Legislature(2017 - 2018)CAPITOL 106
03/14/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB103 | |
| HB174 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 103 | TELECONFERENCED | |
| *+ | HB 54 | TELECONFERENCED | |
| *+ | HCR 2 | TELECONFERENCED | |
| *+ | HB 174 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 174-EXTEND DISASTER EMERGENCY: OPIOID EPIDEMIC
3:50:59 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE BILL NO. 174, "An Act extending the governor's
declaration of disaster emergency to address the opioid
epidemic; and providing for an effective date."
3:51:17 PM
JAY BUTLER, MD, Chief Medical Officer/ DPH Director, Central
Office, Division of Public Health, Department of Health and
Social Services, declared that there were challenges with the
opioid epidemic, as there had been a fourfold increase of death
from opioids in the past 20 years. He said that the Department
of Health and Social Services was awarded a five year grant to
support opioid overdose prevention programs in 2016. He said
that this included distribution of naloxone, the lifesaving drug
administered for an opioid overdose. He shared that there was a
nasal spray form which was now part of the rescue kits in
Project HOPE, Harm reduction, Overdose Prevention, and
Education. He said that Project HOPE had prioritized
partnerships with the staff of organizations which did not have
medical direction, but were most likely to be present when an
overdose occurred. The department had explored ways to provide
the kits under a standing medical order, but the authority to
declare the standing order required a disaster declaration. He
added that although there were a number of mechanisms to achieve
the authority, this seemed to be the way to do it as quickly as
possible and take advantage of the federal resources that had
been made available. Governor Walker issued the declaration on
February 14, with an anticipated legislative concurrent
resolution to extend the declaration longer that the than the 30
day duration defined by Alaska statute. He emphasized that no
state general funds were requested to support Project HOPE, as
it was supported entirely by the federal grant. Since that
declaration, 12 partner organizations had received training to
dispense the medication and provide the kit, and nearly 1300
kits had been dispensed. He reported that Legislative Legal
Services had a different interpretation for the meaning of a
concurrent resolution and had determined that instead a bill was
required to extend the declaration and continue distribution of
the kits under the standing order.
3:54:50 PM
DR. BUTLER paraphrased the Sectional Analysis [Included in
members' packets], which read:
Sec. 1 includes findings on the extent of the public
health threat; acknowledgement and description of the
Governor's disaster declaration; and the need for the
legislature to extend the declaration to address the
epidemic.
Sec. 2 extends the February 14, 2017, disaster
declaration for one year to February 14, 2018.
Sec. 3 makes the effective date retroactive to March
15, 2017, when the disaster declaration expires.
REPRESENTATIVE JOHNSTON asked if the bill was mainly to
distribute [naloxone], and if there was any other way to
accomplish this.
DR. BUTLER explained that naloxone was an FDA (US Food and Drug
Administration) approved drug which could be acquired with a
physician's prescription. To work with the partners in the
program and distribute the overdose kits, it was necessary to
have a standing order under the authority of his prescribing
license, although the best way forward appeared to be as part of
a disaster declaration.
REPRESENTATIVE JOHNSTON asked if DHSS was looking for further
federal grants.
DR. BUTLER replied that this disaster declaration would
primarily achieve the goal of the standing order for the
naloxone distribution, although other grants and other funding
sources were being reviewed.
REPRESENTATIVE JOHNSTON asked if the proposed bill was necessary
to apply for the grants.
DR. BUTLER said they could have applied for the grants without
the proposed bill.
3:57:54 PM
REPRESENTATIVE KITO asked what would happen after the deadline
in the disaster declaration of February 14, 2018.
DR. BUTLER replied that an extension would be necessary if it
was decided to continue distribution under the standing order.
REPRESENTATIVE KITO asked if there was a designated time frame
for the grant.
DR. BUTLER replied that this was a 5 year grant, effective
October 1, 2016, the beginning of the federal fiscal year.
REPRESENTATIVE EASTMAN asked about the number of heroin overdose
deaths in 2015.
DR. BUTLER reported that there were 38 deaths when heroin was
associated or morphine was detected in post mortem. He said
that although it was not uncommon for there to be multiple
drugs, multiple opioids could be recognized at death. He
pointed out that the trend was increasing significantly, and
mirrored other parts of the U.S. and Canada.
REPRESENTATIVE EASTMAN asked about the number of deaths in 2016.
DR. BUTLER opined that this was in the mid-40s.
REPRESENTATIVE EASTMAN asked when the final numbers would be
released.
DR. BUTLER replied that he hoped to have the final numbers by
the end of March.
REPRESENTATIVE SULLIVAN-LEONARD asked if the statistics were
heroin related only or opioid and/or heroin related.
DR. BUTLER replied that these were related to heroin, although
there were more than 80 opioid associated deaths. He explained
that prescription opioids were frequently used interchangeably,
and about 80 percent of heroin users reported that they started
with prescription opioids.
CHAIR SPOHNHOLZ asked about the best tool for utilization after
a year, as proposed HB 174 would expire after one year.
DR. BUTLER said that he was not sure of the best mechanism. He
said that current state law did not provide the authority for
the state medical officer to issue standing orders, which had
been the reason for the earlier disaster declaration. He
declared that the proposed bill was a short term fix for a
possibly longer term administrative fix.
4:03:42 PM
STACIE KRALY, Chief Assistant Attorney General, Statewide
Section Supervisor, Human Services Section, Civil Division
(Juneau), Department of Law, said that she concurred with the
testimony of Dr. Butler, that the proposed bill was a response
to the emergency nature of the event. She offered her belief
that an additional statutory fix would be necessary, although it
would not require extension of the proposed bill. She relayed
that it would be necessary to find the authority for Dr. Butler
to issue the standing orders. She said that there had been an
oversight in the passage of Senate Bill 23 last year, which
created the mechanism for the distribution of naloxone, as it
did not allow for the chief medical officer to issue standing
orders, although there was intent for that to be fixed.
CHAIR SPOHNHOLZ suggested that the proposed bill was an
intermediate remedy.
MS. KRALY expressed agreement.
REPRESENTATIVE EASTMAN asked what would be done if the proposed
bill did not pass.
MS. KRALY replied that, as there would not be any standing order
for the authority to issue the kits, a statutory change would be
necessary for the authorization.
REPRESENTATIVE EASTMAN asked what could be accomplished with
memorandums of agreement instead of a statutory change.
MS. KRALY offered her belief that, without licensed physicians
to step in and provide oversight and standing order services,
the memorandums of understanding or agreement "would not get us
very far." She declared that it was necessary for a licensed
physician to issue the standing order, and without that, there
would be a large gap period for administering the kits.
REPRESENTATIVE EDGMON asked about the zero fiscal note in light
of page 2, line 6 of the proposed bill which discussed the
establishment of a statewide overdose response program. He
asked "how much teeth" this would have.
DR. BUTLER replied that this was a valuable tool for saving a
life, but it did not cure addiction. He stated that the broader
response needed to include access to care and the de-
stigmatizing of addiction. He explained that addiction was a
condition of the brain which needed to be managed as a chronic
health condition. He added that it was necessary to address
ways to manage pain, some of the drivers for self-medication,
and the amount of opioid pain relievers in the community. He
reported that the fiscal note focused entirely on the
aforementioned Project Hope. He stated that this would be a
long term emergency response, similar to a major natural
disaster, with an incident command structure to coordinate the
prolonged recovery phase.
REPRESENTATIVE EDGMON said that he was supportive of the effort
and the proposed bill, but that he was skeptical in the broader
sense that the necessary resources to effectively combat
substance abuse in Alaska were being made available.
DR. BUTLER acknowledged that Representative Edgmon had captured
the complexity of the issue, although, he pointed out, alcohol
still killed more Alaskans than opioids. He added that alcohol
deaths had not been on the same dramatic increase. He stated
that there was not a similar tool for alcohol related mortality.
4:13:16 PM
VALERIE DAVIDSON, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), acknowledged
that the proposed bill would not solve the problem. She
explained that Department of Health and Social Services was
taking a multi-faceted approach with application to "every
federal dollar that we possibly can" and that they had secured
four federal grants designed to do different things. She
explained that the grant mentioned in the proposed bill would be
for administration of an immediate lifesaving intervention for
people during active overdose. She reported that there were
additional federal grants about education and prevention, to
ensure understanding for the dangers of opioids, as well as
allowing for treatment services. She relayed that the Alaska
State Legislature had made funds available in 2016 to provide
treatment for women with children. She said that Central
Peninsula Hospital had received a grant to provide for immediate
detoxification services. She reported that DHSS had applied for
a $2 million grant to allow for medication assisted treatment to
"assist folks to be able to stay clean" combined with available
therapy to "get to the root of the problem" "which was why
people are self-medicating." She declared that there was not
any magic treatment or magic pill. She stated that DHSS was
also pursuing a [Section] 1115 behavioral health waiver, which
would allow for a complete redesign of the behavioral health
system as it was recognized that there were gaps in the
continuum of care. She reported that there were ongoing studies
for determining "the best place for us to be able to provide
those services, what are we missing, can we intervene sooner."
She shared that Alaska had been disproportionately impacted by a
federal law which precluded facilities with more than 16 beds to
seek reimbursement from Medicaid. She reported that DHSS had
received guidance from the Centers for Medicare and Medicaid
Services for working through this with an amended [Section] 1115
waiver.
REPRESENTATIVE KITO asked for explanation to the limitation on
16 beds for treatment.
COMMISSIONER DAVIDSON, in response, explained that previously
individuals experiencing severe mental illness were
institutionalized. The U.S. Congress recognized that housing
those with serious mental illness was not an efficacious way to
support people, and, instead, to treat people in the least
restrictive environment. There was an unintended consequence
that facilities with more than 16 beds providing for substance
use disorders were impacted. She pointed out that this was
possible in the Lower 48, as there was a larger economy of
scale, but, as this was not economically feasible in Alaska, it
impacted the ability to provide more treatment services.
REPRESENTATIVE KITO suggested that, as smaller facilities had
higher incremental costs, hopefully Alaska could address this
issue.
REPRESENTATIVE EASTMAN compared the number of heroin deaths to a
murder epidemic in Alaska. He said that he was familiar with
the declaration process, and that the disaster act was designed
to allow cases of urgent need to bypass the normal
appropriations process, and allow the administration the
opportunity to act decisively without the accompanying
bureaucracy in the budgeting process. He offered his belief
that the declaration in the proposed bill would allow the
governor greater access to funding. He questioned whether the
proposed bill was offering this temptation.
COMMISSIONER DAVIDSON explained that the original disaster
allocation by the governor was "actually drafted extremely
narrowly and limited the resources available to the state to
those of the federal grant." She stated that the zero fiscal
note [Included in members' packets] accompanying the proposed
bill was due to the limits to available federal resources of the
original disaster declaration.
REPRESENTATIVE EASTMAN, directing attention to the limited
resources and the stop gap solution of the proposed bill, asked
what would be the next options.
COMMISSIONER DAVIDSON replied that the current challenge was
that the Chief Medical Officer did not have the authority in
state statute to provide the standing order. She explained that
DHSS was trying to ensure that its community based partner
organizations without medical directors or physicians able to
write a standing order could instead use the standing orders of
the Chief Medical Officer limited to immediate distribution of
the naloxone kits, and ensure that as many kits as possible were
distributed as quickly as possible. She offered as a longer
term solution to provide the Chief Medical Officer with the
authority to issue standing orders when necessary.
REPRESENTATIVE EASTMAN asked about the liability incurred with
any mishaps when naloxone was administered.
DR. BUTLER said that he would not be taking this on beyond the
protections afforded under Senate Bill 23, which focused on
establishing the guidelines around the training. He said that,
as Emergency Medical Services personnel had medical supervision
and were already carrying the kits, they were not a focus of
Project HOPE.
REPRESENTATIVE SULLIVAN-LEONARD offered a personal story and
reflected on the progress of the work in the Matanuska-Susitna
Valley. She reminded the committee that there were also epi-
pens for allergic reactions, and that more training and more
education would have a greater effect on the epidemic.
4:26:18 PM
CHAIR SPOHNHOLZ opened public testimony.
4:26:52 PM
TERRIA WALTERS, President, Founder, Fallen Up Ministries,
offered a personal story, and stated that she was in long term
recovery. She spoke about using a calculation for those who had
lived because of the administration of [naloxone], instead of
calculating the deaths. She declared support for HB 174, noting
that the lack of resources in the state ensured that many
individuals would continue to use drugs and take the risk for
overdose. She reiterated that the availability of naloxone
meant that an overdose could be revived. She reported that
Fallen Up Ministries was conducting a detoxification project
which would serve 25 patients, and would be used for data
collection. She shared that she had been clean and sober for
almost 12 years. She estimated that 129 people died of drug
overdose daily, declaring that this was a disaster.
4:31:44 PM
MARK WEAVER, Vice President, Fallen Up Ministries, shared his
background with local opioid task forces and declared his
support for HB 174. He offered some of his personal
experiences. He opined that a gap in the disaster declaration
would "just be ridiculous." He compared [naloxone] to a
defibrillator or a fire extinguisher. He stated that once a
life had been saved, the individual could be directed toward
available resources for breaking "the entrapment of addiction."
He noted that many people who did not live in downtown locales
were struggling. He declared his desire to help the community.
He added that most of his group were volunteers.
4:35:16 PM
SERENA ESPINOZA, Vice President, Real About Addiction, Board
Administrator, Fallen Up Ministries, reported that she was also
a member of the local opiate task forces. She stated that she
had seen too many accidental overdose deaths, and that there
would have been a chance at recovery if there was access to
[naloxone]. She declared that it was necessary to distribute
naloxone and have continued access to it. She offered her
belief that non-profit treatment facilities, medical providers,
emergency responders, families of addicts, and recovery
advocates would play an important role in saving the lives of
Alaskans if there was immediate access to the [Project} HOPE
kits. She added that the medication disposal bags would also
play a large role in prevention by keeping opiates out of the
hands of youth. She stated her support for the proposed bill.
4:37:49 PM
KARA NELSON, Director, Haven House, Juneau, shared some
background of Haven House and stated that she was in long term
recovery. She said that Haven House, as a recovery residence,
was in partnership with Project HOPE, and offered help to many
women in the community. She shared that they were providing
peer support services as volunteers. She stated her support of
HB 174 and the extension for the declaration of disaster to
address the opioid epidemic. She reiterated that this was a
place of hope for the many organizations and individuals that
allowed them to come together and move forward.
4:41:36 PM
JOHN GREEN, Mat Su Opiate Task Force, shared that his daughter
had died in jail of complications from detoxification. He
reported that getting into recovery was full of obstacles and
barriers, which included required proof of income and waiting
lists. It was daunting for a parent to find recovery help for
their child. He stated his support of HB 174. He shared that
although there was a perception that those for recovery were
soft on crime, the option to get into recovery was better for
the community and public safety because once an addict had
recovered, they became a productive member of society and would
not continue their criminal behavior. He referenced a concern
that naloxone would make addicts more careless, comparing that
to having air bags in cars and people driving into trees to see
if they worked. He emphasized that no one wants to overdose and
die. He stated that naloxone offered people a chance to live
and get into recovery, thereby helping other addicts toward
sobriety.
4:45:14 PM
CHAIR SPOHNHOLZ closed public testimony. She said that this
bill was an extremely urgent and important piece of legislation,
even as it was a small piece of an overall, much broader
strategy. She added that the emergency declaration would expire
in the next day.
4:46:40 PM
REPRESENTATIVE EDGMON moved to report HB 174 out of committee
with individual recommendations and the accompanying zero fiscal
note.
4:46:59 PM
REPRESENTATIVE EASTMAN objected. He said that he had reviewed
the disaster declaration, and he offered his understanding that
it was intended to limit authority to only the federal program.
He asked for clarification.
MS. KRALY explained that the emergency declaration had been very
narrowly drafted within the construct of the statutory
authorization. She said that there was a companion statute
which allowed the department to use the framework to craft a
public health emergency. She stated that they took this
authorization and that the presented documentation provided the
fiscal analysis along with the declaration which identified how
the money was limited to the federal grant. She pointed out
that this was narrowly crafted to make clear that there would be
no additional fiscal impact. She directed attention to AS
26.23.020 and said that the documentation in the packet, along
with the declaration, encompassed that detail.
REPRESENTATIVE EASTMAN said that he only had the fiscal note and
the declaration of disaster which authorized certain things. He
offered his belief that the actual statute read that all state
resources were now at the governor's disposal. He asked if this
was the correct declaration.
MS. KRALY replied that the statutory authorization did offer a
broad array of authority to address an emergency. She explained
that the opioid disaster finance plan had limited the funding to
the $4.1 million from the federal grant. She said that it had
been made clear to the governor's office and to the leadership
of both bodies that no additional authorizations under the
statute were being sought. She offered to supply this
additional documentation.
CHAIR SPOHNHOLZ asked if Representative Eastman had the fiscal
note, which she opined did address the issue.
REPRESENTATIVE EASTMAN asked if there was anything other than
the fiscal note.
MS. KRALY reported that a budget document had also been created.
REPRESENTATIVE EASTMAN maintained his objection.
4:52:00 PM
A roll call vote was taken. Representatives Spohnholz, Kito,
Sullivan-Leonard, Johnston, and Edgmon voted in favor of HB 174.
Representative Eastman voted against it. Therefore, HB 174 was
reported out of the House Health and Social Services Standing
Committee by a vote of 5 yeas - 1 nay.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 103 Sponsor Statement 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Draft Proposed Blank CS ver D 3.13.2017.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Sectional Analysis (CS) 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Explanation of Changes (CS) 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Fiscal Note DCCED--DCBPL 3.13.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document Regulation Flow Chart 3-10-17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB103 Career Guide Optometry 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Documents Optometry Education Flyer 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document Ohio State Optometry Curriculum 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document-Optometrists Practicing in AK 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document-Board of the Examiners in Optometry.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document Medical Liability Premiums Fact Sheet 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Letters of Support 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB103 Letters of Opposition-Support.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB174 Sponsor Statement 3.19.17.pdf |
HHSS 3/14/2017 3:00:00 PM |
HB 174 |
| HB 174 Sectional Analysis Version A.pdf |
HHSS 3/14/2017 3:00:00 PM |
HB 174 |
| HB174 Fiscal Note DHSS-PHAS 3.10.17.pdf |
HHSS 3/14/2017 3:00:00 PM |
HB 174 |