SENATE BILL NO. 168 "An Act relating to state certification and designation of trauma centers; creating the uncompensated trauma care fund to offset uncompensated trauma care provided at certified and designated trauma centers; and providing for an effective date." SENATOR BETTYE DAVIS, sponsor, introduced herself. 9:18:09 AM SENATOR JOHN COGHILL, explained that the bill establishes a fund that will incentivize a higher level of trauma care in Alaska. Section 1 established that the department would establish regulations as to how it would be administered and work with hospitals and doctors to try to increase the delivery of trauma care. Senator Coghill explained that there are several different levels of trauma care, levels I, II, III, and IV, and national standards to follow. The trauma care fund would be administered to those who want to apply. The limitation under Section 2 says that more than 25 percent of total assets of the fund could not be given to any one trauma center in a year. Senator Coghill related that the bill has been through several iterations. The bill originally anticipated general funds and matching funds. 9:20:09 AM Senator Coghill pointed to Section 3, the alcohol tax, as a potential funding source. He left that decision up to the committee. Senator Coghill reported that the trauma care issue in Alaska has been moving forward since about 1992. He referred to a booklet entitled, "Trauma Care in Alaska" (copy on file). He highlighted section nine in the booklet, specifically pages 6 and 7, which list advantages and challenges. He spoke of the reluctance of doctors and hospitals to work together because of economic considerations. The fund is set to provide an incentive to raise the level of trauma care. He referred to the challenges on page 7, some of which have been assuaged by this legislation, such as lack of a strategic plan. Senator Coghill shared that there are currently 24 hospitals in Alaska and only 4 have some trauma care level designation. Most of those hospitals are outside of Anchorage or Fairbanks and are run by Native Health care organization. There is one Trauma II level care system in Alaska, the Alaska Native Health Hospital in Anchorage. Anchorage, itself, does not have a trauma center. 9:23:40 AM Senator Coghill stressed that the fund would incentivize increasing trauma care, rather than mandate it. He reported that there needs to be a plan in his district and especially in rural areas. Co-Chair Stedman asked if there were any questions. He noted zero fiscal notes from the Department of Revenue and the Department of Health and Social Services, and one fiscal note for $2.5 in general funds and $2.5 in federal receipts, drafted by Senator Coghill's office to capitalize the funds used to compensate trauma centers. 9:26:02 AM DR. FRANK SACCO, DIRECTOR, ALASKA TRAUMA SYSTEM, testified via teleconference. He addressed two issues - trauma as a public health problem and trauma and its relationship to alcohol. Alaska has the second highest death rate from trauma in the country. The trauma system is a model developed by the military - a preplanned response. The goal of trauma care is to decrease mortality from serious injuries by 15 to 25 percent. He said that 500 Alaskans die each year from trauma. Alaska is the only state that does not have a Level I or II trauma center. Anchorage is the largest city in the U.S. without a trauma center. He maintained that the value of a trauma center is undisputed. 9:29:37 AM Dr. Sacco referred to trauma as a disease. One of the biggest risk factors for trauma is alcohol. About 50 percent of those admitted to trauma centers with serious injuries have screened positive for alcohol. He shared information about the teachable moment for alcoholics after a traumatic incident. He shared statistics about alcoholism. He concluded that the readmission rate of alcoholism-related trauma is decreased with intervention. He thought the alcohol tax was an appropriate guideline. 9:33:18 AM DR. VIRGINIA CHENNAULT, TRAUMA COMMISSION, ANCHORAGE, testified via teleconference. She spoke in favor of the legislation. She maintained that drugs and alcohol are involved in 70-80 percent of trauma cases. She suggested that alcohol intervention should be done in the form of screening. She stressed that the legislation would save money in the long run. She concluded that Alaska deserves trauma care. 9:35:50 AM ROD BETIT, PRESIDENT/CEO, ALASKA HOSPITAL ASSOCIATION (AHA), related that AHA supports this legislation. He shared statistics about which states have a trauma center. The issue is that Anchorage does not have a Level II trauma center other than a tribal program. He made two points about Level II trauma hospital advantages: having staffed employees for trauma care and compensated care. The bill would allow the department to address those services. He thought this approach was better than a mandated approach. 9:40:36 AM MARK JOHNSON, FORMER EMS PRESIDENT, JUNEAU, made several points about trauma care. He pointed out that trauma is a major cause of hospital admissions, disabilities, and death. He related that the legislation passed in 1993 allowing the Department of Health and Social Services the authority to certify trauma centers was a voluntary approach without incentives. In the 1990's there was a federal grant which co-sponsored reviews of trauma care at eight hospitals. Currently, there are 24 acute care hospitals, but only five have achieved national standards. He maintained that every hospital should meet one of the three levels of standards of trauma care. Trauma centers are expected to be involved in prevention activities such as alcohol screening. He urged the committee to support the legislation. 9:44:11 AM Senator Ellis thanked the presenter for his work. He asked how many states require this level of licensure and how many have incentives to upgrade. Mr. Johnson did not know, but offered to find out. Senator Olson asked if the number of first responders has kept up. Mr. Johnson said EMS in Alaska does provide excellent training for first responders. He thought the numbers compare favorably with other states. One out of two first responders is a volunteer. 9:46:47 AM DAVID HULL, CHAIRMAN, GOVERNOR'S TASK FORCE, ALASKA COUNCIL ON EMERGENCY MEDICAL SERVICES (ACEMS), testified via teleconference. He agreed that EMS is doing a good job of getting people to the hospitals. He spoke in support of the trauma system. The Alaska Council fully supports the bill. 9:49:02 AM Senator Coghill addressed the question asked by Senator Ellis. The information is found in the booklet under Tab 7. It reviews which states have trauma care centers and how they are funded. SB 168 was heard and HELD in Committee for further consideration. 9:50:32 AM