Legislature(1993 - 1994)
03/15/1993 08:40 AM Senate FIN
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 71
An Act relating to emergency medical services; and
repealing obsolete references to the Statewide Health
Coordinating Council and health systems agencies.
Co-chair Pearce directed that SSSB 71 be brought on for
discussion and referenced a proposed amendment by Senator
Leman.
End, SFC-93, #37, Side 1
Begin, SFC-93, #37, Side 2
SENATOR LEMAN, prime sponsor of the legislation, came before
committee. He explained that the bill responds to last
fall's review of the state EMS program by the technical
assistance team of the National Highway Traffic Safety
Administration. The report contained a number of
recommendations, many of which are incorporated within SSSB
71.
Senator Leman explained that secs. 1 through 8 delete the
term "physician trained" as applied to paramedics. That
change acknowledges that training can be provided by
entities and persons other than physicians. The bill also
contains a number of deletions of obsolete references.
Key features of the legislation are that it will allow the
Dept. of Health & Social Services to set standards for
mobile intensive care paramedic training programs in Alaska.
Currently, paramedics must be trained outside the state.
The bill further allows the department to regulate voluntary
compliance by trauma centers.
A substantial amount of the fiscal impact relates to reviews
by "outside reviewers" for establishment of trauma centers
in Alaska. A mechanism is also included whereby hospitals
would pay a portion of the review cost.
The legislation also provides for a "patient care
information system" to accumulate data and allow for
evaluation of standards and quality of care.
Senator Leman next directed attention to Corrected Amendment
No. 1 (copy on file in the original SFC file for SSSB 71).
He explained that it relates to the composition of the
Alaska Council on Emergency Medical Services. The amendment
reflects a suggestion from the Southeast Regional EMS
Council. It provides that at least one of the three members
who are active as prehospital emergency care providers be
from a rural area of the state. Senator Leman acknowledged
that those engaged in EMS services in rural areas encounter
unique obstacles of which the Council should be aware.
In response to a question from Senator Jacko, Senator Leman
said that the Council would consist of eleven members:
1. Two physicians with emergency medicine or trauma
care experience.
2. A registered nurse with experience in emergency
nursing.
3. Three active prehospital emergency care providers.
4. An emergency medical services administrator.
5. An administrator of a hospital or Native health
organization.
6. Three consumers of emergency medical services.
Senator Leman reiterated that under the corrected amendment,
one of the three emergency care providers listed in
subsection 3, above, would be from a rural area.
Co-chair Frank expressed concern regarding the request for
two additional positions on the state payroll. He then
asked if proposed training could occur at the regional level
through nonprofits. Senator Leman said he had raised
similar questions. He further explained that, up to this
time, training services were provided per a federal grant
through the Public Health Service. That grant will expire
on October 1, 1993, and may not be renewed thereafter.
Further, much data will be flowing to the department from
twenty-five hospitals, for the patient care system. The
department will also have to coordinate reviews of hospitals
that could serve as trauma centers.
Co-chairman Frank questioned need for $60.0 for a research
analyst. Senator Leman deferred to staff from the
department.
Senator Kelly advised that he would support the proposed
amendment, but he voiced further need to point out "some of
the consequences of what we do." He then questioned the
wisdom of pulling perhaps the only qualified EMS medic from
a rural area to send him or her to a board meeting.
STEVEN O'CONNOR, Assistant Chief, Central Emergency
Services, Kenai Peninsula Borough, next came before
committee. He explained that he also serves as chair of the
Governor's Advisory Council on Emergency Medical Services.
The current council worked closely with state and regional
EMS offices to bring about the technical assistance review
team study. It has since moved on to support and
enforcement of recommendations from the study. SSSB 71 is
viewed as key legislation to bring the EMS system up to
date.
Speaking to accompanying fiscal notes, Mr. O'Connor termed
them "conservative," given systemwide potential for impact
on long-term health care costs. He urged support for the
legislation.
Co-chair Frank made reference to department movement of
funding from budgetary grant line items into administrative
functions. Mr. O'Connor said that he could not recall such
a transfer. Co-chair Frank noted requests from the EMS
regional councils for an increase to make up for previous
cuts. Mr. O'Connor acknowledged that regional directors
have asked for grant increments to support regional
activities. He attested to the fact that these councils
work hand-in-hand with the state EMS office.
In response to a comment by Senator Rieger, Mr. O'Connor
voiced his understanding that fiscal note costs relate to:
1. Implementation of the review system
2. Setting up of standards for hospital application
to become trauma centers
3. Recruitment of inspection teams for hospital audit
4. Establishment of the patient care information
system.
MARK JOHNSON, Chief, Emergency Medical Services, Dept. of
Health and Social Services, came before committee. Senator
Rieger inquired concerning the relative value of the patient
care information system when compared to hospital
certification. Mr. Johnson explained that the patient care
information system "is a way to evaluate what we're doing."
He acknowledged programs whereby the state spends
substantial sums without knowing whether or not the programs
work. The system will also highlight areas where additional
training is needed as well as define need for better
protocol in the flow and handling of patients. It assists
both hospitals and prehospital ambulance services with data
that tells them "how good a job they did." It also provides
information on the causes and severity of injuries that will
hopefully help prevent them in the future.
Mr. Johnson said there had been no movement of moneys from
regions to the department office. The two positions
requested in the fiscal notes are presently on staff and
will have to be laid off in the fall if funding is not
provided. The grant involved in the effort is four years in
duration and will stop at the end of that time. Department
staff works diligently to garner federal grants. Most of
that funding is passed through to the regions. Mr. Johnson
acknowledged need for increased funding at regional levels
to train medics for rural Alaska. He then requested that
committee members read the division's annual report which
summarizes state and regional activities.
Department staff has agreed to absorb some of the extra
duties under the proposed bill, such as certifying of
emergency medical dispatchers, establishment of standards
for paramedic training programs, etc.
In response to a question from Co-chair Pearce, Mr. Johnston
explained that information gathering has been ongoing since
1988. Information flowing to the division is returned to
hospitals and ambulance services in monthly or quarterly
reports. Injuries, like diseases, are in clusters. The
more that is understood about clusters, the better the
chance to prevent the injuries. Mr. Johnson pointed to an
ongoing study of commercial fishing injuries as an example.
Senator Sharp expressed reluctance to add positions,
previously funded under federal grants, to the state
payroll. He then inquired concerning whether the proposed
legislation would qualify as a safety program under ISTEA
funding. Senator Rieger advised that he had raised the
issue in the Dept. of Public Safety budget subcommittee.
The impression at the time was that it would qualify under
highway safety planning moneys.
Senator Kelly inquired regarding existing staff size. Mr.
Johnson explained that the EMS program is authorized 10
positions. There are currently 9 employees. Three are
under federal grants and might be gone by fall. Staff
supports EMS programs through establishment of standards
for training programs. It does all of the certifying and
provides technical assistance to regional councils, advisory
councils, and volunteer efforts. Staff recently prepared
and distributed a new medivac manual and a billing manual
for volunteer ambulance services. Division prepared
treatment guidelines help doctors keep up with state-of-the-
art treatments. Much effort is hands-on training.
Senator Jacko MOVED for adoption of Corrected Amendment No.
1. No objection having been raised, Corrected Amendment No.
1 was ADOPTED.
Co-chair Pearce then queried members concerning disposition
of the bill. Senator Sharp MOVED that CSSSSB 71 (Fin) pass
from committee with accompanying fiscal notes. Senator
Kelly raised OBJECTION to the fiscal notes. Senator Rieger
voiced his understanding that the committee is not obligated
to fund any fiscal note and could address the issue at
conference committee on the budget. He expressed further
skepticism concerning federal grants that lead to state
funded positions. Senator Kelly concurred. He suggested
that the funding of additional positions in times of tight
budgets often means that as money becomes tighter elsewhere,
centralized planners draw funds from other areas to maintain
the bureaucracy and keep new positions on. He further
suggested that portions of the bill requiring additional
staff be removed or that those activities be undertaken with
existing staff. Senator Rieger noted that federally funded
employees have been performing the work up to this time.
Senator Leman explained that March 16 has been designated
EMS day in the legislature. He voiced his hope to have the
bill on the floor in recognition of that designation.
Senator Kelly suggested that the bill be amended to make the
patient care information system permissive rather than
mandatory. The bill could then be moved from committee for
floor action, and the fiscal note could be dealt with at a
later time.
Senator Sharp WITHDREW his motion for passage of CSSSSB 71
(Finance). No objection having been raised, the motion was
WITHDRAWN.
Senator Kelly directed attention to Page 4, Line 19, and
MOVED to change "shall" to "may." That would provide
flexibility. If funding is available, the project could
proceed. Co-chair Pearce asked what changes the fiscal note
would incur as a result of the amendment. Mark Johnson said
he would still ask for the fiscal note. The division would
do whatever it could with the funding it receives. Co-chair
Pearce questioned whether the change from "shall" to "may"
would adequately address concerns raised by members.
Senator Leman noted that other sections and subsections may
require slight revisions as a result of the language change.
He specifically noted language requiring hospitals to
provide information to the department and questioned need
for that if the patient care information system is not to
proceed. Co-chair Pearce concurred in need to review all
sections prior to movement of the bill.
At the request of the Co-chair, Senator Kelly WITHDREW his
amendment. Ch-chair Pearce then directed that the bill be
HELD until the next meeting and asked that Senator Leman
work with Senator Rieger, chairman of the Health, Education,
and Social Services subcommittee, on proposed amendments to
satisfy fiscal concerns. Prior to conference on the
budget, members will also review the possibility of using
"helmet safety funds for education."
ANNOUNCEMENT
Co-chair Pearce advised that the Wednesday meeting would
begin at 8:30 a.m. SB 84 will be taken up at that time.
ADJOURNMENT
The meeting was adjourned at approximately 10:20 a.m.
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