6 amends 18.08.075, Authority of emergency medical technician, to allow paramedics to provide emergency medical care. (See also Sec. 2.) Sec. 7 amends 18.08.080, Emergency Medical Services/Regulation, to require DHSS to adopt regulations establishing standards for paramedic licenses. Sec. 8 adds a new subsection 18.08.082(a)(5), Issuance of certificates; designations, to add regulation of paramedic licensure to DHSS. (See also Sec. 1.) 1:50:36 PM Sec. 9 amends 18.08.082(b), Issuance of certificates; designations, to clarify that DHSS is the central certifying and licensing agency for all emergency medical services. Sec. 10 amends 18.08.084(a), Certificate required, to prohibit a person from practicing as a paramedic without a license. (See also Sec. 3.) Sec. 11 amends 18.08.089, Authority to pronounce death, to ensure consistent use of the term "mobile intensive care" paramedic throughout the law. Sec. 12 adds a new paragraph (14) to 18.08.200, Emergency Medical Services/Definitions, to add the definition of "mobile intensive care paramedic". (See also Sec. 14.) Sec. 13 amends 37.05.146(c)(77)(F), Definition of program receipts and non-general fund program receipts, to add fees for licensure of paramedics to the list of fees collected by DHSS. Sec. 14 repeals 08.64.366, Liability for services rendered by a mobile intensive care paramedic (See 18.08.086, Immunity from liability, under DHSS). Repeals 08.64.380, Medicine/Definitions to remove (3) "emergency lifesaving service" and (4) "mobile intensive care paramedic" (See also Sec. 12). Sec. 15 amends the uncodified law to provide transitional authorities: (a) A current paramedic license issued before January 1, 2021 remains valid until it expires under the Medical Board, is suspended or revoked, or is converted to a license under DHSS. (b) The Department of Commerce, Community and Economic Development and the Medical Board will transfer to DHSS on January 1, 2021, files of all pending paramedic-related records and proceedings, applications, and disciplinary actions. (c) Authority for DHSS to adopt regulations which shall include the conversion of unexpired paramedic licenses issued under the Medical Board. Sec. 16 provides an immediate effective date for DHSS to adopt regulations. Sec. 17 provides an effective date of January 1, 2021. 1:54:04 PM JILL LEWIS, Deputy Director, Division of Public Health, Department of Health and Social Services, Juneau, Alaska, stated that SB 173 will transfer oversight and licensure of the Mobile Intensive Care Paramedics from the State Medical Board to DHSS effective on January 1, 2021. She advised that DHSS's Division of Public Health has broad scope in its mission to protect and promote the public's health. This includes preparedness for all hazards, which is the focus of the division's Rural and Community Health Section. This section encompasses the State Office of Emergency Medical Services as well as health emergency response operations, Alaska Trauma System, and the Office of Healthcare Access. This section's mission is to ensure high quality healthcare throughout a patient's interaction with the healthcare system. Myriad activities ensure that qualified and well-equipped emergency medical personal are available to respond to the emergency medical needs of Alaska citizens and visitors. Thus, DHSS is ideally positioned to take on paramedic licensure. MS. LEWIS emphasized that SB 173 will make the EMS system better and more efficient. This has been years in the making through a deliberative process that involved hundreds of stakeholders throughout the EMS community, she said. 1:56:27 PM MS. LEWES began a PowerPoint: SB 173 License Mobile Intensive Care Paramedics. MS. LEWIS explained that transferring oversight and licensure of Mobile Intensive Care Paramedics from the State Medical Board to the Department of Health & Social Services will fully integrate the EMS system and ensure it is robust, sustainable, and resilient so it functions optimally. The State Medical Board voted in unanimous support of this transfer on February 7, 2020. 1:58:13 PM MS. LEWIS displayed slide 3, Aligns a fragmented system. She relayed that the 2014 National Highway Transportation Administration review of the Alaska EMS system recommended that oversight of paramedics be transferred to DHSS. It found that the split in oversight of EMS personnel "represents an inconsistency in the state's protection of the public served by EMS." In fact, Alaska is one of just three states that do not have all pre-hospital providers housed under one state agency. She said each component of the EMS system is vital to a well- functioning system. Seamless communication is important so the protocols and guidelines are well-informed and followed. Transferring licensure to DHSS will benefit the system by reducing administrative burden and ensure that paramedics only have to communicate with one state agency for licensure, certification, and patient-care data entry. This will make communication among all EMS providers more efficient and improve oversight of the entire pre-hospital system. Communication with providers will also be more efficient when paramedics are able to use the DHSS data system. Further, paramedics have representation on the Governor's Alaska Council on Emergency Medical Services, but they do not have representation on the Medical Board. 2:00:26 PM MS. LEWIS reviewed the bulleted points on slide 4, Protects the public health: square4 Aligns all emergency medical services under an agency whose sole purpose is to ensure a comprehensive EMS system. square4 Allows for the full integration of paramedics into quality initiatives such as stroke, cardiac arrest, trauma, telehealth and community paramedicine. square4 Medical direction by the Department of Health & Social Services' Chief Medical officer and an EMS Medical director's committee. square4 Direct oversight will not change 2:02:08 PM MS. LEWIS reviewed the organization chart slide 5 that outlined the authority for regulation of the pre-hospital system. Currently, the Department of Health & Social Services is the certifying body for EMTs, ground ambulances, medevac services, instructors and training, but not paramedics. In fact, the state EMS Office has always been the approval body for the initial and refresher paramedic training courses. The State Medical Board does not approve the education for paramedics. She directed attention to the left side of the slide, stating that the Chief Medical Officer, the Alaska Council on Emergency Medical Services, the State EMS Medical Director, and the EMS Medical Directors' Committee comprise the elements of the medical direction that oversees the pre-hospital medical care system. Under that are the types of providers, training, instruction, and services that the department certifies and oversees. She directed attention to the right side of the slide, which shows that paramedics are not regulated by DHSS. They fall under the State Medical Board. CHAIR BISHOP commented that the issue is not that paramedics are not regulated, but that they fall under the jurisdiction of the State Medical Board. MS. LEWIS confirmed that paramedics are regulated, but not by the Department of Health & Social Services. 2:04:00 PM SENATOR STEVENS asked why it took so long to make what appears to be a commonsense change. MS. LEWIS replied this transition has been a long time in the making. She anticipated that the history of paramedics in Alaska would be provided during public testimony. Responding to a further question, she said there has been no opposition to the bill. SENATOR REVAK posited that some paramedics would say the current system is broken. 2:05:10 PM MS. LEWIS displayed slide 6, Continuity during transition. She assured the committee that DHSS and the Department of Commerce, Community and Economic Development have been working to make this transition seamless. Existing paramedic licenses will transfer to DHSS and remain valid until they expire. All paramedic files, records, and proceedings will be transferred from DCCED to DHSS. 2:06:24 PM MS. LEWIS stated that there will be no change to the current scope of practice, licensure requirements, or fee structure for the 600 paramedics in Alaska. Further, DHSS believes that the increased caseload and associated $20,000 cost can be absorbed by existing staff and budget so the transition will have no fiscal impact. The existing data system needs no additional programming to incorporate paramedics into the system. She assured the committee that that the State EMS Office is well-positioned to provide the organization and oversight to support this change. It has six full-time employees, five of which are required to have paramedic experience. 2:09:31 PM MS. LEWIS concluded her comments saying that paramedics are an essential part of the state's comprehensive pre-hospital system. Aligning all these services under one agency will promote public safety while bringing efficiencies to the licensure process. SENATOR STEVENS asked who employs paramedics. MS. LEWIS answered that most paramedics are employed by fire departments and EMS Services, but they work in a variety of settings, including as industrial paramedics for corporations on the North Slope. 2:11:15 PM BRIAN WEBB, representing self, Juneau, Alaska, characterized himself as one of the old guard paramedics who has institutional knowledge about the profession. He became an emergency medical technician (EMT) in Anchorage in 1978. He was certified by the national registry of EMTs because the Emergency Medical Services Section, Division of Public Health, Department of Health and Social Services (DHSS) did not exist at the time. The same was true for paramedics and they were eventually housed with the State Medical Board. There were fewer than 50 paramedics statewide at the time and now there are more than 600. He became a paramedic in 1980 while he was still serving as a U.S. Navy Corpsman and returned to Alaska in 1984. He spent time working as an EMS training coordinator at the EMS office in Anchorage, dealing primarily with license questions and impediments. He said that he has been striving for the past 25 years to bring all EMS pre-hospital care solely under the DHSS with single regulations. 2:12:32 PM MR. WEBB stated that paramedics would not receive any pay increases by transitioning from a licensed paramedic under the State Medical Board to a certified paramedic under DHSS. He recalled that some arguments have been made to keep paramedics under the State Medical Board because they deliver advanced procedures such as tracheal intubation and administer intravenous medications like those given during cardiac arrest. That argument is not valid because the EMS Section manages EMT-2 and EMT-3 certified EMS providers who deliver many of the same medications. The EMS Section is well equipped to manage any advanced EMS providers, he said. MR. WEBB listed some of the benefits of moving the oversight of paramedics to the EMS Section. First, the EMS section currently performs research for the source documents in packets for medics seeking initial licensure, re-licensure, and recommendations to the Division of Occupational Licensing for licensure. Second, transferring paramedics will allow the EMS Section to adopt regulations to meet emerging skills and practices and procedures that meet nationally recognized standards of care for all levels of EMS providers. Critically, this would also give the EMS Section the ability to provide real-time adjustments to the scope of practice for all pre-hospital providers during declared emergencies. Fourth, it would streamline the process of EMS responders regarding the standing mutual aid agreements in their compacts. MR. WEBB highlighted that the EMS Section currently provides some guidance for the paramedics via some EMS oversight committees. Of the 12 members in the Alaska Council on Emergency Medical Services (ACEMS), seven are paramedics, 11 of 12 members of the ACEMS training subcommittee are paramedics, and all 11 are either emergency room physicians or currently EMS system physicians in charge of paramedics. These physicians manage the day-to-day oversight of their EMTs and paramedics, not the state or the State Medical Board. The National Association of State Emergency Medical Services Officials work on the EMS national scope of practice and national compact. The EMS Section manager is a standing member of that national committee. By contrast, the State Medical Board does not have any councils, committees, or working groups that examine the practices or skills for paramedics. MR. WEBB emphasized that the EMS Section provides a robust investigative process to answer any allegations against the certified EMTs. Although paramedics are currently investigated by the board, the EMS Section is always heavily involved in any investigations. The current EMS Section process also includes a providers' self-reporting system that can capture unreported issues. He offered his view that this is an important tool for paramedics to be able to access. Most importantly, the EMS Section is staffed by paramedics who fully understand the paramedics' role and function. He offered his view that the transfer will streamline the application process, including comity for other states' applicants, training, and recertification. All EMS functions would be housed in one section. Finally, paramedics do not have representation on the State Medical Board since they do not hold any seat. He offered his view that paramedics will never have a seat on the board. This means the current 600 paramedics practicing in Alaska do not have any decision-making say on their professional practice. However, the EMS Section has had a long-standing system that allows all certified EMS professions to have input on any regulatory changes that will affect them. He said this is significant and all the paramedics he has polled support this bill. 2:17:10 PM SENATOR REVAK asked him to relay his personal story. MR. WEBB explained that when he returned to Alaska in 1984 he was a medic, having served as a U.S. Navy corpsman. He submitted his application and supporting documents to the State Medical Board to be certified as a paramedic, but was denied licensure because the medical director of his paramedic school had died, so nobody could verify his initial paramedic training. It took six months to verify his paramedic training, but by then his license had expired. This meant he had to spend two years retaking paramedic training. He opined that these types of problems would not exist if the paramedic function is transferred to the EMS section. He acknowledged that even after 35 years it is still painful to talk about his licensing issues and circumstances. 2:19:23 PM SARA CHAMBERS, Director, Division of Corporations, Business & Professional Licensing, Department of Commerce, Community and Economic Development, Juneau, Alaska, spoke in support of SB 173. She said the division believes that the changes in SB 173 provide a good fit for paramedics for all the reasons that Ms. Lewis and Mr. Webb mentioned. DHSS is structured to provide education and oversight and the type of programming that the DCCED is not funded to provide. She offered her view that the EMS Section in DHSS can add a lot of value to paramedic licensure. ALYSIA JONES, Executive Administrator, Alaska State Medical Board, Division of Corporations, Businesses, and Professional Licensing, Department of Commerce, Community and Economic Development, Juneau, Alaska, echoed Ms. Chamber's comments. She said that as Ms. Lewis explained, it makes more sense to have EMS services in one place. Further, as previously stated, there is not any representation on the State Medical Board for paramedics. She reported that the State Medical Board unanimously supported this change during its February 2020 meeting. 2:21:09 PM MS. CHAMBERS added that some of the difficulties that Mr. Webb went through in 1984 no longer exist, but it is a reminder that the licensing requirements need to be logical and attainable. 2:21:44 PM CHAIR BISHOP opened public testimony on SB 173. 2:22:09 PM ALEX BOYD, Paramedic; Member, Board of Directors, Alaska Fire Chiefs Association; Assistant Chief of Training, Anchorage Fire Department, Anchorage, Alaska, stated that he was representing these two organizations as well as himself since he is a paramedic. The Alaska Fire Chiefs Association supports SB 173 for many reasons mentioned already. Primarily, it will improve efficiencies, ease workforce development and provide a streamlined process within the same agency. He pointed out the inefficiency of having emergency responders for fire departments report to two different agencies. Transitioning paramedics to DHSS oversight will alleviate this problem. He said that as the Assistant Chief of Training for the Anchorage Fire Department, he oversees the licensure and certification of over 300 EMTs and 90 paramedics. All 90 paramedics have multiple certifications in the EMS Section and the State Medical Board. The efficiencies in SB 173 will allow the Anchorage Fire Department to reduce redundancies. He reported that the fire department sometimes has had to wait for the State Medical Board to act on paramedic licensures for up to nine months, which is costly. Further, the department has experienced delays in processing the applications for paramedics from the last academy held nearly a year ago. By contrast, the department has enjoyed almost instant response and certification from the EMS Section of DHSS for the 50 people it has hired in the last 24 months. He said he looks forward to the improvements and efficiencies under SB 173. 2:25:25 PM WILMA VINTON, Executive Director, Interior Region Emergency Medical Services Council, Inc.; Assistant Chief of Emergency Medical Services, Steese Volunteer Fire Department, Fairbanks, Alaska, stated that she has served as a mobile intensive care paramedic (MICP) since 2007 and an EMT since 1979. She serves as an EMS instructor and previously as an adjunct faculty for the University of Alaska Fairbanks paramedic program. In her work and training roles, she regularly assists EMTs and MICPs in acquiring and maintaining their certifications and professional licenses. She said moving paramedic oversight from the State Medical Board to the EMS Section in the Division of Public Health, Department of Health and Social Services is an excellent way to streamline the licensing process. The move will align with the actions in many other states. As previously mentioned, the EMS Section already provides certification to EMTs in an efficient and effective manner. She offered her view that adding paramedic oversight and regulation would not stress that smooth process. Currently, EMTs are processed within 20 days and are typically certified within a week of testing. She said the State Medical Board only meets to approve licenses quarterly, whereas staff in the EMS Section perform that function daily. She said shortening the paramedic certification time will benefit students, military medics seeking certification in Alaska, and paramedics from other states seeking reciprocity. She offered her view that this move will be the first step in eliminating existing barriers to becoming a paramedic in Alaska. She urged members to support the bill. 2:28:03 PM ANJELA JOHNSTON, Training Coordinator, Southeast Region, Alaska Emergency Medical Services Council (ACEMS), Division of Public Health, Department of Health and Social Services, Juneau, Alaska, said she submitted a letter of support dated February 14, 2020, which read: [Original punctuation provided.] I am writing in support of SB173 License Mobile Intensive Care Paramedics. I currently chair the state's EMS Training Committee, a committee of the Alaska Council of Emergency Medical Services (ACEMS), established in 1981 in order to advise ACEMS and the EMS Office. We are comprised of members from across Alaska, representing EMS educators in a variety of rural and urban settings throughout the state. On hearing of the introduction of SB173, our committee unanimously and enthusiastically voted to endorse this bill. Some reasons for our endorsement of SB173 include: square4 Increased patient safety in emergency medical services (EMS) and prehospital care, made available by having all EMS oversight under one roof, instead of pieced out as it is currently. square4 Cost-savings involved with streamlining functions currently duplicated by both the Office of EMS and the State Medical Board, square4 The robust data collection capabilities made available by consolidating EMS leadership, oversight, and regulation, square4 Less cumbersome processes for initial licensure and license maintenance for Paramedics and employing agencies in public safety and industry, and square4 A narrowing of focus by Alaska's Medical Board, whose members could focus exclusively on licensure of physicians and physician assistants, further increasing patient safety across the healthcare spectrum in Alaska. In short, supporting this bill should be the least controversial, most constituent-friendly non-partisan win in front of you this session. There is no downside, and it's the right thing for patients and Alaska taxpayers. Most of our members, including this writer, are Alaska-licensed Mobile Intensive Care Paramedics, and these members offered the most vocal and enthusiastic support for SB173. MS. JOHNSTON said she chairs the EMS Training Committee, which is a subcommittee of the Alaska Council of Emergency Medical Services (ACEMS) and they voted unanimously to support SB 173. The ACEMS Training Committee is comprised of members from all over Alaska, including public safety, industrial EMS, rural health aides, and private flight medevac services. She offered her view that it was an accident of history that paramedics were placed under the State Medical Board and paramedics have limped along with the arrangement. She urged members to support the bill not only to help paramedics but to help patients. In closing, she said that SB 173 will strengthen, add efficiencies and oversight, and resilience to the integrated system of pre- hospital medical care statewide. She emphasized that this system must be strong. 2:29:45 PM CHAIR BISHOP closed public testimony on SB 173. He asked for the anticipated timeline to process a new paramedic license once this change is made. MS. LEWIS replied paramedic licenses could be processed in the same timeline that the Division of Public Health, EMS Section has for EMTs. this ranges from five days to less than a month once the application is complete with supporting documents. CHAIR BISHOP asked if the timeline for license renewals is the same. MS. LEWIS replied license renewals take less time. She explained that new license applications require scrutiny of all the original documentation for education and experience. She anticipated it would be on the shorter end of the spectrum for license renewals. 2:31:25 PM SENATOR STEVENS described the process as a logical transition from working as a military [paramedic] to becoming a civilian [paramedic]. MS. LEWIS deferred to Mr. Webb. 2:31:58 PM MR. WEBB said the transition from a military medic to a civilian medic is seamless in other states. With this change, if a paramedic from Montana or California wished to come to Alaska to work, the licensure process would be simple. He reiterated that the current EMS automated system for certification and recertifications is a streamlined process that only takes a few days to accomplish. 2:33:30 PM SENATOR REVAK thanked the individuals who spoke in support of the bill. 2:33:46 PM CHAIR BISHOP held SB 173 in committee for future consideration. 2:34:19 PM There being no further business to come before the committee, Chair Bishop adjourned the Senate Labor and Commerce Standing Committee meeting at 2:34 p.m.