02/09/2010 03:00 PM House HEALTH & SOCIAL SERVICES

                HB 168-TRAUMA CARE CENTERS/FUND                                                                             
                                                                                                                                
4:48:03 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON announced  that the final order  of business would                                                              
be HOUSE  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  JOHN COGHILL,  Alaska State  Legislature, explained  that                                                              
HB  168 created  an account  for improving  trauma care  delivery.                                                              
He explained  that the  Department of  Health and Social  Services                                                              
(DHSS)  commissioner would  create regulations  based on  national                                                              
standards  for trauma  care, and  evaluate  each delivery  system.                                                              
He referenced  the packet,  "Alaska Trauma  Center," [Included  in                                                              
the members  packets] which the  information presented  during the                                                              
prior  year.    He  shared  that   this  was  just  one  incentive                                                              
suggested by the  College of Surgeons to the State  of Alaska.  He                                                              
reported  that   DHSS  had  created  a  trauma   response  systems                                                              
administrator.   He detailed  that he had  met with  the Emergency                                                              
Medical  Services Council,  and  was encouraged  by  its focus  on                                                              
response systems,  especially in remote  areas.  He  expressed the                                                              
need  to  better  coordinate  emergency   response  systems.    He                                                              
detailed the desire  to create a fund to incentivize  hospitals to                                                              
enhance  trauma   care.    He   suggested  putting   money  toward                                                              
uncompensated care  as it would  allow hospitals to  contract with                                                              
more  doctors for  emergency trauma  care.   He  pointed out  that                                                              
Alaska had  24 acute care hospitals,  but only 1 Level  Two trauma                                                              
center.   He requested a systemic  approach to emergency  response                                                              
systems, and opined  that creating incentives was a  good place to                                                              
begin.   He pointed  out that discussions  were taking  place with                                                              
military doctors for  a licensing structure to allow  them to work                                                              
with the  civilian  hospitals.   He summarized  that the two  most                                                              
critical  issues  were  equipping  the medical  personnel  in  the                                                              
remote parts  of Alaska,  and creating a  fund to incentivize  the                                                              
hospitals to enhance the trauma care.                                                                                           
                                                                                                                                
4:55:37 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON opened public testimony.                                                                                        
                                                                                                                                
4:55:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON  read  a  statement  from  Representative  Cissna                                                              
[original punctuation provided]:                                                                                                
                                                                                                                                
     "Mr. Chair:   I have  an unavoidable conflict  and won't                                                                   
     be  able to  remain  in this  meeting.   Broadening  the                                                                   
     discussion   with   all   stakeholders   would   be   an                                                                   
     improvement.   Increasing  other  incentives also  would                                                                   
     be beneficial.   I am in  favor of passage of  this bill                                                                 
     (as well as strengthening the bill.)"                                                                                      
                                                                                                                                
4:56:15 PM                                                                                                                    
                                                                                                                                
DAVID HULL,  Chair, Alaska Council  on Emergency  Medical Services                                                              
(ACEMS), testified  that he was speaking  on behalf of  ACEMS.  He                                                              
opined that trauma  calls were increasing every year.   He defined                                                              
trauma as any bodily  injury from an external source,  and that it                                                              
could  be accidental  or intentional.   He  quoted statistics  for                                                              
death  and hospitalizations.    He  shared that  a  study in  2004                                                              
revealed  that the  hospital  stay for  trauma  patients was  more                                                              
than $73 million,  and that 1 in  4 was not compensated  care.  He                                                              
defined a  trauma system as  a "pre-determined, organized,  multi-                                                              
disciplinary  response  to  managing  the care  and  treatment  of                                                              
severely  injured people,"  and that a  statewide system  provided                                                              
"a  framework  for  disaster  preparedness   and  response."    He                                                              
emphasized that  the most important  time frame for survival  of a                                                              
severely  injured   person  was   the  time  between   injury  and                                                              
definitive  care,  "the Golden  Hour."    He  opined that  it  was                                                              
necessary for increased  hospital participation for  the statewide                                                              
trauma system to  function optimally.  He shared that  the goal of                                                              
the statewide trauma  system was to ensure that  every hospital in                                                              
Alaska was  a designated trauma  center.  He testified  in support                                                              
of funding for  the development of trauma centers,  incentives for                                                              
trauma  care designation,  and  uncompensated  patient  care.   He                                                              
offered support for HB 168.                                                                                                     
                                                                                                                                
4:59:31 PM                                                                                                                    
                                                                                                                                
DR. FRANK  SACCO, Trauma Director,  Alaska Native  Medical Center;                                                              
Chair,  Alaska State  Trauma Systems  Review Committee,  explained                                                              
that trauma was  the leading cause of death for  Alaskans under 44                                                              
years  of age,  and that  Alaska had  the second  highest rate  of                                                              
trauma in  the U.S.   He opined  that a  good trauma system  would                                                              
decrease the  mortality by 15-25  percent.  He reflected  on prior                                                              
legislation  which  was only  voluntary  with no  incentives,  and                                                              
consequently,  there  was  only  one  Level  2  Trauma  Center  in                                                              
Alaska.   He  summarized an  American College  of Surgeons  review                                                              
that "the  achievements to date  have been largely  unplanned with                                                              
limited coordination;  as the result, incongruity  exists with the                                                              
current trauma  system."   He commended  the Alaska Native  health                                                              
facilities for working  toward trauma designation,  but he decried                                                              
the  lack  of  commitment  for  "achieving  nationally  recognized                                                              
standards  of  trauma  care"  from most  health  facilities.    He                                                              
stated that  Alaska was the  only state  without a Level  2 Trauma                                                              
Center  for the  majority of  the population,  and that  Anchorage                                                              
was the  largest city  in the United  States without  a designated                                                              
Level  1  or  Level  2 trauma  center  for  the  majority  of  the                                                              
population.   He expressed support  for HB 168, and  declared that                                                              
it was not a partisan issue.                                                                                                    
                                                                                                                                
5:04:06 PM                                                                                                                    
                                                                                                                                
DR.  REGINA   CHENNAULT,  Chair,  American  College   of  Surgeons                                                              
Committee  on  Trauma,  Alaska  Trauma  System  Review  Committee,                                                              
expressed concern  that Alaska  did not  have a designated  trauma                                                              
hospital for the  general public.  She reported that  Alaska had a                                                              
lot of  trauma, with a  lot of domestic  violence.   She requested                                                              
that   an  organized,   systems   approach  to   trauma  care   be                                                              
implemented as soon as possible.                                                                                                
                                                                                                                                
5:05:30 PM                                                                                                                    
                                                                                                                                
MARK JOHNSON, Alaska  Trauma System Review Committee,  opined that                                                              
[trauma]  care  would  be  improved  if  more  hospitals  met  the                                                              
national standards.   He referred to the 2008  American College of                                                              
Surgeons   review   of   Alaska  hospitals   which   included   70                                                              
recommendations,  of  which  16  were  listed  as  priority.    He                                                              
supported the incentives within HB 168.                                                                                         
                                                                                                                                
5:07:30 PM                                                                                                                    
                                                                                                                                
WARD  HURLBURT,  Chief  Medical  Officer;  Director,  Division  of                                                              
Public Health,  Office of the  Commissioner, Department  of Health                                                              
and Social  Services (DHSS), shared  his personal experience  as a                                                              
trauma physician.   He  shared that trauma  was the  third highest                                                              
cause of  death in Alaska,  and the highest  cause for ages  up to                                                              
44  years.   He  reflected on  the  American  College of  Surgeons                                                              
trauma  system review  and  noted with  concern  that the  "trauma                                                              
infrastructure's  unplanned,  under  developed,  under  resources,                                                              
and  lacks sufficient  coordination  and  integration."   He  also                                                              
expressed  the administration's  concern  that  Anchorage was  the                                                              
largest city  in the  U.S. without  Level 1  or 2 trauma  centers.                                                              
He shared that  the administration encouraged  collaboration among                                                              
the health  care systems  and the  development  of a "more  mature                                                              
trauma system."   He  stated that  the administration  was neutral                                                              
on HB 168.                                                                                                                      
                                                                                                                                
5:11:55 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON noted a proposed amendment for funding.                                                                         
                                                                                                                                
5:12:23 PM                                                                                                                    
                                                                                                                                
SENATOR COGHILL  replied that  it was a  good amendment,  but that                                                              
the funding would be drawn from the general fund.                                                                               
                                                                                                                                
5:12:48 PM                                                                                                                    
                                                                                                                                
[HB 168 was held over.]