Legislature(2005 - 2006)BELTZ 211
02/24/2005 03:30 PM Senate STATE AFFAIRS
| Audio | Topic |
|---|---|
| Start | |
| SB104 | |
| SB95 | |
| SB75 | |
| SB101 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 75 | TELECONFERENCED | |
| *+ | SB 101 | TELECONFERENCED | |
| = | SB 104 | ||
| = | SB 95 | ||
SB 75-PUBLIC HEALTH DISASTERS/EMERGENCIES
3:55:51 PM
CHAIR GENE THERRIAULT announced SB 75 to be up for consideration
and recognized Dr. Mandsager.
3:55:56 PM
RICHARD MANDSAGER, M.D., director Division of Public Health
stated he would explain why SB 75 is important, review problems
with current statutes, and briefly review the bill. He noted the
PowerPoint handout in the packets and said he would use that to
introduce the bill.
3:57:28 PM
Slide 2: A quote from the Institute of Medicine. "Public Health
is what we, as a society, do collectively to assure the
conditions in which people can be healthy."
SB 75 is about the governmental side of public health, he said.
One hundred years ago, public sewer and water systems were the
most important aspect of public health and following WW II the
concern was vaccinations to protection against preventable
diseases. In the last 25 years the focus has been clean indoor
air policies, removing lead from gasoline and paint, and
removing DDT from pesticides.
3:58:22 PM
Slide 3: Public Health is not health care; it's a focus on
populations rather than individuals and on prevention rather
than treatment. Government has a very real role in that
responsibility.
4:00:02 PM
Slide 4: Division of Public Health core services include:
infectious disease control; chronic disease control; injury
prevention; response to disasters; access to quality care; and
protection against environmental health hazards.
4:00:24 PM
Slide 5: Emergency preparedness does play a larger role in
public health since 911, but the more ordinary part is
infectious disease.
4:03:03 PM
Slide 6: Preparation weakness is the reasoning for SB 75 because
legal authority is inadequate to deal with public health threats
such as Sudden Acute Respiratory Syndrome (SARS) or Bird Flu.
Two thirds of public health funds are federal and problems are
increasing as the federal government shifts its priorities.
4:03:25 PM
Slides 7 and 8: Old Public Health Enemies and Traditional
Disease Control. In the past the public trusted government to do
the right thing but societal expectations have changed over time
and the public is somewhat suspicious of governmental
authorities and individual due process has become more an issue.
4:04:16 PM
Slide 9: The Next SARS. The tools need to be in place for quick
action to protect public health.
4:04:39 PM
Slide 10: Alaska Public Health Law Reform Proposal. Except for
tuberculosis control in 1995 and SARS control in 2003, most of
the current public health statutes date from Territorial days.
4:05:33 PM
Slide 11: The Proposed Solution - updated laws that provide: a
statutory framework that supports the public health mission,
services and role; clear authority for control of conditions of
public health importance; and modern due process provisions for
the protection of individual rights.
4:06:20 PM
Slide 12: SB 75 is the result of years of work and includes: the
definition of essential public health services; description of
the state's role in health protection and promotion; provisions
for clear authority for disease control through surveillance;
epidemiologic investigation and medical treatment; quarantine
and isolation; requires protection of individual due process
rights; and strengthens requirements for confidentiality and
data security.
4:07:16 PM
Slide 13: Discusses the amendments to SB 75.
4:07:41 PM
Slide 14: Speaks to separate sections of SB 75
4:08:20 PM
Slide 15: Tools are needed to protect public health, but that
must be balanced with due process.
4:09:04 PM
Slide 16: The constitutional constraints on public health powers
must satisfy four tests: public health necessity; reasonable
means; proportionality; and harm avoidance.
4:10:01 PM
Slide 17: Summarizes the limitations SB 75 has on governmental
powers. In particular, "An individual has the right to refuse
treatment and may not be required to submit to involuntary
treatment (AS 18.15.380).
4:10:44 PM
SENATOR WAGONER joined the hearing.
4:11:11 PM
Slide 18: Lists additional governmental limitations in the
balance between individual rights and common good. Point two
says, "The department shall isolate or quarantine by the least
restrictive means necessary to prevent the spread of disease (AS
18.15.385(b)(1))."
4:12:08 PM
Slide 19: Due process provisions are listed. The government must
be able to move quickly in cases of contagious disease, but the
individual needs a clear set of rights available if they feel
they are treated unfairly.
4:13:54 PM
Pursuant to conversations regarding further limiting the
government's role, two amendments are proposed. The first
deletes a provision to remove party status of parents of minors
from court proceedings when quarantine/isolation orders are
contested and the second addresses indirect court rule
amendments.
4:14:31 PM
SENATOR HUGGINS asked for clarification.
4:14:38 PM
DR. MANDSAGER suggested Mr. Branch from the Department of Law
respond.
4:14:44 PM
Slide 20: Evaluation by Trust for America places Alaska as the
only state in the U.S. that doesn't have statutory authority to
quarantine and respond to a hypothetical bio-terrorism attack
scenario.
4:15:14 PM
CHAIR THERRIAULT referenced the repealers in Section 12 and
asked for clarification.
DR. MANDSAGER said the repealers deal with the tuberculosis and
SARS statutes for the most part and SB 75 generalizes the
particular authorities and removes disease specific reference.
CHAIR THERRIAULT referenced the findings in Section 1 and
remarked he routinely drops findings. He noted there was nothing
compelling in (a) and little more in (b) and questioned the
necessity of including that section.
4:17:17 PM
DR. MANDSAGER responded since it makes no difference in the law
and because it is a statement of intent, it doesn't matter from
a legislative point. However, what these people do is important
and it does matter, he emphasized.
4:17:42 PM
CHAIR THERRIAULT suggested reading a letter of intent into the
record and that he would be happy to do so in the debate on the
Senate floor.
4:18:05 PM
CHAIR THERRIAULT asked Senator Elton whether he had separate
legislation to address proposed amendment 1.
SENATOR KIM ELTON replied he would like to return to the comment
made regarding page 2, line 8-10 to ask whether it might be
appropriate to keep that subsection.
CHAIR THERRIAULT admitted the justification was a bit stronger.
SENATOR ELTON remarked it is different than the other language.
CHAIR THERRIAULT agreed there might be a compelling need for
that section.
CHAIR THERRIAULT asked about Representative Wilson's amendment
related to embalming.
4:19:05 PM
DR. MANDSAGER responded the embalming language was inserted in
the Senate Health Education and Social Services (HES) Committee.
4:19:14 PM
SENATOR ELTON added it's on page 6, lines 17-20.
CHAIR THERRIAULT noted the second amendment relates to indirect
court rules and explained that it takes a two-thirds vote for
the Legislature to make court rule changes.
4:19:58 PM
SENATOR CHARLIE HUGGINS questioned why it is called indirect
court rule.
4:20:28 PM
DAN BRANCH Department of Law, explained that the Legislature
sometimes passes legislation that indirectly changes a court
rule and Legislative Legal attorneys felt the provisions of SB
75 would do just that.
4:21:23 PM
DR. MANDSAGER mentioned the suggested amendment to change the
party status for minors on the bottom of the page containing
Senator Elton's proposed amendment. He acknowledged it had been
an oversight to exclude parents from court proceedings.
4:21:53 PM
CHAIR THERRIAULT questioned whether that was included in the
version under consideration.
DR. MANDSAGER replied "that was put in the House version that's
not in the Senate version yet."
CHAIR THERRIAULT asked whether the Senate Health Education and
Social Services (HES) Committee took that up.
DR. MANDSAGER replied the issue came up after Senate HES took
action on the bill.
4:22:15 PM
CHAIR THERRIAULT asked Dr. Mandsager to explain the issue.
DR. MANDSAGER explained it doesn't make sense that parents can't
be present during court proceedings in situations when
quarantine/isolation orders are contested.
4:22:55 PM
SENATOR ELTON asked whether \G was the working document.
4:23:08 PM
CHAIR THERRIAULT replied the \G version came to the committee so
it is the working document.
4:23:15 PM
SENATOR ELTON asked if he would like a motion to adopt the
amendment.
CHAIR THERRIAULT indicated agreement.
SENATOR ELTON motioned to place a period after "minor" on page
15, line 13 and to strike the rest of the sentence. There being
no objection, Amendment 1 passed.
4:23:48 PM
CHAIR THERRIAULT noted there were no further questions for Dr.
Mandsager and he called Ms. Rarick.
4:24:16 PM-4:28:12 PM
ALICE RARICK, Alaska Public Health Association board member,
read a letter of support for SB 75 into the record.
CHAIR THERRIAULT called on Patricia Senner.
4:28:30 PM - 4:32:19 PM
PATRICIA SENNER, Alaska Nurses Association (ANA) representative,
testified in support of SB 75 but suggested some changes and
questioned how some sections interact with existing laws.
Because Section 18.15.387 refers to disease outbreaks only when
referring to quarantines and thereafter discusses
decontamination, the AMA suggests expanding the section to refer
to situations in which people are exposed to toxic substances.
AS 18.15.360 authorizes the department to request information
from individuals and inspect health care records maintained by
health care providers that identify individuals with other
conditions of public health importance. The AMA suggests that
authority is too broad.
AS 18.15.380 states that an individual may refuse treatment, but
the AMA suggests the individual should also accept personal
responsibility to the extent of taking measures to ensure that
others aren't infected.
4:32:30 PM
SENATOR ELTON referenced the right to refuse treatment and said
others addressed that point as well. He asked whether model
language suggested by the Christian Science Committee on
Publication for Alaska would address that concern. That language
states: "The provisions of this section do not apply to an
individual who objects to the testing, examination or screening
because of the individual's religious beliefs; provided, such
individual may be subject to isolation or quarantine under the
provisions of this Act."
4:33:22 PM
MS. SENNER agreed that a qualifier should be inserted and made
the point that measures short of isolation and quarantine might
be taken to prevent the spread of illness.
4:34:14 PM
CHAIR THERRIAULT asked Dr. Mandsager if he wanted to comment on
the suggestions.
4:34:32 PM
DR. MANDSAGER said the suggested language Senator Elton read
came as a result of religious concerns and he would like to
consider combining that with Ms. Senner's suggestion regarding
individual responsibility.
SENATOR WAGONER said he doesn't object to someone refusing
treatment for religious reasons, but he certainly thinks that
personal financial responsibility should be written into the
bill.
4:36:00 PM
DR. MANDSAGER said people should have the choice, but it ought
to be clear that the financial cost associated with that choice
would not be borne by the state.
CHAIR THERRIAULT asked about the other suggested modifications.
DR. MANDSAGER mentioned the highly toxic substances suggestion
and said he needed to think about that.
4:36:55 PM
CHAIR THERRIAULT asked about the broad authority related to
reportable disease or other conditions of public health
importance.
DR. MANDSAGER responded the ACLU suggested narrowing the
conditions of public health importance, but most issues that
become a great concern aren't clear in the beginning. At this
point it would be worrisome to narrow the definition. That being
said, DHSS is currently working on proposed amendments to raise
the bar for quarantine and isolation.
4:38:08 PM
CHAIR THERRIAULT referenced obesity.
DR. MANDSAGER agreed that narrowing for that type of condition
makes sense. "We shouldn't be going into health records for
those purposes. It ought to be ... a standard that is more than
just of interest."
CHAIR THERRIAULT agreed it should be tied to the spread of
infectious disease or something similar.
DR. MANDSAGER said they would work with that suggestion as well.
CHAIR THERRIAULT asked Mr. McCleod-Ball to testify.
4:38:49 PM - 4:42:20 PM
WES MCCLEOD-BALL, ACLU representative, announced he wouldn't go
over the testimony he gave in previous hearings on this topic,
but he would say they agree that the bill is needed to clarify
the state's authority in this area. They also agree it is the
Legislature's task to find the balance between protecting an
individual's right to privacy and protecting the public health.
The ACLU has four areas of concern. The first is the state's
scope of authority authorized in the bill. He suggested there
should be a higher standard for the exercise of the powers for
quarantine or isolation, forced testing, and government access
to individual medical records. They also have concern about
privacy as it relates to protecting private medical records. The
ACLU would like assurance that there are no negative impacts in
civil or criminal proceedings for individuals subject to
quarantine or isolation orders. Finally, they have concern about
procedural measures such as ex parte proceedings because they
see no reason why the subject should be excluded from those
proceedings.
CHAIR THERRIAULT noted the ACLU document was well organized in
its explanation of the four areas of concern and asked Dr.
Mandsager if he was working from the same document.
DR. MANDSAGER responded they are using two documents. One is
testimony submitted to Representative Wilson in the House Health
Education and Social Services Committee and a follow up document
suggesting line-by-line changes to the bill.
CHAIR THERRIAULT called on Mr. Johnson.
4:42:52 PM - 4:44:40 PM
NATHAN JOHNSON, Anchorage Municipal Health and Human Services
division manager, testified in support of SB 75 and read his
testimony into the record.
"The bill is important to the Municipality of Anchorage because
it clarifies the extent and scope of public health powers and
provides specific due process to protect individual rights."
CHAIR THERRIAULT asked Ms. Smith to come forward.
4:45:04 PM
BEVERLY SMITH, Christian Science Committee on Publications for
Alaska, said she watches for legislation that could erode
Alaskan's rights to pursue spiritual means for the prevention
and cure or disease according to the individual's religious
beliefs.
After reviewing the bill thoroughly they request the following
amendments: Add a new subsection (f) to Section 18.15.375 that
would read, "The provisions of this section do not apply to an
individual who objects to the testing, examination or screening
because of the individual's religious beliefs; provided, such
individual may be subject to isolation or quarantine under the
provisions of this Act." She justified the explanation by
reading the following into the record:
The purpose of the amendment is to provide for those
instances in which a person is unwilling to undergo
medical testing, examination or screening because the
person is relying on a religious non-medical method of
treatment for his or her health and well-being.
Christian Science is one of the religious non-medical
forms of treatment that relies on spiritual means
through prayer to heal illness, injuries and other
conditions. Christian Science has been systematically
practiced, quietly and successfully, in many Alaska
families for a century, sometimes through many
generations. The application of this religious non-
medical method of healing does not involve any type of
medical examination or screening. The experience of
those practicing Christian Science is that this
healing method has both preventative and curative
effects.
The amendment recognizes an individual's right of
self-determination, including the right to refuse
medical testing, examination or screening; however, it
also recognizes legitimate public health concerns by
providing that a person who refuses medical testing,
examination or screening because of religious beliefs
may be subject to isolation or quarantine.
The amendment language is based on similarly worded
provisions in Section 602 of The Model State Emergency
Health Powers Act (revised December 21, 2001; the
"Model Act"). The Model Act was prepared by The Center
for Law and the Public's Health at Georgetown and
Johns Hopkins Universities for the Centers for Disease
Control (CDC) to assist Governors and State
Legislatures and others in formulating emergency
health powers plans.
MS. SMITH noted she attached copies of the Model State Emergency
Health Powers Act and copies of statutes from other states that
contain the language suggested for the amendment.
4:48:33 PM
CHAIR THERRIAULT asked whether she had any comment on the issue
of who should bear the cost.
MS. SMITH responded she didn't have any prepared comments, but
the personal responsibility request is reasonable.
CHAIR THERRIAULT announced he would hold SB 75 in committee for
further work.
4:49:50 PM
SENATOR ELTON said this has been a refreshing process and he
appreciates Dr. Mandsager's efforts and approach.
4:50:17 PM
SENATOR HUGGINS said he doesn't like government to intrude on
people's lives, but neither does he want to find there is need
to revisit the issue after an epidemic or a terrorist attack.
CHAIR THERRIAULT acknowledged they would both have to work to
convince their constituents that they are working to strike a
balance.
4:51:45 PM
CHAIR THERRIAULT announced he would set SB 75 aside for further
work.
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