04/19/1995 09:02 AM Senate HES

                                                                               
                 SB 138 TUBERCULOSIS CONTROL                                 
                                                                               
 Number 374                                                                    
                                                                               
 CHAIRMAN GREEN introduced  SB 138  as the next order of business              
 before the committee.                                                         
                                                                               
 RUSSELL WEBB, Division of Public Health, said that tuberculosis               
 remains a serious public health problem in Alaska.  There have been           
 several serious outbreaks in the last year.  Current law makes it             
 difficult to combat tuberculosis and its threat to the public's               
 health.  He explained that tuberculosis is an airborne disease that           
 is easily spread by routine contact such as coughing in a confined            
 area.  Tuberculosis can be successfully treated, however, the                 
 treatment can be lengthy.  He specified that treatment can take 6             
 to 24 months and may require taking multiple drugs.  Some persons             
 may find it difficult to voluntarily complete treatment.  Mr. Webb            
 emphasized that it is critical to complete the entire treatment               
 because tuberculosis can develop a resistance to drugs.  He                   
 informed the committee that there are strains that are resistant to           
 all known antibiotics.  Therefore, someone who does not complete              
 treatment could possibly pass on a drug resistant strain to others.           
                                                                               
                                                                               
 Mr. Webb emphasized the importance of having the tools to ensure              
 that people who fail to voluntarily comply with treatment are                 
 required to comply with treatment.  SB 138 would provide such tools           
 and update the current law.  SB 138 would provide some                        
 constitutional safeguards for persons who are involuntarily                   
 required to comply with treatment.  He anticipated that quarantine            
 and isolation would be necessary in rare cases, however, when that            
 is necessary the ability to implement that is critical.  In                   
 conclusion, Mr. Webb reiterated the importance of SB 138 to Alaska            
 and the efforts to control tuberculosis.                                      
                                                                               
 SENATOR LEMAN asked if there were other diseases such as                      
 tuberculosis where this type of action, quarantine, may be                    
 necessary.  He also asked what was being done about those disease             
 if they exist.  RUSSELL WEBB clarified that he was not a medical              
 doctor.  Mr. Webb said that he had been informed, after discussions           
 with Dr. Nakamura and Dr. Middaugh, that tuberculosis is a                    
 particular case because of the manner in which the disease is                 
 spread as well as the difficulty faced in treatment.  Treatment for           
 tuberculosis often requires taking a combination of drugs for a               
 lengthy time period.                                                          
                                                                               
 Number 443                                                                    
                                                                               
 ELFRIDA NORD, Chief of Public Health Nursing, explained that there            
 are no other diseases that are like tuberculosis as far as                    
 quarantine is concerned.  The air-sharing nature of tuberculosis              
 allows a person to get the disease without any effort on their                
 part; that is the specialness of tuberculosis.  Most other diseases           
 require an individual to have some part in getting the disease.               
                                                                               
 SENATOR LEMAN said that he did not have a problem with this                   
 procedure.  However, there may be other diseases which could have             
 a better effort to protect the public for the same reasons as                 
 SB 138.  Why are those aggressive procedures not being done with              
 those other diseases?  He commended everyone for bringing this                
 issue to everyone's attention.                                                
                                                                               
 RUSSELL WEBB pointed out that there are a variety of other control            
 mechanisms being used for other diseases and those mechanisms are             
 being utilized.  Tuberculosis is a special case which requires a              
 change in the law in order to address the disease.                            
                                                                               
 CHAIRMAN GREEN asked if tuberculosis was more of a problem in                 
 Alaska because of the circumstances of Alaska.  ELFRIDA NORD                  
 replied no.  Ms. Nord specified that with tuberculosis the problem            
 stems from the nature of the disease and the nature by which this             
 disease is spread to others.  Furthermore, the long term aspect of            
 tuberculosis also poses problems.  Ms. Nord indicated that the goal           
 is to keep a person with tuberculosis under surveillance while the            
 treatment is given to the person regularly.                                   
                                                                               
 Number 474                                                                    
                                                                               
 SENATOR MILLER informed the committee that he had a proposed                  
 amendment from the department.  Senator Miller moved that Amendment           
 1 be adopted.                                                                 
                                                                               
 RUSSELL WEBB explained that the amendment provides for protection             
 of the privacy rights by allowing the option of closed court                  
 proceedings relating to a tuberculosis court order.  The other                
 portion of the amendment would eliminate the criminal penalty for             
 failure to comply with a tuberculosis order.  He noted that                   
 provision had been left in due to a drafting error.  He indicated             
 that the criminal penalty is ineffective and unnecessary.  SB 138             
 provides more effective civil means in which to protect the public            
 health.  DHSS and the Division of Public Health are interested in             
 protecting the public health without imposing criminal penalties.             
                                                                               
 CHAIRMAN GREEN asked if there was any objection to Amendment 1.               
 Hearing no objection, Amendment 1 was adopted.                                
                                                                               
 KRISTEN BOMENGEN, Human Services Section with the Department of               
 Law, explained that currently in tuberculosis cases the State                 
 Medical Officer can order an examination and quarantine.  The next            
 tool is the enforcement of the order by notifying law enforcement             
 officials and leveling a criminal charge for failure to follow a              
 medical order.  SB 138 would provide the needed intermediate steps            
 between the initial order and the enforcement of the order.  She              
 noted that the bill is designed to provide due process                        
 considerations such as a hearing before an impartial decision-                
 maker, an opportunity to be represented by council and raise                  
 constitutional issues.  Ms. Bomengen informed the committee that              
 this was before the legislature now because of a case encountered             
 in the past year in which the department was before the courts with           
 a criminal order to enforce the quarantine provisions.  In regards            
 to the amendment, the criminal penalties were not necessary when              
 the intermediate steps were in place; a civil contempt proceeding             
 is more appropriate to enforce the order.                                     
                                                                               
 SENATOR MILLER moved that CS SB 138(HES) be moved out of committee            
 with individual recommendations.  Hearing no objection, it was so             
 ordered.