03/10/2010 09:00 AM Senate FINANCE

SENATE BILL NO. 168                                                                                                           
                                                                                                                                
     "An   Act   relating   to   state   certification   and                                                                    
     designation   of    trauma   centers;    creating   the                                                                    
     uncompensated trauma care fund to offset uncompensated                                                                     
     trauma care provided at certified and designated                                                                           
     trauma centers; and providing for an effective date."                                                                      
                                                                                                                                
SENATOR BETTYE DAVIS, sponsor, introduced herself.                                                                              
                                                                                                                                
9:18:09 AM                                                                                                                    
                                                                                                                                
SENATOR JOHN COGHILL, explained  that the bill establishes a                                                                    
fund that will incentivize a  higher level of trauma care in                                                                    
Alaska.  Section 1  established  that  the department  would                                                                    
establish  regulations as  to how  it would  be administered                                                                    
and work with  hospitals and doctors to try  to increase the                                                                    
delivery of trauma care.                                                                                                        
                                                                                                                                
Senator Coghill  explained that there are  several different                                                                    
levels  of trauma  care,  levels  I, II,  III,  and IV,  and                                                                    
national standards to follow. The  trauma care fund would be                                                                    
administered  to those  who want  to  apply. The  limitation                                                                    
under  Section 2  says that  more than  25 percent  of total                                                                    
assets of  the fund  could not  be given  to any  one trauma                                                                    
center in a year.                                                                                                               
                                                                                                                                
Senator  Coghill  related that  the  bill  has been  through                                                                    
several iterations. The  bill originally anticipated general                                                                    
funds and matching funds.                                                                                                       
                                                                                                                                
9:20:09 AM                                                                                                                    
                                                                                                                                
Senator Coghill pointed to Section  3, the alcohol tax, as a                                                                    
potential funding  source. He left  that decision up  to the                                                                    
committee.                                                                                                                      
                                                                                                                                
Senator  Coghill  reported that  the  trauma  care issue  in                                                                    
Alaska  has  been  moving  forward   since  about  1992.  He                                                                    
referred  to a  booklet  entitled, "Trauma  Care in  Alaska"                                                                    
(copy on file). He highlighted  section nine in the booklet,                                                                    
specifically  pages  6  and 7,  which  list  advantages  and                                                                    
challenges.  He  spoke  of the  reluctance  of  doctors  and                                                                    
hospitals   to    work   together   because    of   economic                                                                    
considerations. The fund  is set to provide  an incentive to                                                                    
raise  the  level  of  trauma   care.  He  referred  to  the                                                                    
challenges on  page 7, some  of which have been  assuaged by                                                                    
this legislation, such as lack of a strategic plan.                                                                             
                                                                                                                                
Senator  Coghill   shared  that   there  are   currently  24                                                                    
hospitals in Alaska  and only 4 have some  trauma care level                                                                    
designation.  Most   of  those  hospitals  are   outside  of                                                                    
Anchorage or  Fairbanks and  are run  by Native  Health care                                                                    
organization. There  is one Trauma  II level care  system in                                                                    
Alaska,  the Alaska  Native  Health  Hospital in  Anchorage.                                                                    
Anchorage, itself, does not have a trauma center.                                                                               
                                                                                                                                
9:23:40 AM                                                                                                                    
                                                                                                                                
Senator  Coghill stressed  that the  fund would  incentivize                                                                    
increasing trauma care, rather  than mandate it. He reported                                                                    
that  there  needs  to  be   a  plan  in  his  district  and                                                                    
especially in rural areas.                                                                                                      
                                                                                                                                
Co-Chair  Stedman  asked if  there  were  any questions.  He                                                                    
noted zero fiscal  notes from the Department  of Revenue and                                                                    
the  Department  of  Health and  Social  Services,  and  one                                                                    
fiscal note  for $2.5 in  general funds and $2.5  in federal                                                                    
receipts, drafted by Senator  Coghill's office to capitalize                                                                    
the funds used to compensate trauma centers.                                                                                    
                                                                                                                                
9:26:02 AM                                                                                                                    
                                                                                                                                
DR. FRANK  SACCO, DIRECTOR, ALASKA TRAUMA  SYSTEM, testified                                                                    
via teleconference.  He addressed two  issues - trauma  as a                                                                    
public  health problem  and trauma  and its  relationship to                                                                    
alcohol.  Alaska  has the  second  highest  death rate  from                                                                    
trauma  in  the  country.  The  trauma  system  is  a  model                                                                    
developed by the military -  a preplanned response. The goal                                                                    
of  trauma  care  is  to  decrease  mortality  from  serious                                                                    
injuries by 15 to 25 percent.  He said that 500 Alaskans die                                                                    
each year  from trauma. Alaska  is the only state  that does                                                                    
not have  a Level I  or II  trauma center. Anchorage  is the                                                                    
largest  city  in  the  U.S. without  a  trauma  center.  He                                                                    
maintained that the value of a trauma center is undisputed.                                                                     
                                                                                                                                
9:29:37 AM                                                                                                                    
                                                                                                                                
Dr.  Sacco referred  to  trauma  as a  disease.  One of  the                                                                    
biggest  risk  factors  for  trauma  is  alcohol.  About  50                                                                    
percent  of those  admitted to  trauma centers  with serious                                                                    
injuries  have  screened  positive for  alcohol.  He  shared                                                                    
information about the teachable  moment for alcoholics after                                                                    
a   traumatic   incident.   He   shared   statistics   about                                                                    
alcoholism.  He  concluded  that  the  readmission  rate  of                                                                    
alcoholism-related  trauma is  decreased with  intervention.                                                                    
He thought the alcohol tax was an appropriate guideline.                                                                        
                                                                                                                                
9:33:18 AM                                                                                                                    
                                                                                                                                
DR.  VIRGINIA   CHENNAULT,  TRAUMA   COMMISSION,  ANCHORAGE,                                                                    
testified  via teleconference.  She  spoke in  favor of  the                                                                    
legislation.  She  maintained  that drugs  and  alcohol  are                                                                    
involved  in 70-80  percent of  trauma cases.  She suggested                                                                    
that  alcohol intervention  should be  done in  the form  of                                                                    
screening.  She stressed  that  the  legislation would  save                                                                    
money in  the long run.  She concluded that  Alaska deserves                                                                    
trauma care.                                                                                                                    
                                                                                                                                
9:35:50 AM                                                                                                                    
                                                                                                                                
ROD  BETIT,   PRESIDENT/CEO,  ALASKA   HOSPITAL  ASSOCIATION                                                                    
(AHA),  related  that  AHA  supports  this  legislation.  He                                                                    
shared statistics  about which states have  a trauma center.                                                                    
The issue is that Anchorage does  not have a Level II trauma                                                                    
center  other than  a  tribal program.  He  made two  points                                                                    
about Level  II trauma  hospital advantages:  having staffed                                                                    
employees  for trauma  care and  compensated care.  The bill                                                                    
would  allow the  department to  address those  services. He                                                                    
thought this approach was better than a mandated approach.                                                                      
                                                                                                                                
9:40:36 AM                                                                                                                    
                                                                                                                                
MARK  JOHNSON, FORMER  EMS PRESIDENT,  JUNEAU, made  several                                                                    
points about  trauma care. He  pointed out that trauma  is a                                                                    
major  cause  of   hospital  admissions,  disabilities,  and                                                                    
death.  He  related  that the  legislation  passed  in  1993                                                                    
allowing the  Department of Health  and Social  Services the                                                                    
authority  to   certify  trauma  centers  was   a  voluntary                                                                    
approach  without  incentives. In  the  1990's  there was  a                                                                    
federal grant  which co-sponsored reviews of  trauma care at                                                                    
eight  hospitals.   Currently,  there  are  24   acute  care                                                                    
hospitals, but  only five have achieved  national standards.                                                                    
He maintained  that every  hospital should  meet one  of the                                                                    
three  levels of  standards of  trauma care.  Trauma centers                                                                    
are expected  to be involved  in prevention  activities such                                                                    
as alcohol screening. He urged  the committee to support the                                                                    
legislation.                                                                                                                    
                                                                                                                                
9:44:11 AM                                                                                                                    
                                                                                                                                
Senator Ellis thanked  the presenter for his  work. He asked                                                                    
how  many states  require this  level of  licensure and  how                                                                    
many have incentives  to upgrade. Mr. Johnson  did not know,                                                                    
but offered to find out.                                                                                                        
                                                                                                                                
Senator Olson  asked if the  number of first  responders has                                                                    
kept  up.  Mr.  Johnson  said EMS  in  Alaska  does  provide                                                                    
excellent  training for  first  responders.  He thought  the                                                                    
numbers compare favorably with other  states. One out of two                                                                    
first responders is a volunteer.                                                                                                
                                                                                                                                
9:46:47 AM                                                                                                                    
                                                                                                                                
DAVID HULL, CHAIRMAN, GOVERNOR'S  TASK FORCE, ALASKA COUNCIL                                                                    
ON  EMERGENCY   MEDICAL  SERVICES  (ACEMS),   testified  via                                                                    
teleconference. He  agreed that EMS  is doing a good  job of                                                                    
getting people to the hospitals.  He spoke in support of the                                                                    
trauma system. The Alaska Council fully supports the bill.                                                                      
                                                                                                                                
9:49:02 AM                                                                                                                    
                                                                                                                                
Senator  Coghill addressed  the  question  asked by  Senator                                                                    
Ellis. The information is found  in the booklet under Tab 7.                                                                    
It reviews  which states  have trauma  care centers  and how                                                                    
they are funded.                                                                                                                
                                                                                                                                
SB  168  was  heard  and   HELD  in  Committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
9:50:32 AM