Legislature(2003 - 2004)
03/24/2004 01:44 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 25-HEALTH CARE SERVICES DIRECTIVES
The committee took up CSHB 25(JUD).
SENATOR LYDA GREEN moved to adopt the committee substitute (CS),
version V [labeled 23-LS0137\V, Bannister, 3/24/04] as the
working document before the committee. [There being no
objection, it was treated as adopted.]
CHAIR DYSON said that after Ms. Sylvester's testimony, he would
run through a list of issues still being addressed that would be
included in the next version of HB 25.
MS. LINDA SYLVESTER, staff to Representative Weyhrauch,
explained that version V was the result of a 3/8/04 staff
meeting that included the lieutenant governor's chief of staff,
and Chip Wagoner from the Alaska Catholic Conference (ACC). The
document they settled on had approximately 66 amendments; she
said she would summarize the important ones. She began by
stating that "emancipated minors" had been eliminated from HB
25. Changes were made to the role of a surrogate (noting that
surrogates are a new part of HB 25) and the role of physicians
was amplified in the decision-making process, when surrogates
are evenly split.
CHAIR DYSON offered that this serves to bring the "best
interest" of the patient into the conversation.
MS. SYLVESTER continued that regarding surrogates, the
prominence of best interest was increased. The intention is to
include a definition of best interest in the form, although it
has not [yet] been included. She said the new language that
amplifies the physician's role in detecting...
TAPE 04-15, SIDE A
MS. SYLVESTER continued, "... that's come forward or that's been
nominated, isn't necessarily an appropriate one. The
protections are in place. The physician has standing already to
recommend this to go to guardianship procedures, but we just
want to put that in there, so we want to direct the physician to
take a more proactive role in that situation."
MS. SYLVESTER told members that most importantly there are new
guidelines for surrogate decision-making when the decision
involves withdrawal of life support. "We've used language from
the Illinois statute. These are strict guidelines; our concern
was we wanted to make sure if there was a 35-year old who was in
a motorcycle accident and he was going to recover from his
injuries but the spouse took the opportunity to push forward
wishes of not being resuscitated, we wanted to make sure that
this wouldn't happen."
CHAIR DYSON interjected, "a big estate, and she's got a
boyfriend."
MS. SYLVESTER continued that regarding anatomical gifts, updates
were made so that the role of the hospital was taken out
somewhat, because Life Alaska has stepped into that role. Ms.
Sylvester referenced Section 4 of the 1987 Uniform Anatomical
Gift Act, and noted that changes had been made to verify that
Alaska is not an opt-out state. If ever that were to change, a
bill would need to come through the Legislature; it would be a
policy decision of its own.
MS. SYLVESTER said portability was of concern; it's important
that all advance directives outside of Alaska are recognized to
the extent that Alaska law is not violated. The committee
reviewed those Sections and regarding the "do not resuscitate
(DNR)" order, one more clarification needs to be made so that
it's perfectly clear that EMTs in the field who are sure there's
a DNR in place can act in good faith. She gave the analogy of
somebody obtaining a driver's license in Montana where the speed
limit is 75 mph; although that license is valid in Alaska, that
person can't drive at 75 mph.
MS. SYLVESTER said that some changes were made to the [optional]
form itself. A helpful reminder was added indicating that
euthanasia and mercy killing is not legal in Alaska. A change
was made to the pain relief option so that space in the form is
given for the principal to state his/her wishes regarding pain
relief. Also, the intent is to add some critical definitions to
the form, but the drafter missed those. Witness requirements
were modified somewhat; "witnesses need to be in place and there
are criteria for who the witnesses can be because that will be
the protection that foul play isn't a part of this."
MS. SYLVESTER said that interestingly enough, HIPAA [Health
Insurance Portability and Accountability] concerns were raised
and have been addressed in two places: in the institution's
immunity for providing medical records, to make sure that
surrogates and agents have access to those records; also,
hospitals sometimes cannot give medical records to individuals
because of not knowing if the principal has lost capacity - it's
a loop because the person needs to see the records - so that's
been fixed, she said.
MS. SYLVESTER said the committee was mindful of the policy
considerations; there were six, and the bulk of them have been
addressed. Language has been added so that there is a
presumption in favor of life in the absence of someone's stated
intent that they presume to be kept alive. The role of the
surrogate and the agent has been clarified regarding life
support. Reciprocity has been addressed, although it still
needs some work. The question, "At what point does the
definition of a 'qualified patient' kick in?" has been addressed
by stipulating the conditions necessary for a surrogate to make
decisions relative to life support. "Anatomical gifts" has been
clarified and corrected. She noted that she couldn't read her
notes on the last one, number six.
CHAIR DYSON said excellent work has been done on the bill, and
he understands that there is still work being done on the issue
of nutrition and hydration to more clearly differentiate between
persons who are unarguably terminal and those who are just
injured, maybe incapacitated or comatose. There may be a little
more work to do regarding surrogates, as there is still the
question of limiting the authority of the decision-makers and
strengthening the best interest of the patient. Also, there is
the issue of reciprocity. There are ongoing discussions on
those three items, he said.
DR. MARIA WALLINGTON, a medical ethicist at Providence Alaska
Medical Center, said she could be available at the bill's next
hearing, that she was available to answer questions.
CHAIR DYSON asked if she had a copy of the latest version.
DR. WALLINGTON said she has not seen it, but she conversed with
Ms. Sylvester about it.
CHAIR DYSON suggested that she contact his office or
Representative Weyhrauch to get a copy. He announced there were
copies available for those wanting to see the latest version of
the bill.
SENATOR GUESS noted concern about the intended timeline and
asked if there would be sufficient time to ask questions
pertaining to the different versions.
CHAIR DYSON assured her that there would be time for questions,
saying, "We're not going to railroad this thing, it's too
valuable and too sweeping." HB 25 was held in committee.
There being no further business to come before the committee,
Chair Dyson adjourned the meeting at 3:28 p.m.
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