03/17/2015 01:30 PM Senate LABOR & COMMERCE

         SB  14-EMERGENCY MED. SERVICES; DEFIBRILLATORS                                                                     
                                                                                                                                
1:33:42 PM                                                                                                                    
CHAIR  COSTELLO announced  the consideration  of  SB 14. "An  Act                                                             
relating to the appointment of  a mobile intensive care paramedic                                                               
to  the   State  Medical  Board;   relating  to   medical  review                                                               
organizations;  relating  to  immunity  pertaining  to  automated                                                               
external defibrillators; and providing for an effective date."                                                                  
                                                                                                                                
SENATOR  JOHN  COGHILL,  sponsor  of  SB  14,  stated  that  this                                                               
legislation  adds a  paramedic  to the  State  Medical Board  and                                                               
gives emergency  medical service  (EMS) agencies  protections for                                                               
peer review  activities. He deferred further  introduction to his                                                               
staff.                                                                                                                          
                                                                                                                                
1:35:23 PM                                                                                                                    
SENATOR GIESSEL joined the committee.                                                                                           
                                                                                                                                
JORDAN SHILLING, Staff,  Senator John Coghill, stated  that SB 14                                                               
does three  things: 1) it adds  a paramedic to the  State Medical                                                               
Board; 2)  it add EMS agencies  and fire departments to  the peer                                                               
review statutes;  and 3)  it repeals  problematic language  in AS                                                               
09.65.087, the automated external defibrillator statutes.                                                                       
                                                                                                                                
He reviewed the bill sections and  the rationale for the bill. He                                                               
explained  that the  State Medical  Board regulates  five medical                                                               
professions   in  Alaska   -  physicians,   osteopathic  doctors,                                                               
physician  assistants  (PA),  podiatrists,  and  paramedics.  The                                                               
board  has five  physician seats,  one  PA seat,  and two  public                                                               
seats. Paramedics have been regulated  by the board for more than                                                               
30  years  and the  sponsor  feels  that giving  this  distinctly                                                               
different profession a seat is  long overdue. Despite the lack of                                                               
representation, the board  plays a significant role  in the lives                                                               
of paramedics  by disciplining, levying  fines, and  making final                                                               
licensing  decisions.  Adding  an   EMS  seat  will  broaden  the                                                               
perspective of  the board  and add  the expertise  of prehospital                                                               
medicine.  He  reported  that  there  are  currently  463  active                                                               
paramedics  in Alaska.  These  professionals,  the State  Medical                                                               
Board, and the five physicians that  sit on the board support the                                                               
legislation.                                                                                                                    
                                                                                                                                
SENATOR COGHILL  asked Mr.  Shilling to  discuss the  peer review                                                               
process.                                                                                                                        
                                                                                                                                
MR. SHILLING explained that peer  review is a rigorous evaluation                                                               
process that healthcare organizations  use to monitor and improve                                                               
patient care.  Hospitals generally  have a peer  review committee                                                               
to  look  at  patient  documentation,  review  reports  and  give                                                               
feedback, all  of which is  statutorily protected  from discovery                                                               
in a civil  trial. This is an important  protection that promotes                                                               
honest, candid  feedback. All 50  states provide  this protection                                                               
and many are  adding it for EMS agencies because  they go through                                                               
the  same  rigorous evaluation  process.  The  sponsor feels  EMS                                                               
agencies should be extended the same protection as hospitals.                                                                   
                                                                                                                                
MR. SHILLING read a statement from a national EMS assessment.                                                                   
                                                                                                                                
     For EMS systems  to be used to  their maximum potential                                                                    
     with  respect to  performance improvement,  peer review                                                                    
     protection is required and should  be the goal of every                                                                    
     state.                                                                                                                     
                                                                                                                                
He highlighted that a group  of EMS experts last year recommended                                                               
that the legislature provide  statutory protection from discovery                                                               
for quality improvement activities related  to EMS care. The bill                                                               
provides this protection in Sections 2-4.                                                                                       
                                                                                                                                
1:41:24 PM                                                                                                                    
SENATOR STEVENS  asked if  paramedics would be  in a  position to                                                               
make a disciplinary licensing decisions about a physician or PA.                                                                
                                                                                                                                
MR. SHILLING answered yes.                                                                                                      
                                                                                                                                
SENATOR STEVENS  asked if paramedics  would be  comfortable being                                                               
in that position.                                                                                                               
                                                                                                                                
MR. SHILLING answered yes.                                                                                                      
                                                                                                                                
SENATOR COGHILL  clarified that the  paramedic member  would have                                                               
one vote, the  physicians would have five votes, the  PA one vote                                                               
and the public member one vote.                                                                                                 
                                                                                                                                
SENATOR GIESSEL  asked if paramedics have  been misrepresented or                                                               
if disciplinary action has been inappropriate.                                                                                  
                                                                                                                                
1:43:55 PM                                                                                                                    
MR. SHILLING replied he has  anecdotal evidence that not having a                                                               
voice has negatively affected the  profession and some paramedics                                                               
personally.                                                                                                                     
                                                                                                                                
SENATOR COGHILL added that the  unique circumstance of paramedics                                                               
isn't addressed to their satisfaction.                                                                                          
                                                                                                                                
1:45:17 PM                                                                                                                    
CHAIR COSTELLO asked  if adding a paramedic to  the State Medical                                                               
Board follows a national trend.                                                                                                 
                                                                                                                                
MR. SHILLING  replied he hasn't  reviewed what other  states have                                                               
done, but  Alaska is somewhat unique  in that EMTs are  under the                                                               
purview of the  Department of Health and  Social Services (DHSS),                                                               
whereas paramedics  and physicians are  under the purview  of the                                                               
State Medical Board.                                                                                                            
                                                                                                                                
CHAIR COSTELLO  asked if the  physicians on the board  have given                                                               
verbal or written support for the legislation.                                                                                  
                                                                                                                                
MR.  SHILLING  advised  that  on   January  13  the  board  voted                                                               
unanimously to  support this concept  and wrote a letter  to that                                                               
effect.                                                                                                                         
                                                                                                                                
CHAIR COSTELLO  asked him  to describe the  value of  making this                                                               
change,  and if  he'd  heard any  arguments  for maintaining  the                                                               
status quo.                                                                                                                     
                                                                                                                                
MR. SHILLING  said the value  is having someone  with prehospital                                                               
expertise  being  involved  in discussions  that  regulate  their                                                               
profession. The  sponsor's office has heard  mild opposition from                                                               
the  Alaska  State  Medical Association,  just  as  they  opposed                                                               
giving  PAs a  seat  a  few years  ago.  Their  suggestion is  to                                                               
designate one of the public seats as public or paramedic.                                                                       
                                                                                                                                
CHAIR COSTELLO  noted the  letter from  the Alaska  State Medical                                                               
Association that was  just distributed. She asked  the sponsor to                                                               
respond to the suggestion Mr. Shilling described.                                                                               
                                                                                                                                
SENATOR COGHILL  said he  sees equal value  in having  people who                                                               
are not  in the industry on  a board and those  who are regulated                                                               
by the board.                                                                                                                   
                                                                                                                                
1:50:38 PM                                                                                                                    
CHAIR COSTELLO opened public testimony on SB 14.                                                                                
                                                                                                                                
1:51:06 PM                                                                                                                    
THOMAS MEYER, President, Paramedic  Association of Alaska, voiced                                                               
support  for  adding  a  paramedic to  the  State  Medical  Board                                                               
because they  currently do not  have representation.  The board's                                                               
terms of  initial licensure requirements, the  terms of renewals,                                                               
and disciplines are among if  not the strictest and most punitive                                                               
in the country. Mobil Intensive  Care Paramedics (MICPs) permeate                                                               
the  system  in   vital  areas  for  emergency   care.  They  are                                                               
firefighters  responding to  medical and  fire emergencies;  they                                                               
provide emergency  services in industrial  and remote  sites; EMT                                                               
teachers are almost  all paramedics; they are  in law enforcement                                                               
special operations;  SWAT and field  officers are often  EMTs and                                                               
paramedics; para rescuers working for  the Air National Guard are                                                               
MICPs; the  U.S. Coast  Guard has MICPs  licensed in  Alaska; and                                                               
air medivac services require an MICP on board.                                                                                  
                                                                                                                                
CHAIR COSTELLO asked  if he could support the  statement that the                                                               
State Medical Board is the most punitive in the country.                                                                        
                                                                                                                                
MR. MEYER  replied the national  registry of state  medical board                                                               
actions and fines  on these licensees shows that  Alaska has been                                                               
in the top five most punitive for many years.                                                                                   
                                                                                                                                
1:55:31 PM                                                                                                                    
DON HUDSEN,  MD., Anchorage, Alaska,  said he's an ER  doctor who                                                               
has worked as  a medivac in remote areas of  Alaska, as a medical                                                               
director, and with  several paramedic schools. When  he served on                                                               
the  State Medical  Board it  was disconcerting  to see  that the                                                               
members really didn't  know what paramedics did for  a living. He                                                               
was pleased  when he saw the  bill come up because  he and others                                                               
have supported having a paramedic on the board since 1981.                                                                      
                                                                                                                                
1:57:25 PM                                                                                                                    
MITCH  FLYNN,  Fire  Chief,  Steese  Volunteer  Fire  Department,                                                               
Fairbanks, Alaska, stated  support for adding a  paramedic to the                                                               
State Medical  Board, but  expressed concern  that SB  14 doesn't                                                               
extend peer review protection to volunteer fire departments.                                                                    
                                                                                                                                
ROBERT  "MEL"  VOSTRY,   representing  himself,  Palmer,  Alaska,                                                               
testified  in support  of SB  14.  He has  been a  state-licensed                                                               
paramedic since 1984  and has been involved with  EMS since 1979.                                                               
He  explained that  the first  paramedics chose  to be  under the                                                               
purview of  the State  Medical Board in  the hopes  of eventually                                                               
attaining  a  professional  status.  The field  of  medicine  has                                                               
evolved in the  last 45 years and being a  paramedic is no longer                                                               
simply  serving on  an  ambulance.  They now  attend  a 1-2  year                                                               
university-level accredited  program. The State Medical  Board is                                                               
made up  of physicians and  most recently a  physician assistant,                                                               
and those professionals  may or may not know  anything about what                                                               
a paramedic does in the field or their level of education.                                                                      
                                                                                                                                
MR.  VOSTRY  said  he  values  the  stringent  requirements  that                                                               
paramedics  are held  to by  the Medical  Board, but  they should                                                               
have a voice.                                                                                                                   
                                                                                                                                
2:04:35 PM                                                                                                                    
KATHLEEN  MCLERON,   representing  herself,   Anchorage,  Alaska,                                                               
testified  in  support of  SB  14.  She  relayed  that she  is  a                                                               
licensed physician  assistant (PA) and a  licensed paramedic. The                                                               
State Medical Board regulates the  practice of PAs and paramedics                                                               
and she  was pleased  when PAs got  representation on  the board.                                                               
She  expressed  strong  support  for  giving  paramedics  similar                                                               
representation,  describing it  as a  logical next  step for  the                                                               
State Medical Board.                                                                                                            
                                                                                                                                
2:05:58 PM                                                                                                                    
CHAIR  COSTELLO found  no further  testifiers  and closed  public                                                               
testimony  on SB  14. She  invited Sara  Chambers to  explain the                                                               
fiscal note.                                                                                                                    
                                                                                                                                
2:06:42 PM                                                                                                                    
At ease from 2:06 p.m. to 2:07 p.m.                                                                                             
                                                                                                                                
2:07:43 PM                                                                                                                    
SARA   CHAMBERS,  Professional   Licensing  Operations   Manager,                                                               
Division of  Corporations, Business, and  Professional Licensing,                                                               
Department  of  Commerce,  Community  and  Economic  Development,                                                               
explained that  the fiscal note  reflects the  estimated addition                                                               
cost  for  travel for  the  State  Medical  Board. The  board  is                                                               
statutorily required to hold quarterly  meetings and has found it                                                               
benefits from face-to-face meetings  so it travels throughout the                                                               
state. Some of  the travel is to remote areas  to ensure that the                                                               
message is  clear that the voice  in rural Alaska is  valued. The                                                               
estimate, based  on past  travel expenses,  is $7,000  per person                                                               
per year.                                                                                                                       
                                                                                                                                
SENATOR  GIESSEL  pointed  out  that  this  falls  under  receipt                                                               
services, which means the board pays for it.                                                                                    
                                                                                                                                
CHAIR  COSTELLO  asked  what  the fees  are  for  paramedics  and                                                               
physicians.                                                                                                                     
                                                                                                                                
MS.  CHAMBERS  explained  that the  biannual  licensing  fee  for                                                               
paramedics  is $50  and physicians  pay $300  biannually. Receipt                                                               
supported  services  and  any  additional   costs  are  borne  by                                                               
licensees of the board.                                                                                                         
                                                                                                                                
CHAIR COSTELLO asked  if the board is operating in  the black and                                                               
if the fees will change.                                                                                                        
                                                                                                                                
MS.  CHAMBERS reported  that  at  the end  of  FY2014, the  State                                                               
Medical Board had a surplus of over $600,000.                                                                                   
                                                                                                                                
CHAIR COSTELLO  asked if  the licensing fees  are expected  to go                                                               
down or remain the same.                                                                                                        
                                                                                                                                
MS. CHAMBERS replied they will remain  the same this year but may                                                               
go up after  the next analysis, depending on whether  or not fees                                                               
from new licensees offset rising costs.                                                                                         
                                                                                                                                
CHAIR COSTELLO asked  if, in addition to  the regularly scheduled                                                               
meetings, the board meets on an as-needed basis.                                                                                
                                                                                                                                
MS. CHAMBERS confirmed  that all the boards in  the division meet                                                               
at the  will of the  board, while  adhering to the  Open Meetings                                                               
Act.  When  the board  deems  it  appropriate, a  mail  balloting                                                               
system can be employed.                                                                                                         
                                                                                                                                
SENATOR GIESSEL asked about the repeal language in Section 5.                                                                   
                                                                                                                                
2:11:54 PM                                                                                                                    
MR. SHILLING explained  that it repeals an  exception to immunity                                                               
related to automatic external defibrillators  (AED) if the use of                                                               
the  device is  not preceded  by employer-provided  training. The                                                               
sponsor believes  that the use  of an AED is  straightforward and                                                               
has  heard that  the  training requirement  tends  to inhibit  an                                                               
employer from having  a device on the premises.  This concern was                                                               
brought forward by the chief of the university fire department                                                                  
in Fairbanks who had noticed a decrease in the use of AEDs in                                                                   
public spaces.                                                                                                                  
                                                                                                                                
CHAIR COSTELLO held SB 14 in committee for further                                                                              
consideration.