Legislature(2005 - 2006)CAPITOL 106
02/23/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB442 | |
| Overview(s) || Alaska Mental Health Board: Advisory Board on Alcoholism and Drug Abuse (abada) | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 426 | TELECONFERENCED | |
| += | HB 412 | TELECONFERENCED | |
| *+ | HJR 31 | TELECONFERENCED | |
| *+ | HB 258 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| *+ | HB 442 | TELECONFERENCED | |
| += | HB 271 | TELECONFERENCED | |
| *+ | HCR 5 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 23, 2006
3:56 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Carl Gatto
Representative Vic Kohring
COMMITTEE CALENDAR
HOUSE BILL NO. 442
"An Act relating to the validity of advance health care
directives, individual health care instructions, and do not
resuscitate orders; relating to the revocation of advance health
care directives; relating to do not resuscitate orders; relating
to resuscitative measures; relating to the liability of health
care providers and institutions; relating to an individual's
capacity for making health care decisions; and providing for an
effective date."
- HEARD AND HELD
OVERVIEW(S): ALASKA MENTAL HEALTH BOARD: ADVISORY BOARD ON
ALCOHOLISM AND DRUG ABUSE (ABADA)
- HEARD
HOUSE BILL NO. 258
"An Act relating to aggravating factors at sentencing."
- BILL HEARING POSTPONED TO 2/28/06
HOUSE BILL NO. 412
"An Act relating to the waiver of undergraduate expenses for a
spouse or dependent of a deceased resident peace officer or
member of the armed services or fire department."
- BILL HEARING POSTPONED TO 2/28/06
HOUSE BILL NO. 426
"An Act relating to medical assistance eligibility and coverage
for persons under 21 years of age."
- BILL HEARING POSTPONED TO 2/28/06
HOUSE JOINT RESOLUTION NO. 31
Relating to designating September 9, 2006, as Fetal Alcohol
Spectrum Disorders Awareness Day.
- BILL HEARING POSTPONED TO 2/28/06
HOUSE BILL NO. 271
"An Act relating to limitations on overtime for registered
nurses in health care facilities; and providing for an effective
date."
- SCHEDULED BUT NOT HEARD
HOUSE CONCURRENT RESOLUTION NO. 5
Relating to support of community water fluoridation.
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 442
SHORT TITLE: HEALTH CARE DECISIONS
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH
02/10/06 (H) READ THE FIRST TIME - REFERRALS
02/10/06 (H) HES, JUD
02/21/06 (H) HES AT 3:00 PM CAPITOL 106
02/21/06 (H) Scheduled But Not Heard
02/23/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JACQUELINE TUPOU, Staff
to Representative Bruce Weyhrauch
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 442 on behalf of
Representative Weyhrauch, sponsor.
JAMES BROOKS, Administrator
Anchorage Anesthesia Group
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Responded to questions on HB 442.
MICHAEL NORMAN, Anesthesiologist
Alaska Physicians and Surgeons
Anchorage, Alaska
POSITION STATEMENT: Responded to questions on HB 442.
TERRI BANNISTER, Attorney
Legislative Legal and Research Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Responded to questions on Amendment 1, and
Amendment 2, to HB 442.
JOHN DAWSON, Attorney
Davis Wright and Tremaine Limited Liability Partnership (LLP);
Representative, Providence Anchorage Anesthesia Medical Group
Anchorage, Alaska
POSITION STATEMENT: Responded to questions on HB 442.
JIM DUNCAN, Chairman
Advisory Board on Alcoholism and Drug Abuse (ABADA)
Soldotna, Alaska
POSITION STATEMENT: Co-presenter of the overview for the Alaska
Board on Alcoholism and Drug Abuse (ABADA).
LONNIE WALTERS, Chief Petty Officer, Naval Retiree;
Vice Chair, Advisory Board on Alcoholism and Drug Abuse (ABADA);
President, Substance Abuse Directors Association;
Executive Director of Communities Organized for Health Options
on Prince of Wales Island (COHO)
Craig, Alaska
POSITION STATEMENT: Co-presenter of the overview for the Alaska
Board on Alcoholism and Drug Abuse (ABADA).
CARL WEBB, Ketchikan School Board
Ketchikan, Alaska
POSITION STATEMENT: Testified on behalf of the Alaska Board on
Alcoholism and Drug Abuse (ABADA).
ROSALIE NADEAU, Executive Director
Akeela Drug and Alcohol Treatment Services
Anchorage, Alaska
POSITION STATEMENT: Co-presenter of the overview by the Alaska
Mental Health Board.
VERNER STILLNER, MD
Specialist, Alcohol and Drug Dependencies
Psychiatrist, Bartlett Regional Hospital;
Member, Advisory Board on Alcoholism and Drug Abuse (ABADA)
POSITION STATEMENT: Testified on behalf of the Alaska Board on
Alcoholism and Drug Abuse (ABADA).
FRED GLENN (ph)
Moose Pass, Alaska
POSITION STATEMENT: Testified on behalf of the Alaska Board on
Alcoholism and Drug Abuse (ABADA).
KAT MCELROY, Clinical Supervisor,
Substance Abuse Treatment Service
Railbelt Mental Health Addiction;
Member, Advisory Board on Alcoholism and Drug Abuse (ABADA)
Nenana, Alaska
POSITION STATEMENT: Testified on behalf of the Alaska Board on
Alcoholism and Drug Abuse (ABADA).
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:56:40 PM.
Representatives Anderson, Cissna, Gardner, and Wilson were
present at the call to order. Representative Seaton arrived as
the meeting was in progress.
HB 442-HEALTH CARE DECISIONS
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 442, Version 24-LS1618\G, "An Act relating to the
validity of advance health care directives, individual health
care instructions, and do not resuscitate orders; relating to
the revocation of advance health care directives; relating to do
not resuscitate orders; relating to resuscitative measures;
relating to the liability of health care providers and
institutions; relating to an individual's capacity for making
health care decisions; and providing for an effective date."
3:57:29 PM
JACQUELINE TUPOU, staff to Representative Bruce Weyhrauch,
Alaska State Legislature, presented HB 442, on behalf of
Representative Weyhrauch, paraphrasing from a written statement,
which read as follows [original punctuation provided]:
Passage of the Health Care Decisions Act ("Alaska
Act") in 2004, was an important step forward in
modernizing and improving Alaska's health care laws
for the terminally ill, their families, and loved
ones. House Bill 442 makes minor changes to the Alaska
Act in order to provide clearer direction to those
implementing health care decisions.
Current law imposes a duty of investigation upon
doctors when carrying out the health care directives
of their patients. House Bill 442 amends the current
statute to conform the language in the Alaska Act to
Uniform Act language, thus requiring a doctor to act
in "good faith" when time is often critical for their
patients. The bill also substitutes the word
"physician" for "attending physician", to clarify the
intent that all physicians treating a patient adhere
to the patient's advanced health care directives.
Finally, House Bill 442 clarifies when CPR may be
used, addresses the validity of orders from other
jurisdictions, and indicates under what circumstances
a Do Not Resuscitate order may be revoked.
The Health Care Decisions Act has been beneficial and
important for all Alaskans in letting terminally ill
patients have their wishes heard. House Bill 442 helps
caregivers carry out those wishes.
3:59:55 PM
REPRESENTATIVE GARDNER asked whether this bill provides for a
distinction between a physician and an attending physician, and
the need for each to act in good faith regarding their patient's
health care instructions.
4:00:37 PM
JAMES BROOKS, Administrator, Anchorage Anesthesia Group,
Providence Alaska Medical Center, pointed out that it is not
unusual for a patient to have several physicians. Nor is it
uncommon, he explained for a patient to arrive in the operating
room (OR) and request that the anesthesiologist waive the
existing do not resuscitate (DNR) order to ensure that they
survive the anesthesia and surgical processes. If a patient
makes this type of request, it would be important to respect
that choice without delaying the patient's care while locating
the attending physician. He stressed the importance for every
physician involved in a patient's care to be authorized to
adhere to a patient's DNR orders without constraint. In
response to Representative Gardner, he said that the attending
physician is the primary physician on a patient's chart.
4:02:53 PM
MICHAEL NORMAN, Doctor of Anesthesiology, Alaska Physicians and
Surgeons, clarified that "admitting physician" is the correct
term, and the term "primary physician" is no longer used in
modern practice.
4:03:25 PM
REPRESENTATIVE ANDERSON, referenced page 3, lines 16-27, and
asked whether the language "the patient requests", refers to an
oral or a written request, and should it refer to an oral
directive, how would that directive be verified.
DR. NORMAN responded that it relates to an oral request, notated
in the patient's chart by whomever it is provided to, and signed
by the patient.
CHAIR WILSON drawing from her nursing experience said that a
request of this nature may be stated by a patient to an
attendant and witnessed by any available second party.
4:06:17 PM
REPRESENTATIVE ANDERSON directed the witness' attention to page
4, lines 26-31, and asked Dr. Norman to explain the addition of
sub-paragraphs (C) and (D).
DR. NORMAN addressed sub-paragraph (D), stating that this
language is to provide clarity in a situation where someone is
arriving in surgery for a reason unrelated to the condition for
which they have initiated a DNR order, and he provided an
example. Further, he said that sub-paragraph (C) addresses the
situation of a child being affected by whatever happens to the
mother.
MS. TUPOU added that sub-paragraph (C) provides clarity for
secondary conditions which are not related to the original DNR
order qualifying condition.
CHAIR WILSON hypothesized, "Like maybe they broke their arm and
it has to be set under anesthesia, ...."
4:09:09 PM
REPRESENTATIVE SEATON requested further clarity regarding how
the DNR order qualifying condition effects a secondary condition
that may arise.
DR. NORMAN stated that at issue is a doctor's ability to treat
whatever condition arises during a procedure, and to resuscitate
the patient appropriately. Currently, it is not clear who can
revoke a DNR order. If a patient requests that a DNR order be
revoked, the doctor would like to be able to correct anything
that is not related to the qualifying illness, such as an
anesthetic, or an error made with a scalpel. These are errors
which a doctor can rectify and then continue with the intended
procedure.
4:11:12 PM
REPRESENTATIVE SEATON asked how the language on page 3, lines 25
and 26, relates to the revocation of a DNR order.
DR. NORMAN defined a qualifying condition as an untreatable or
incurable disease, and provided examples.
4:12:18 PM
REPRESENTATIVE ANDERSON noted that there is a statutory
definition of what constitutes a qualifying condition.
TERRI BANNISTER, Attorney, Legislative Legal and Research
Services, Legislative Affairs Agency, read the statutory
definition of a qualifying condition which refers to a "terminal
condition" or a "permanent unconsciousness" in a patient, and
stated that statute also defines a "terminal condition", as well
as "permanent unconsciousness".
MS. TUPOU cited AS 13.52.160 for further details and clarity,
and deferred to John Dawson, who worked with the physicians in
drafting the bill.
4:13:56 PM
JOHN DAWSON, Attorney, Davis Wright and Tremaine Limited
Liability Partnership (LLP); Representative, Providence
Anchorage Anesthesia Medical Group, stated that he was
significantly involved in the preparation of the analysis and
also the drafting of the amendment.
4:14:27 PM
REPRESENTATIVE SEATON referred to page 4, lines 28-31, and asked
whether a person undergoing a procedure unrelated to the DNR
order qualifying condition, who looses vital signs during
surgery, could have the DNR order disregarded by the physician
and thus be inappropriately resuscitated.
MR. DAWSON confirmed Representative Seaton's understanding of
the language. He highlighted, however, that the language does
not require the physician to resuscitate, but rather that the
physician will not be held liable if he elects to resuscitate
under such circumstances.
4:16:28 PM
REPRESENTATIVE SEATON asked whether the language on page 3,
[lines 25 and 26] also allows the physician to make a unilateral
determination and disregard the DNR order.
MR. DAWSON stated:
If he [a physician] believes reasonably that the
patient does not have a qualifying condition, which is
defined in the statute, then that physician could
rescind the DNR order. ... As opposed to ...
performing cardio pulmonary resuscitation (CPR) in the
face of an order.
4:17:48 PM
REPRESENTATIVE SEATON asked that the qualifying conditions be
read once again.
4:18:01 PM
MS. BANNISTER read from statute [AS 13.52.390(42)]:
A "qualifying condition" means a "terminal condition"
or "permanent unconsciousness".
(42) "terminal condition" means an incurable or
irreversible illness or injury
(A) that without administration of life-
sustaining procedures will result in death in a short
period of time;
(B) for which there is no reasonable prospect of
cure or recovery;
(C) that imposes severe pain or otherwise imposes
an inhumane burden on the patient; and
(D) for which, in light of the patient's medical
condition, initiating or continuing life-sustaining
procedures will provide only minimal medical benefit.
MS. BANNISTER responding to further inquiry, stated that someone
who is aged, exhausted from life, and ready to pass, would not
qualify under statute to hold a DNR order.
4:20:10 PM
REPRESENTATIVE CISSNA referred to page 2, lines 7-17, and stated
that this section appears to be contradictory.
CHAIR WILSON pointed out that this section represents current
statute, and pertains to patients "in the case of mental
illness" where a guardian or other third party is involved, and
needing to make decisions for the principal [patient].
MS. TUPOU confirmed that this section sets forth a decision
making process for a patient who is deemed to be incompetent.
4:23:56 PM
MR. DAWSON stated that this bill does an excellent job of
remedying a number of significant issues that were raised by the
original statute, which, given the situations faced daily by
health care professionals, effectively requires doctors to make
legal decisions.
4:25:13 PM
CHAIR WILSON requested further clarity regarding when a doctor
can override a DNR order.
MR. DAWSON provided two examples to illustrate key decision
situations, which a doctor may be faced with: A patient who
holds a DNR order for a terminal cancer condition, and who
arrives in need of a medical procedure for an acute reaction to
a bee sting, which requires resuscitative measures; and when a
surgeon's own actions precipitate a problem such as an
anesthesiologist administering too much medication, requiring a
reversal of procedure. He opined that in either of these
situations the physician should be able to take life-sustaining
actions, as provided for in HB 442.
4:27:04 PM
REPRESENTATIVE GARDNER requested further clarity on whether a
family member, of an infirm patient, could insist that a DNR
order be upheld over the physician's desire to recover from an
error, thus negating the DNR order.
4:28:01 PM
REPRESENTATIVE ANDERSON asked whether there is a delineation
between surgical procedures which may require resuscitation, and
being sustained on a life support system.
MS. TUPOU said that this bill provides permissive language,
which allows for appropriate medical action based on "a good
faith belief".
4:29:25 PM
REPRESENTATIVE SEATON expressed his concerns that this language
continues to impose legal decisions on the physician.
Furthermore, he stated that when a physician chooses to ignore
the desire of a patient by rescinding a DNR order for any
reason, it is a violation of the patient's wishes. He said, "I
don't think that's where we want to be."
CHAIR WILSON pointed out that a permit is signed prior to
surgery which provides for certain assumptions of procedure
while a patient is undergoing anesthesia. However, current law
is not clear when a doctor is to be held liable and in violation
of a DNR order, if they resuscitate for certain circumstances.
4:31:48 PM
DR. NORMAN confirmed that two separate contexts are being
addressed here namely, the OR surgical release, and the DNR
order for a qualifying condition. He explained:
The decision of what we are going to do in surgery is
made before we enter the operating room. [As] pointed
out ... where the person did not want to have anything
done no matter what, that was honored. If the person
says I want to have anything done that's not related
to my illness, if I have ... a cardiac arrest or if I
have one of these events I want you to resuscitate me.
I don't believe the intent of the law is to change
your plan of attack after you're already in the
operating room, ... before we start we have rules of
engagement established. We're trying to clarify what
those rules are, ... these things are gray areas, and
we're trying to change that.
4:33:05 PM
REPRESENTATIVE SEATON said that if a patient has signed a
surgical order which stipulates resuscitative measures are to be
taken, then that would negate the implementation of a DNR order.
However, this language allows a doctor to make an independent
decision outside of these established qualifications.
4:33:38 PM
MR. DAWSON highlighting the crux of the issue, stated:
If a physician is not permitted to correct his mistake
... the fact [that] there's a DNR order in place, does
not mean that the physician can't be sued for
malpractice .... So you've put the physician in the
untenable position of ... [not being] allowed to
correct his own error, and yet he can then be sued by
the family for that error. There does seem to be
something unfair about that. ... When somebody goes
into surgery, ... the game plan is to bring them out
of surgery. ... It seems ... to be against medical
practice and medical common sense to suggest that, if
somebody because of something the surgeon does, is put
in a position where they need CPR, that ... the
physician should be helpless to ... [perform a
corrective procedure]. Obviously, the patient hopes
to be able to come out of this surgery ... and the
physician expects to be able to do his job without
being afraid of being sued. ... It's important to
remember that we're only talking about patients with a
qualifying condition, and ... dementia [previously
mentioned] ... is not in fact a qualifying condition.
... The places where this is going to come up are
going to be very few, and ... in those places we ought
to err on the side of good medicine. ... That's ...
what the doctor's who are hoping to see these changes
come about ... are hoping that the legislature will
look to: what's good medicine; what makes practical
sense when we're trying to actually minister to
patients.
4:35:36 PM
REPRESENTATIVE GARDNER restated her concern, that if a conflict
should arise for the physician, for philosophical or liability
reasons, that his/her needs should not "trump the express desire
of the patient and the patient's family."
MR. BROOKS explained that an ethical matrix exists to ensure
that a physician is chosen who is able to go into surgery and
appropriately honor the patient's or the guardian's wishes.
Furthermore, this occurs everyday, and upholding DNR requests is
a priority in the profession, he said.
REPRESENTATIVE GARDNER pointed out that what Mr. Brooks does in
his own practice may not be what is upheld across the board, and
therein lies the importance of passing this legislation.
4:38:31 PM
CHAIR WILSON announced that HB 442 would be held in committee to
allow for further testimony and amendment opportunities, prior
to moving it to the Judiciary Committee.
4:40:25 PM
^OVERVIEW(S)
^ALASKA MENTAL HEALTH BOARD: ADVISORY BOARD ON ALCOHOLISM AND
DRUG ABUSE (ABADA)
CHAIR WILSON announced that the final order of business would be
a presentation by the Advisory Board on Alcoholism and Drug
Abuse (ABADA).
4:42:07 PM
JIM DUNCAN, Chairman, Advisory Board on Alcoholism and Drug
Abuse (ABADA), introduced the presentation for the Alaska Mental
Health Board (AMHB) by the Advisory Board on Alcoholism and Drug
Abuse (ABADA), and stated that over 54,000 Alaskan's are
impacted by drug and alcohol use, as reported by a recent
McDowell Group survey, provided in the committee packet.
LONNIE WALTERS, Chief Petty Officer, Naval Retiree; Vice Chair,
Advisory Board on Alcoholism and Drug Abuse (ABADA); President,
Substance Abuse Directors Association; Executive Director of
Communities Organized for Health Options on Prince of Wales
Island (COHO), provided a personal history of his experience as
a long-term alcoholic, and he described the four treatment
processes that he participated in during his 22 year career in
the Navy. Referring to his alcoholic experiences and the
subsequent 24 years of sobriety , he said:
Treatment works; it may not always work the first
time, but it works. ... I didn't get a choice, I was
coerced into treatment. ... I hear ... people say that
treatment doesn't work if it's coerced. Of course it
... works if it's coerced. ... I was able to change
and ... go into sobriety.
MR. WALTERS listed the tragic alcoholic history in his immediate
family and reported that he has raised two children who are not
substance abusers, thus breaking the cycle. He stressed the
importance of treatment and the profound impacts that treating
an alcoholic has on the family and acquaintances of the treated
alcoholic. Further, he stated:
I was ... told to ... tell you what works. Treatment
works, prevention works, support for treatment works.
I don't only need money, I need emotional support;
people on this hill ... talking about this as a
disease, not as a social problem, not as a moral
problem, but as a disease.
4:46:53 PM
MR. WALTERS continued with an analogy of alcohol prevention and
other industries, which have had success with prevention
programs such as tobacco and dental health. He stressed that
for prevention to work, a program must be sustained and on-
going. Additionally, he said, treating substance abusers
locally is more cost effective than sending them to jail or to
out-of-state for treatment facilities.
4:48:51 PM
MR. WALTERS provided an example of three substance abusers whom
he has worked with on Prince of Wales Island. These three
clients have appeared in court on 52, 56, and 45 different
occasions and represent a combined 21 years of prison time. He
reported that each have attended a residential program, Nugent's
Farm, Wasilla, Alaska, and following that treatment have
incurred no further costs to the state. He pointed out the cost
effectiveness of providing the one and a half years of treatment
versus court and incarceration costs expended on these
individuals. Despite these type of success stories, he said
that there continues to be a reduction of treatment capacity in
Alaska. He stated:
We even have a phenomenon now that didn't happen when
I was a counselor and moved to Alaska. ... We are
losing counselors to the lower 48 because they're
paying better in the lower 48. ... For 15 years, since
I've been in this field in Alaska, we haven't had an
increase in our budget, we've even had decreases. We
haven't even had a cost of living increase. ... The
myth is ... you have to want treatment for it to work;
that's absolutely untrue, you don't have to want it.
You have to get in the doors. Once you get in the
doors it's the counselor's jobs to make you want it.
4:50:47 PM
REPRESENTATIVE SEATON referred to a presentation provided by the
Petersburg Mental Health Services (PMHS) [HESS meeting 1/16/06].
Recalling a young testifier who was asked to compare substance
abuse experiences in Utah versus Petersburg, he said:
His comment was that [underage] alcohol [use] was much
more tolerated ... [in] Petersburg than ... in Utah.
... The attitude among adults here was that they're
going to it anyway so it's OK, and [adults] would buy
booze for [teens]. ... There seems to be an attitude
shift ... that needs to take place not just treatment
of individuals, but ... individuals are picking up
cues of what's acceptable from their community. ... It
was quite revealing ... it was alcohol which was ...
basically accepted among the members of the community
for underage people to participate in .... It's a
tough thing to figure out where the prevention line on
this is too, and how we get there ... with the
attitude shift.
4:52:48 PM
MR. DUNCAN stated that, although funds are limited, prevention
is a target area for ABADA, and to that end "inroads" are being
made. He reported that 25 percent of Alaska's population does
not drink, however, he said that ABADA has focused outreach into
the rural areas of the state where alcohol abuse is at "crisis"
level.
4:54:27 PM
CHAIR WILSON provided a personal story of alcoholism in her
family, and she said:
We made inroads with ... smoking and heart disease ...
because people in society started changing their
philosophy. ... When I look at the numbers, 54,000
Alaskans, and how many times do we put them through
[rehabilitation programs] ... it's an impossibility.
We have to find ... ways to help it work because we
don't have the money to do it. [Alaska] is number one
in ... alcohol related problems. ... Economically,
it's very, very difficult.
4:55:41 PM
REPRESENTATIVE GARDNER referred to current youth prevention
programs, such as "Protecting You, Protecting Me" (PY/PM)
[Mother's Against Drunk Drivers (MADD) elementary curriculum
program] and "Drug Abuse Resistance Education" (DARE). Although
these are high profile programs, she questioned their
effectiveness, and asked whether Mr. Duncan could offer
suggestions for outreach programs, which he would consider
beneficial for youth and elementary age children.
MR. DUNCAN opined that peer generated programs are especially
helpful, but he said that gaining access to the schools can be
difficult. The schools are understandably cautious to engage
new programs.
CHAIR WILSON pointed out that the communities youth corps has
been a successful program.
4:57:36 PM
CARL WEBB, Ketchikan School Board, introduced himself as a
recovering alcoholic and a treatment program alumnus. He said:
I believe if we could implicate prevention and
education in ... [kindergarten] through sixth [grade]
throughout the state it's going to be huge in keeping
these students ... from using drugs and alcohol. ...
It's been proven ... that children and students who
don't use drugs and alcohol and tobacco ... are less
likely to have problems with [substance abuse] in
their productive lives.
CHAIR WILSON described her experience as a school nurse
providing smoking prevention classes for first through third
grade classes. She said that using the visual of a doll
breathing in smoke was a helpful visual aid, but conceded that
it would be difficult to illustrate the effects of alcohol in a
similar way.
4:59:59 PM
REPRESENTATIVE SEATON offered that the adults who counsel the
children not to drink, do not provide a personal model of
abstinence, thus the young child receives a mixed message. He
pointed out that community events often include alcohol, as well
as other public gatherings, which may highlight activities such
as wine tasting. He maintained that it becomes confusing for a
young person, when two different messages are being modeled.
5:01:12 PM
MR. WEBB underscored the need for the adults of the community to
set the right example. To this end the Ketchikan School Board
recently did a voluntary drug test for the school district
staff. He reported that one member of the board challenged the
effectiveness of such role setting, expecting that the gesture
would essentially go unnoticed by the students; however, the
member was proven wrong when the community's youth appeared in
numbers at a subsequent board meeting to testify. Further, he
said that since being in treatment and becoming sober, he has
been able to pay restitution to the state for the costs he
incurred, and has also become a productive member of society.
5:02:51 PM
REPRESENTATIVE CISSNA offered that, with the availability and
acceptance of alcohol, it is important to get to the grass roots
to change a culture that values drinking.
5:04:10 PM
MR. DUNCAN directed attention to the graph in the committee
packet titled Funding Sources for Alaska Substance Abuse
Spending, prepared by AMHB/ABADA, 2/22/06, He pointed out that
the majority of funds in the last two years have been received
from alcohol taxes, and the federal government. The state
funding has not been increased, which has prevented the addition
of treatment programs within the state. He said that only two
long-term programs exist, Nugent's Ranch of Wasilla, and Akeela
in Anchorage.
CHAIR WILSON asked what the lengths of the long-term programs
are and what the resident capacity is for these two facilities.
MR. WALTERS provided that Nugent's Ranch has a one year program.
ROSALIE NADEAU, Executive Director, Akeela Drug and Alcohol
Treatment Services, interjected that the Akeela program extends
to a maximum of two years. Further, she said that the facility
has 48 beds, but the funding provides for 20 beds.
MR. WALTERS agreed that an attitude shift in our entire
population is required to effect change. He said:
I do a lot of public speaking and every time I go any
place in Alaska and I say, "Why do you think there is
so much drinking in Alaska?" ... Every single group
will tell me, "There's nothing to do." ... I always
back that up with, "Well, why is there so much
drinking in New York, or San Diego, or Los Angeles, or
Las Vegas, where there's everything in the world to
do.
5:07:23 PM
REPRESENTATIVE GARDNER asked to follow-up on whether the
Ketchikan School Board took the drug test.
MR. WEBB responded that several did, not everyone, and he
reported that the gesture was viewed by the public in a positive
way. Ketchikan is one of the few communities which requires
that student activity participants submit to random drug tests,
as a means to promote abstinence; a positive example for the
aspiring athletes in the lower grades.
5:09:41 PM
VERNER STILLNER, MD, Specialist, Alcohol and Drug Dependencies,
Psychiatrist, Bartlett Regional Hospital; Member, Advisory Board
on Alcoholism and Drug Abuse (ABADA), stated:
We have no money. There is a $19 million amount right
now in the alcohol tax that could be used for
prevention ... and treatment efforts. When that bill
passed a couple of years ago ... it was to supplement
the current activities. Unfortunately, those monies
have been used to supplant current activities. It is
an attitudinal issue in my mind, ... not only in the
general public, but in the legislature, towards
prevention and treatment of Alaska's number one public
health problem. And I also think that no other state
can boast $30 billion in their coffers. [Thus], if we
are not able to deal with this issue, I don't know who
will. I urge your committee to investigate the use of
these monies, and use them as they were intended, even
though they cannot be designated .... Also, the
wholesale taxes have not been increased on spirits
since statehood, and they're also capped at a very
unreasonably low number, so there's another source of
new revenue ....
5:11:15 PM
CHAIR WILSON invited the gallery to attend the House Finance
Committee meeting, at 7:00a.m., 2/24/06, where $20 million would
be taken out of the governor's budget; primarily affecting
prevention programs across the state.
CHAIR WILSON announced that she would turn the gavel over to
Vice Chair Seaton for the remainder of the ABADA overview.
VICE CHAIR SEATON clarified the meeting to be the HESS Finance
Subcommittee, at 7:00a.m., in room 519 of the Capital building.
5:12:51 PM
MS. NADEAU, stated that Akeela provides a significant prevention
programs and a long-term program, and she said:
Prevention has been decimated already to a large,
large extent. We ran a primary substance abuse
library [providing] ... documents ... to programs
throughout the state. It has operated for twenty
years. This year the department refused to fund it.
... That library ... no longer exists; ... it was part
of our prevention funding and it disappeared.
MS. NADEAU described the Strengthening Families program, which
is a nationally tested, recognized, and respected model aimed at
dealing with families at risk who have children age 6-12. She
stated, "It's a great program; we've less than $100,000 in that
program so it's a kind of intensive program without a lot of
money to it." The Primed for Life program, she explained is
aimed at school age children, which Akeela administered
throughout the Anchorage school district, as did Volunteers of
America (VOA). Due to funding cuts, Akeela now operates the
Primed for Life program on a minimal basis, in a district with
50,000 children; however VOA continues to provide these
services.
MS. NADEAU stated that Akeela provides services "in 18 rural
communities ... with a program that's not funded by the state."
She explained that Akeela has subcontracted with an outside
institute for research and evaluation, and she stated:
What we're doing ... is looking at what we're calling
legal, harmful products, and that would be the kid
whose inhaling; those kinds of activities. We started
out with programs aimed at the communities, [and] with
a community organizer. ... We now are in the second
phase of that, which is in the schools. So we are
dealing with the superintendents in all of those
communities. ... It'll be about a five year project.
When we complete it, we're going to be able to provide
some data about what does and does not work with this
program.
5:17:05 PM
MS. NADEAU stated her understanding that state funding can be
based on outcome data and she said:
I have [a] great hope that ABADA is going to step into
... a leadership void in what needs to happen in
[that] area. ... I know ... that lack of outcome data,
... 'are we throwing good money after bad,' fears are
there, and so I think it's incumbent upon us. But one
of the messages that I want to bring to you is [that]
those of us who are individual providers have very
little control over that. That is a state bureaucracy
kind of issue. I can tell you what my program does.
I can tell you the severity of the illness of the
people who come into my treatment program. I can tell
you what they're doing as they're released and for
about a five year period. I can't tell you what's
going on statewide, because I don't have access to
that. You don't fund individual programs, you fund a
state department.
MS. NADEAU opined that the $20 million in budget cuts, are in
part frustration that the legislature's not receiving outcome
information and stated:
That kind of cut, although it may be aimed at
delivering a message to the department, ... is a cut
at the local provider level. When that cut comes to
me, I cut my Strengthening Families program; a
nationally tested, respected, and revered ... program.
... I urge you to share that message with your
colleagues ... [to] find another way to hit somebody
other than the small provider over the head with a big
stick, because we're the ones on the front line[s]
trying to help folks.
MS. NADEAU directed attention to the committee's packet, and the
new McDowell Group study. She compared the funding figures of
the current one page summary with the figures on the previous
summary, prepared in 2001. Referring to the static figure for
public assistance, she opined that the figure has not changed
over the past five years because of the state having placed a
cap on welfare. However, she said:
It's not getting less expensive to provide this kind
of service, and to pay for not providing it. We pay a
lot more for not providing it than we do for even what
somebody may regard as 'failure to follow through with
legislative intent' from the department. Please talk
to your colleagues about finding another way to get
that message in.
5:21:33 PM
FRED GLENN (ph), provided a personal history of raising a child
in a small community where drinking was touted as acceptable by
the child's peers. He explained that despite the failure of his
counseling the child subsequently became a successful graduate
of the DARE program.
5:24:00 PM
KAT MCELROY, Clinical Supervisor, Substance Abuse Treatment
Service, Railbelt Mental Health Addiction; Member, Advisory
Board on Alcoholism and Drug Abuse (ABADA), as a recovering
third generation alcoholic she provided a brief history, praise
and gratitude for the state mandated intervention programs,
which eventually lead to her recovery. She said:
I pay taxes today. I can't tell you how wonderful it
is not to have to be a recipient for food stamps. To
not have to be a recipient for energy assistance. To
not have to be a person who lives at the expense of
the state, but as a person who is able to work and
support themselves. My daughter ... is a mother of
three. She does not drink, and she does not smoke,
and she does not get in trouble with the law. ... I
think that is a direct result of my treatment ... and
of the prevention programs that were in place during
her formative years.
MS. MCELROY said that every year which she has worked as a
substance abuse counselor for the state, the funding has been
"cut, cut, cut," and yet the agency has been asked to provide
more assistance "with less and less." She stated:
In the jails today ... we do not provide treatment for
the captive audience. ... People are in jail, they
aren't going anywhere, let's talk to them about what
got them there. ... It certainly has to be more cost
effective than what we're doing; that cycling in and
out of those jails, and mental hospitals, and other
emergency rooms, and detox [units]. Everybody says
that we can't afford treatment, but we can't afford
not to provide treatment.
MS. MCELROY described an incident as a counselor with a seven
year old child in Nulato, who was able to detail the makings of
home brew. Further, the child related what would happen when
the "hootch" was ready for consumption; she would hide as "all
hell breaks loose in her home. She said that despite the heart
break of these tragic stories, she carries a message of hope
when she speaks with children, because their lives don't need to
be like those of their parents. She stated:
It's important that we put our money to that avail.
It's important that we make that decision, and it's
important that we have our voices be heard. That
we're not talking about dollars and cents, we're
talking about people's lives. ... The money that we
spend on treatment, intervention, and prevention
services will [be] pay[ed] back to the state ten times
over. ... I'm living proof to that.
REPRESENTATIVE GARDNER stated, "I just want to stand up and
applaud you."
5:29:02 PM
VICE CHAIR SEATON stressed the importance and helpfulness of
everyone's testimony.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:29:02 PM.
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