02/12/2024 01:30 PM Senate LABOR & COMMERCE

        HB  57-EMERGENCY MED. SVCS: REVIEW ORGANIZATIONS                                                                    
                                                                                                                                
2:26:43 PM                                                                                                                    
CHAIR  BJORKMAN   reconvened  the   meeting  and   announced  the                                                               
consideration of  HOUSE BILL NO.  57, "An Act relating  to review                                                               
organizations  and  permitting   an  emergency  medical  services                                                               
provider  to establish  a review  organization;  and relating  to                                                               
patient records."                                                                                                               
                                                                                                                                
2:27:19 PM                                                                                                                    
REPRESENTATIVE STANLEY WRIGHT, District 22, Alaska State                                                                        
Legislature, Juneau, Alaska, sponsor of HB 57, read the                                                                         
following statement:                                                                                                            
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     This  legislation corrects  an inequity  that has  long                                                                    
     affected  our  emergency   medical  services  (EMS)  in                                                                    
     Alaska.  This bill  seeks to  extend  the same  quality                                                                    
     assurance  program  protections  to  EMS  workers  that                                                                    
     fixed  healthcare facilities  have benefitted  from for                                                                    
     years.                                                                                                                     
                                                                                                                                
     This  is not  an unprecedented  request, several  other                                                                    
     states have already recognized and  acted upon the need                                                                    
     to  provide these  protections  to  their EMS  systems.                                                                    
     Alaska's  EMS system,  particularly  in  our rural  and                                                                    
     super rural areas, operates largely  on the strength of                                                                    
     volunteerism.                                                                                                              
                                                                                                                                
     It's important to understand  that these volunteers are                                                                    
     not just our emergency  technicians and paramedics, but                                                                    
     include  volunteer  medical  directors as  well.  These                                                                    
     selfless  individuals,  many  of whom  are  physicians,                                                                    
     play a crucial role  in ensuring their communities have                                                                    
     access to state-certified Emergency Services.                                                                              
                                                                                                                                
     However,  a  glaring  discrepancy exists:  while  these                                                                    
     physicians  enjoy  quality   assurance  protections  in                                                                    
     their primary roles within  clinics and hospitals, they                                                                    
     are stripped  of these protections when  serving as EMS                                                                    
     medical  directors   in  the  same   communities.  This                                                                    
     discrepancy not  only poses  a risk  to the  health and                                                                    
     safety  of   Alaskans  but  also  threatens   the  very                                                                    
     existence of our rural EMS systems.                                                                                        
                                                                                                                                
     This   amendment  is   critical  for   maintaining  the                                                                    
     viability  of  our EMS  programs,  and  the health  and                                                                    
     safety of our communities across Alaska.                                                                                   
                                                                                                                                
2:29:41 PM                                                                                                                    
RACHEL GUNN, Staff, Representative Stanley Wright, Alaska State                                                                 
Legislature, Juneau, Alaska, gave a presentation on HB 57. She                                                                  
read the following statement:                                                                                                   
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     Emergency  Medical  Services  in  Alaska  stands  as  a                                                                    
     hybrid   organization,   intersecting   transportation,                                                                    
     safety,  medical, and  public health  disciplines, with                                                                    
     an unwavering  commitment to  saving lives  outside the                                                                    
     walls of primary care facilities.                                                                                          
                                                                                                                                
     Many emergency physicians are  involved with the direct                                                                    
     care provided in the field  by EMTs and Paramedics, and                                                                    
     these  Emergency  medicine   specialists  are  pivotal,                                                                    
     extending  their  expertise  beyond hospital  walls  to                                                                    
     guide  EMT   and  Paramedics  in  the   field.  Through                                                                    
     "medical   control,"  they   issue  treatment   orders,                                                                    
     ensuring immediate  and appropriate  care. Furthermore,                                                                    
     pre-hospital  protocols,  or standing  orders,  empower                                                                    
     EMS  teams  with  clear  guidelines  for  patient  care                                                                    
     before hospital arrival.                                                                                                   
                                                                                                                                
     In emergency  care, every second counts,  and decisions                                                                    
     are  made in  the  blink of  an  eye. These  decisions,                                                                    
     often made under extreme  conditions, can have profound                                                                    
     effects on  patient outcomes.  After the  dust settles,                                                                    
     our   EMS    professionals,   including    ETTs   EMTs,                                                                    
     paramedics,  and  their  medical directors,  engage  in                                                                    
     critical  self-reflection  through Peer  Review  Boards                                                                    
     and Quality Assurance programs.                                                                                            
                                                                                                                                
     The Peer Review Process  is comprised of providers with                                                                    
     similar  competencies evaluating  the care  provided to                                                                    
     the patient  and encourages  EMS providers  to evaluate                                                                    
     and refine  their patient  care systems  continually. A                                                                    
     successful  Quality Assurance  committee is  essential,                                                                    
     usually comprised  an auditor, a medical  director, and                                                                    
     a  feedback  provider.  This team  focuses  on  patient                                                                    
     outcomes,  leveraging data  to  pinpoint and  implement                                                                    
     process improvements.  Here they dissect  each decision                                                                    
     and  action,  asking,  "Could   we  have  handled  that                                                                    
     better? What  can we learn from  this?" This reflective                                                                    
     practice   is  crucial   for  continual   learning  and                                                                    
     improvement,  ensuring better  patient  care in  future                                                                    
     emergencies.                                                                                                               
                                                                                                                                
     Under  the  current  framework, any  admission  by  EMS                                                                    
     personnel, any acknowledgment  of potential improvement                                                                    
     areas,  could   be  misconstrued  as  liability   in  a                                                                    
     lawsuit.  Protections  that  are inherent  for  medical                                                                    
     directors  administering care  as a  doctor or  surgeon                                                                    
     within the walls  of the hospital do not  extend to the                                                                    
     review  process  for  the EMS  cases  they  oversee.  A                                                                    
     considerable   portion  of   EMS   providers  and   the                                                                    
     physicians  and  medical   directors  guiding  them  in                                                                    
     Alaska   serve   voluntarily,   and  the   absence   of                                                                    
     protective measures  for them  is a glaring  neglect of                                                                    
     our frontline workforce.                                                                                                   
                                                                                                                                
     This fear stifles open,  honest review and discussiona                                                                     
     cornerstone of medical  improvement and patient safety.                                                                    
     Our proposed  legislation seeks  to shield  these frank                                                                    
     discussions from being weaponized in legal battles.                                                                        
     It does not prevent an  EMS provider a Medical Director                                                                    
     from  being  sued,  it simply  limits  the  information                                                                    
     gleaned   from  Peer   Review   Programs  and   Quality                                                                    
     Assurance  meetings allowable  for discovery.  It's not                                                                    
     about  evading responsibility;  it's  about creating  a                                                                    
     safe space  for EMS  professionals to learn,  grow, and                                                                    
     enhance the  quality of care  they provide  without the                                                                    
     constant  fear of  legal repercussions.  This proactive                                                                    
     approach  to  continuous  learning and  improvement  is                                                                    
     vital for  the evolution of emergency  medical services                                                                    
     and protecting our Medical  Directors and EMS providers                                                                    
     the way we protect our healthcare.                                                                                         
                                                                                                                                
CHAIR BJORKMAN announced invited testimony on HB 57.                                                                            
                                                                                                                                
2:33:16 PM                                                                                                                    
BRIAN WEBB,  representing self,  Anchorage, Alaska,  testified by                                                               
invitation on  HB 57.  He said  he has  been an  Alaska Emergency                                                               
Medical  Services  (EMS)  clinician   since  1978  and  currently                                                               
volunteers for  Alaska EMS improvement  and advocacy  efforts. He                                                               
stated  that Alaska  EMS  services should  be  afforded the  same                                                               
program  protections that  fixed facilities  enjoy and  requested                                                               
that the  legislature correct this inequity.  Referring to Alaska                                                               
Statute  definitions, he  explained  that this  wording does  not                                                               
include pre-hospital  personnel or  activities. Therefore,  HB 57                                                               
seeks  to change  this  definition.  He said  that  EMS does  not                                                               
experience a two-way  flow of information. He  explained the lack                                                               
of protections  has had a  chilling effect  for many, as  what is                                                               
discussed or presented by EMS  is discoverable outside of the EMS                                                               
process. As  a result,  EMS providers  are often  concerned about                                                               
privacy issues.  He said that  this effects both  the educational                                                               
growth  and  patient  care improvement  systems.  He  added  that                                                               
protecting this  process allows EMS  providers to safely  grow in                                                               
their  craft  and  become  better   patient  care  advocates.  He                                                               
compared EMS  to a  three-legged stool and  explained that  it is                                                               
able   to  survive   due  to   its   volunteerism  of   services,                                                               
volunteerism  of EMS  clinicians, and  EMS medical  directors. He                                                               
said  that all  three of  these must  be balanced  to ensure  the                                                               
safety of citizens.                                                                                                             
                                                                                                                                
2:35:15 PM                                                                                                                    
MR. WEBB explained that HB 57 seeks  to fix a crack in one leg of                                                               
the  stool that  is impacting  volunteer EMS  clinicians and  EMS                                                               
medical directors.  He stated  that, nationwide,  EMS recruitment                                                               
has faced  challenges. He stated  that losing  valuable volunteer                                                               
EMS clinicians and  EMS medical directors would result  in a lack                                                               
of protection. He pointed out  that most of these individuals are                                                               
no  longer  willing  to  risk  their  financial  or  professional                                                               
futures because of this disclosure.  He said that during the day,                                                               
EMS  medical  directors have  protection,  yet  when they  switch                                                               
gears  after   daytime  working  hours  and   volunteer  for  EMS                                                               
services, they  no longer have  protection. This has  resulted in                                                               
the  loss  of many  volunteers.  He  emphasized  that a  lack  of                                                               
volunteers means  no EMS  to respond  - and  no EMS  services. He                                                               
listed states that have enacted these protections.                                                                              
                                                                                                                                
2:37:03 PM                                                                                                                    
SENATOR BISHOP asked if this  definition change would result in a                                                               
lower insurance premium.                                                                                                        
                                                                                                                                
2:37:50 PM                                                                                                                    
MR.  WEBB said  that this  issue was  discussed during  committee                                                               
hearings in  the House.  He explained that  HB 57  precludes many                                                               
things that  can be discovered  through lawsuits. He  stated that                                                               
indemnity for  medical directors  is a  separate issue  and noted                                                               
that many  regional offices are working  to build insurance-based                                                               
solutions  for volunteer  EMS medical  directors, but  added that                                                               
this is a very long process.                                                                                                    
                                                                                                                                
2:39:00 PM                                                                                                                    
DR.  TIM  PETERSON,  Capital City  Fire  Rescue  (CCFR),  Juneau,                                                               
Alaska, testified by invitation on HB  57. He said he has been an                                                               
emergency physician at Bartlett  Regional Hospital since 1989 and                                                               
has  dealt  with  EMS  volunteers  from  around  the  state  when                                                               
patients have required medivac. He  said he is co-chair of Alaska                                                               
Council for  Emergency Medical  Services (ACEMS),  which recently                                                               
finished  a  four-year  project  relating  to  scope  of  medical                                                               
practices. He stated that information  regarding updated scope of                                                               
medical practices must  be provided to those in  the industry via                                                               
training and education.  He said he is also  the medical director                                                               
for Southeast Regional EMS Council  (SEREMS), which covers remote                                                               
areas  that  are  volunteer-dependent.   He  explained  that  the                                                               
volunteer EMS  system was strained during  the Covid-19 pandemic.                                                               
He added that many older volunteers  simply quit, and they are in                                                               
the process  of rebuilding. The job,  he said, is to  ensure that                                                               
Alaska EMS services  are operating to a standard of  care that is                                                               
equivalent to the standard of  care across the country. He stated                                                               
that "quality  assurance" refers to  the quality of  the services                                                               
offered.  He  explained that  for  many  small communities,  "run                                                               
reviews"  are  done.  In  rural  communities,  few  doctors  have                                                               
malpractice insurance  because they  don't know  where or  how to                                                               
get it, or the associated  costs. He emphasized the importance of                                                               
open and honest  dialogue around what is working and  what is not                                                               
-  and expressed  a  desire  to have  bullet  points  of what  is                                                               
discussed at meetings (with  all personal identifying information                                                               
removed).                                                                                                                       
                                                                                                                                
2:42:53 PM                                                                                                                    
SENATOR   BISHOP   commented  that   HB   57   would  allow   EMS                                                               
professionals to  discuss issues and  keep records that  they can                                                               
then share with their peers  around the state and hopefully avoid                                                               
repeating problematic behaviors.                                                                                                
                                                                                                                                
2:43:37 PM                                                                                                                    
DR. PETERSON  replied that  he would  like to  be able  to attend                                                               
conferences and  discuss cases with  others in the  profession in                                                               
order  to  learn  from  other people's  mistakes,  which  is  not                                                               
possible currently.                                                                                                             
                                                                                                                                
2:44:11 PM                                                                                                                    
DR.  MICHAEL   LEVY,  representing  self,   Eagle-River,  Alaska,                                                               
testified by  invitation on HB  57. He  said he is  the immediate                                                               
past  president of  the National  Association  of EMS  Physicians                                                               
(NAEMSP) and State of Alaska EMS  Medical Director. He is the EMS                                                               
Medical  Director   for  various  state  EMS   agencies  and  has                                                               
practiced in  Alaska since  1989. He said  he is  board certified                                                               
with an  EMS medicine specialty  and explained that  EMS medicine                                                               
is  a  sub-specialty  that  offers  board  certification  by  the                                                               
American Board of  Medical Specialties since 2013.  He added that                                                               
this  is  an acknowledgement  that  EMS  medicine is  a  distinct                                                               
practice of  medicine - and  that EMS  is part of  the healthcare                                                               
system. He said that many  states have established laws providing                                                               
peer-review  protection  for  EMS agencies,  which  ensures  that                                                               
information  gathered for  the purposes  of improving  quality of                                                               
health   remains  non-discoverable   in  legal   proceedings.  He                                                               
provided a list  of examples of this information.  He stated that                                                               
EMS is evolving as a  versatile community health resource that is                                                               
integral to  local and  regional systems of  care. He  added that                                                               
EMS  is  clearly  a  public  health entity  and  must  be  people                                                               
centered.   He  stated   that  EMS   treatments  should   include                                                               
processes,  protocols, and  practices that  are designed  to have                                                               
the  best  practices  for   individuals.  EMS  clinicians  should                                                               
deliver  care by  evidence-based practices.  He pointed  out that                                                               
peer  review and  quality  of  care have  long  been accepted  as                                                               
fundamental  tools for  improved care;  however, protection  from                                                               
discovery  has not  explicitly included  EMS.  He commented  that                                                               
many EMS  providers question whether  they did the right  thing -                                                               
yet they are not able to  receive feedback on their decisions. He                                                               
emphasized the value  of feedback for improvement  and added that                                                               
HB 57  is a  step toward supporting  EMS practitioners  by adding                                                               
protections already provided by other states.                                                                                   
                                                                                                                                
2:48:10 PM                                                                                                                    
SENATOR  DUNBAR  commented that  Dr.  Levy  and others  with  the                                                               
Anchorage Fire  Department did tremendous work  leading to nation                                                               
leading results in cardiac arrest  survival rates. He pointed out                                                               
that in  the United States  military, certain  investigations can                                                               
lead  to  punitive  actions;  however,   they  also  have  safety                                                               
investigations  that are  for improved  safety going  forward. He                                                               
explained   that    information   provided   during    a   safety                                                               
investigation cannot lead to punishment.                                                                                        
                                                                                                                                
2:49:18 PM                                                                                                                    
SENATOR GRAY-JACKSON echoed Senator Dunbar's comments.                                                                          
                                                                                                                                
2:49:37 PM                                                                                                                    
DR. LEVY expressed appreciation.                                                                                                
                                                                                                                                
2:49:49 PM                                                                                                                    
CHAIR  BJORKMAN expressed  gratitude for  the work  Dr. Levy  has                                                               
done in his district.                                                                                                           
                                                                                                                                
2:50:01 PM                                                                                                                    
CHAIR BJORKMAN  opened public testimony  on HB 57;  finding none,                                                               
he closed public testimony.                                                                                                     
                                                                                                                                
2:50:40 PM                                                                                                                    
CHAIR BJORKMAN held HB 57 in committee.                                                                                         
                                                                                                                                
2:51:02 PM