02/13/2014 03:00 PM House HEALTH & SOCIAL SERVICES

         HB 269-IMMUNITY FOR TEMP. HEALTH CARE PROVIDER                                                                     
                                                                                                                                
3:06:40 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS  announced that the  first order of  business would                                                               
be HOUSE  BILL NO.  269, "An Act  providing immunity  for certain                                                               
licensed temporary health care providers  who provide free health                                                               
care services."                                                                                                                 
                                                                                                                                
REPRESENTATIVE  KELLER  moved  to adopt  the  proposed  committee                                                               
substitute (CS) for HB  269, labeled 28-LS1251\U, Martin\Wallace,                                                               
2/4/14, as the  working draft.  There being no  objection, it was                                                               
so ordered.                                                                                                                     
                                                                                                                                
                                                                                                                                
REPRESENTATIVE STEVE THOMPSON, Alaska State Legislature, reading                                                                
from a prepared statement:                                                                                                      
                                                                                                                                
     An act providing immunity for certain licensed                                                                             
     temporary health care providers who provide free                                                                           
     health care services.  HB 269 was drafted due to                                                                           
     liability concerns surrounding an inaugural Alaska                                                                         
     Mission of Mercy (AKMOM) event organized by the Alaska                                                                     
     Dental Society, and scheduled in Anchorage this coming                                                                     
     April.  The Mission of Mercy program was started by a                                                                      
     group of dentists thirteen years ago in Virginia.  The                                                                     
     MOM programs provide free dental care to local                                                                             
     residents who would not otherwise have access to                                                                           
     affordable dental care.  To date, the Mission of Mercy                                                                     
     Program in Alaska has 187 dentist volunteers, 7 are                                                                        
     from out of state.  The AKMOM program will provide                                                                         
     extractions, fillings and cleanings as well as other                                                                       
     procedures that can be appropriately performed in a                                                                        
     mission setting.  Out-of-State dental professionals                                                                        
     will be licensed to provide pro bono service under                                                                         
     courtesy licenses issued by the Alaska Board of Dental                                                                     
     Examiners.  A courtesy license is a medical                                                                                
     professional license issued by the Board for the                                                                           
     purposes of providing free services and enforcing                                                                          
     state disciplinary provisions.                                                                                             
                                                                                                                                
     The issue is that there is no clear answer as to                                                                           
     whether an out-of-state dentist professional issued a                                                                      
     courtesy license is covered under Alaska Statute                                                                           
     09.65.300.  AS 09.65.300 provides statutory immunity                                                                       
     against civil damages resulting from an act or                                                                             
     omission of a health care provider who provides free                                                                       
     health care service, within the scope of their                                                                             
     license.  Under AS 09.65.300 a patient must receive                                                                        
     written notice of this immunity as well as give                                                                            
     informed consent before any medical service is                                                                             
     provided.  Under AS 09.65.300 patients still have the                                                                      
     right to sue the medical provider for civil damages                                                                        
     resulting from the provider's gross negligence, or                                                                         
     reckless or intentional misconduct.  Unfortunately, an                                                                     
     attorney general's opinion indicated that it would                                                                         
     take a court case to definitively decide if courtesy                                                                       
     licenses have protections.                                                                                                 
                                                                                                                                
     The original intent of the statute was to allow                                                                            
     retired Alaska physicians to volunteer their services.                                                                     
                                                                                                                                
     The Department of Law opines that the meaning of the                                                                       
     law as to out of state providers will ultimately have                                                                      
     to be interpreted by the court.                                                                                            
                                                                                                                                
     HB 269 will clarify AS 09.65.300, ensuring that civil                                                                      
     immunity is extended to these out-of-state medical                                                                         
     professionals who are licensed to provide dental                                                                           
     services in Alaska during the Mission of Mercy Event,                                                                      
     without having the issue come before a lengthy                                                                             
     proceeding before the Court.                                                                                               
                                                                                                                                
REPRESENTATIVE THOMPSON urged the support of the committee.                                                                     
                                                                                                                                
3:10:18 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS asked whether  military dentists, when volunteering                                                               
their  time, had  immunity coverage.   He  shared that  the legal                                                               
opinion  from the  Department  of Law  was  for immunity  status,                                                               
unless  the courts  stated otherwise.   He  noted that  he was  a                                                               
dentist.                                                                                                                        
                                                                                                                                
3:11:54 PM                                                                                                                    
                                                                                                                                
DAVID  LOGAN,  Legislative  Committee  and  DAPAC  Chair,  Alaska                                                               
Dental Society, in response to  Chair Higgins, explained that, as                                                               
a  general  rule, military  dentists  did  not carry  malpractice                                                               
insurance  policies, unless  they worked  away from  the military                                                               
base.                                                                                                                           
                                                                                                                                
CHAIR HIGGINS relayed  a concern from Timothy  M. Lynch [Included                                                               
in  members'  packets]  whether  a  temporary  courtesy  provider                                                               
license  would be  in  conjunction with  the  requirements for  a                                                               
temporary permit  under AS  08.64.270.  Mr.  Lynch asked,  if the                                                               
proposed bill removed the requirement  for state licensing, would                                                               
someone other  than a State  Medical Board have the  authority to                                                               
license physicians  under this approach, which,  he opined, would                                                               
create   an  ambiguous   situation  regarding   licensing.     He                                                               
questioned  whether  this would  prompt  a  conflict between  the                                                               
State Medical Board and the Alaska State Medical Association.                                                                   
                                                                                                                                
3:14:27 PM                                                                                                                    
                                                                                                                                
DR.  LOGAN  replied  that  the  proposed  bill  would  extend  AS                                                               
09.65.300, which defined  that a health care  provider could hold                                                               
a temporary courtesy  license under AS 08.01.62.   He pointed out                                                               
that  courtesy  licenses  were   very  different  from  temporary                                                               
licenses,  which were  issued under  AS  08.064.270, and  allowed                                                               
work and  remuneration in any  capacity.  He noted  that courtesy                                                               
licenses  were  reserved  for unique  situations,  and  specified                                                               
under various  professions.   He shared  that a  courtesy license                                                               
was issued  for short term  pro bono work.   He pointed  out that                                                               
there could  not be any  earnings with a courtesy  license, other                                                               
than reimbursement for travel.                                                                                                  
                                                                                                                                
REPRESENTATIVE  TARR asked  for information  about any  necessary                                                               
follow-up procedures for patients after the AKMOM event.                                                                        
                                                                                                                                
DR. LOGAN  deferred the  question to Dr.  Julie Robinson,  as she                                                               
could speak  more specifically to  the procedures and  any follow                                                               
up  care.   He  surmised that  many of  the  procedures would  be                                                               
limited, as this was not the setting for more complicated needs.                                                                
                                                                                                                                
3:18:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  why the proposed bill  did not cover                                                               
military courtesy licensing for these voluntary services.                                                                       
                                                                                                                                
DR. LOGAN  explained that  the Alaska  Board of  Dental Examiners                                                               
allowed military dental  courtesy licenses.  He  opined that most                                                               
of the other medical boards  had provisions in place for military                                                               
courtesy licensing.                                                                                                             
                                                                                                                                
3:19:56 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS opened public testimony.                                                                                          
                                                                                                                                
JULIE ROBINSON,  Alaska Dental Society, Alaska  Mission of Mercy,                                                               
in response to  Chair Higgins, explained that  the Alaska Mission                                                               
of  Mercy program  had 1058  volunteers, and  202 dentists.   She                                                               
declared that  Alaska was the  27th state to offer  this program,                                                               
and that  there was a follow  up care protocol.   She pointed out                                                               
that,  in  this  type  of  setting, the  scope  of  practice  was                                                               
limited.   She stated that  the main  goal was to  eliminate pain                                                               
and infection, and to restore  smiles.  She relayed that patients                                                               
were informed that  the dentists may be from  out-of-town or out-                                                               
of-state.    The  registration,  which must  be  signed,  has  an                                                               
immunity  clause  printed  on  the  back  of  the  form.    After                                                               
treatment,  there  was  post-operative   care  during  which  the                                                               
treatment  was reviewed  and written  instructions for  care were                                                               
provided,  which  included an  emergency  phone  number that  was                                                               
monitored  by  a  dentist  for  the following  two  weeks.    She                                                               
reported that  the Anchorage Neighborhood Health  Center had also                                                               
agreed  to see  ten people  for no  charge, following  the Alaska                                                               
Mission of  Mercy program.   Other dentists  had also  offered to                                                               
see post-operative  patients.  She  reported that  these programs                                                               
in  other  states  with similar  numbers  of  participants  would                                                               
usually have fewer than six post-operative calls.                                                                               
                                                                                                                                
DR.  ROBINSON  explained that  dentists  not  able to  see  post-                                                               
operative patients had  so indicated on their  registration.  She                                                               
reported that of the 202  participating dentists, 8 were military                                                               
or  federal service  dentists, and  9  were previous  volunteers,                                                               
with dental licenses  from many other states.   She expressed the                                                               
goal to serve  2000 Alaskans in two days, and  that the long term                                                               
goal was for  this to be an annual event  throughout Alaska.  She                                                               
noted the  greater challenges  for a program  in Alaska  than for                                                               
the contiguous  states.  She  asked that immunity  protection for                                                               
the courtesy license be extended.                                                                                               
                                                                                                                                
3:26:31 PM                                                                                                                    
                                                                                                                                
DR.  ROBINSON,  in  response  to Chair  Higgins,  said  that  the                                                               
treatment dates were  April 11 and 12, with  service beginning at                                                               
4:30 a.m.                                                                                                                       
                                                                                                                                
CHAIR HIGGINS  declared his  desire for the  program to  focus on                                                               
the working class  who could not afford to go  to the dentist and                                                               
did not have  insurance, stating that people  covered by Medicaid                                                               
already had coverage.  He offered  his services if he was granted                                                               
time off from  the legislative session.  He  declared his support                                                               
for the program.                                                                                                                
                                                                                                                                
REPRESENTATIVE  TARR  asked  how  to promote  the  event  in  the                                                               
future.                                                                                                                         
                                                                                                                                
3:29:06 PM                                                                                                                    
                                                                                                                                
RANDI SWEET,  Director, Health Impact,  United Way  of Anchorage,                                                               
reported that  the United Way  was a partner  in the event.   She                                                               
spoke in support of HB  269, declaring that the current volunteer                                                               
health care  provider immunity act provided  protection to Alaska                                                               
health  care  providers  who  volunteered   their  time  to  help                                                               
Alaskans.    She reported  that  Alaskans  were among  the  least                                                               
insured  in the  nation, with  a recent  study showing  that 20.6                                                               
percent of  the state  did not  have insurance.   She  noted that                                                               
only five  other states  had a  higher percentage  of un-insured.                                                               
She read appreciative comments  from individuals participating in                                                               
the  earlier  free  clinics  offered   by  University  of  Alaska                                                               
Anchorage  and  the Anchorage  Project  Access.   She  asked  for                                                               
support for proposed HB 269.                                                                                                    
                                                                                                                                
3:33:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  moved to  report  CSHB  269, Version  28-                                                               
LS1251\U,   Martin\Wallace,  2/4/14,   out   of  committee   with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There  being no  objections,  CSHB 269(HSS)  was  moved from  the                                                               
House Health and Social Services Standing Committee.