Legislature(2019 - 2020)BUTROVICH 205
03/09/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing | |
| SB229 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 229 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 229-LIABILITY OF CONSULTING PHYSICIANS
1:47:40 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 229, "An Act relating to
immunity for consulting physicians, podiatrists, and
osteopaths."
He stated his intent to hear an overview of the bill and invited
and public testimony. He invited Senator Kiehl to the table.
1:48:05 PM
SENATOR JESSE KIEHL, Alaska State Legislature, spoke as sponsor
of SB 229. When Alaska passed medical malpractice caps, he
thought the caps were too low. However, the practice of medicine
is complex. There are specialties and subspecialties and medical
professionals frequently consult with one another to get the
necessary advice and expertise. A generalist might call a
specialist in a bodily system or organ to help decide whether to
treat a symptom or refer a patient for full workup and treatment
by that specialist. A specialist might call a psychiatrist about
a mental health condition that is complicating treatment. The
sole practice doctor in a small town might call a doctor in a
hub or larger city to decide whether to treat an injury at home
or call for a medevac with the costs and risks that those can
bring. The term for these consultations is "curbside consults."
Patients do not see these consultations, but these consultations
are an essential part of Alaskans health care.
SENATOR KIEHL said SB 229 protects curbside consultations. He
recalled that over a year ago, the Minnesota Supreme Court
considered a case where something went wrong and decided the
consulting doctor could be liable for damages to a patient. The
consulting doctor had never seen or treated the patient or taken
a fee. It was in many ways a first-of-its-kind ruling that
alarmed the medical community. Without this bill, if that ruling
holds, Alaska would see significant increases in health care
costs as medical malpractice insurance rises. With Alaskas long
distances and small communities with few specialists, it is
likely that health care would suffer if doctors stopped curbside
consults. It will create more risk to patients if treating
doctors lose access to their colleagues experience and advice.
SENATOR KIEHL said SB 229 shields the consulting doctor in a
curbside consult from liability if the patient gets injured. SB
229 will ensure that an injured patient still has access to
justice. Under SB 229, the treating doctor cannot reduce
liability by shifting some of the blame to the consulting
doctor. The treating doctor remains responsible for patient
care. That is the fundamental point of the bill. Alaskans can go
to the doctor, get seen, doctors can get needed advice and
expertise from colleagues, and Alaskans will benefit without
raising costs, without raising risks, and without denying anyone
access to justice.
CHAIR WILSON noted that it is a one-section bill, so the
committee did not need an in-depth sectional analysis.
1:53:08 PM
SENATOR SHOWER asked if SB 229 will affect other health care
providers who give advice, such as nurse practitioners and
nurses.
SENATOR KIEHL replied that since he has introduced the bill,
some people in the medical community have suggested that it
should be expanded to include advance practice registered nurses
and physician assistants. It makes sense, but he does not have
any amendments. He said he has been working to begin that
drafting process.
SENATOR SHOWER asked if there are any other similar court cases.
SENATOR KIEHL deferred to his staff to respond.
1:55:19 PM
CATHY SCHLINGHEYDE, Staff, Senator Jesse Kiehl, Alaska State
Legislature, Juneau, Alaska, said that she does not have a case
involving an advanced practice registered nurse as the
consultant, but she could do some research.
SENATOR GIESSEL thanked Senator Kiehl for being open to her
input on SB 229. She often consults with pharmacists about how a
medication she might prescribe would interact with a disease
condition or other medication, as do her physician colleagues.
CHAIR WILSON called on invited testimony.
1:56:35 PM
ROBERT CRAIG, Chief Executive Officer, Alaska Heart and Vascular
Institute, Anchorage, Alaska, said he has been at the Alaska
Heart and Vascular Institute for about four years. He has about
30 years of experience in health care administration. Alaska
Heart Institute has 32 physicians providing cardiology expertise
in Alaska in the form of general cardiology, interventional, and
electrophysiology. The goal with SB 229 is not to start a tort
issue or seek immunity for the care doctors provide to patients
but to resolve this consult dilemma. Often the Heart Institute's
physicians receive calls about patients who are not established
with the practice from locations where there is no cardiologist,
typically in remote and small communities. Rather than insist
that these patients be flown in or travel to the institute, it
is more desirable to have a collaborative discussion about the
care than contributing to increases in health care costs. The
institutes physicians have always answered these calls freely,
without compensation, regardless of the time of day or night.
The institute believes the calls are valuable for the expertise
provided, which helps to ensure the patient receives the right
care at the right time. These calls provide assistance to other
health care providers in remote areas without the physician
being left vulnerable.
1:59:47 PM
JACOB KELLY, M.D., Alaska Heart and Vascular Institute,
Anchorage, Alaska, said he has been a cardiologist in advance
heart failure and cardiac transplant cardiologist in Alaska for
three years. He came to Alaska for the unique ability to pursue
an outdoor lifestyle and to care for a diverse population of
patients who are often off the road system. In the tradition of
medicine, practitioners share, teach, and learn together. It is
human nature to want to deliver care to all individuals despite
location, ability to pay, race, gender, location. This drives
him and his colleagues to practice medicine in Alaska and to
provide curbside consults with medical providers across the
state.
DR. KELLY said he often receives calls at night regarding
someone experiencing atypical chest pain. These patients often
have low to low intermediate risk and may live in a region that
is quite remote. It would disrupt the workflow and the patients
ability to pay to immediately transfer the patient, potentially
on multiple flights, to Anchorage when sometimes the doctor can
help the provider reassess the risk, provide some good
education, and if the patient's condition worsens, the patient
could be transferred to Anchorage. However, there is risk there
for him with opening this up to curbside consultation and the .1
to 1 percent of the times it could be more severe. He often has
patients with heart failure symptoms.
CHAIR WILSON asked if there is a difference between formal and
informal consultations.
DR. KELLY replied an informal consult on the phone giving
general advice can be 30 seconds to three minutes. The
conversation typically ends with the statement that if the
patient gets sicker or the practitioner is concerned, the
provider should call the institute back. The practitioner may
give a brief reading of an EKG or chest x-ray. He characterized
these types of calls as unofficial or curbside consults. He
acknowledged some intermediate things could be trickier when
there may be borderline amounts of material. Telehealth is
attempting to address this. The difficulty with telehealth is
that someone must engage vital signs and a certain amount of
durable and electronic equipment is needed to transfer
information. A full consult involves seeing the patient or with
an official telehealth visit, a practitioner can visualize the
patient, receive vitals, and review the patient's chart.
SENATOR VON IMHOF asked if there is generally fee-for-service
with telehealth, if so, it would fall outside of the purview of
this bill.
DR. KELLY agreed that telehealth is a separate billable charge,
and that does not fall under this bill. He said that telehealth
is complicated and not specific to this bill.
2:05:44 PM
SENATOR VON IMHOF said the definition of telehealth is expanding
and the bill sponsor should contemplate what triggers the
difference between a curbside consult and telehealth. She
offered her belief that the trigger is if money changes hands.
SENATOR BEGICH pointed out that line 14 specifically states "not
compensated", which would be the trigger. This bill will ensure
that informal conversations between physicians can continue.
2:08:06 PM
BOB URATA, M.D., Valley Medical Care, Juneau, Alaska, said he
has been practicing family medicine in Juneau since 1984. The
purpose of SB 229 is to protect consultations from lawsuits and
to allow this important service for his patients to continue.
These consultations improve overall care and keep costs under
control. He utilizes this service in his practice at least five
times a week. He calls various specialists, including heart
doctors, cancer specialists, chest surgeons, neurosurgeons,
high-risk obstetricians, endocrinologists who deal with thyroid
and diabetes, and neurologists. He encouraged members to expand
the bill to include midlevel practitioners like physician
assistants and nurse practitioners. He has given curbside
consults for patients and providers in Yakutat, Skagway, Haines,
and Gustuvus. These midlevel practitioners are the only health
care available in those towns. These professionals provide good
care, but occasionally call to discuss patients, who may need to
be sent to Juneau or Anchorage for further care. He
characterized these as more of a triage-type curbside consult.
He agreed with Senator Giessel that the consultations should
include pharmacists. He finds that with the complexity of
various medications now, he needs to ask a pharmacist about
different side effects, drug interactions, and other similar
things.
2:11:08 PM
CHAIR WILSON opened public testimony and after ascertaining that
no one wished to testify, closed public testimony on SB 229.
SENATOR KIEHL said the question on telehealth is excellent. SB
229 does not immunize doctors who treat their patients. Only if
a health care provider is with a patient providing treatment
would the providers consultation with another doctor elsewhere
fall under the bill. Generally speaking, when a provider treats
a patient by telehealth, there is a doctor-patient relationship
and the doctor presents a billing for services.
SENATOR KIEHL referenced a question about the development of
malpractice law. He related his understanding that medical
malpractice has developed more by case law than by legislative
action. The new development from the Minnesota Supreme Court is
a step in the wrong direction. This bill would put a legislative
marker down in Alaska to say that Alaska is not going in that
direction.
SENATOR VON IMHOF said she wanted to make sure that the
committee does not confuse the definition of telehealth.
Telehealth is different than the electronic transfer of health
information, like emailing lab results or an x-ray that a doctor
elsewhere would review. She said she appreciates that Senator
Begich spoke about compensation for the consultation. If there
is a transfer of information electronically and another doctor
reviews it to provide consultation [at no cost], it is not
telehealth.
SENATOR KIEHL agreed. The consulting doctor would be the one
protected in the bill. That doctor could review an EKG under
this bill as long as the consulting doctor does not determine
treatment for the patient.
SENATOR GIESSEL said another way to describe the distinction of
curbside versus telehealth is that someone cannot be compensated
for something that is not documented. If the consulting
physician gets a lab result and actually writes a report, which
is then sent back to the person who asked for the consultation,
that clinician can bill for the time to write the report. That
is the process a telehealth clinician uses for telehealth
documents and for payment. She viewed curbside consultations as
ones between health care providers who might discuss a patient
with a heart murmur, who has a sore throat, and what that might
mean. Someone is giving informal advice and not billing for it.
It is very different from telehealth.
SENATOR KIEHL said these physicians want to be able to continue
to have unpaid consultations, which plays a role in health care
for Alaskans.
2:16:32 PM
CHAIR WILSON suggested that the bill sponsor and committee chair
may want to consider drafting amendments or a committee
substitute to address the concerns. He held SB 229 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HSS Medical Board Boswell #1.pdf |
SHSS 3/9/2020 1:30:00 PM |
Confirmation Hearing - Med Board - D Boswell |
| SB 229 v. A 2.25.2020.pdf |
SHSS 3/9/2020 1:30:00 PM SHSS 3/23/2020 1:30:00 PM |
SB 229 |
| SB 229 Sponsor Statement 2.25.2020.pdf |
SHSS 3/9/2020 1:30:00 PM SHSS 3/23/2020 1:30:00 PM |
SB 229 |
| SB 229 Sectional Analysis v. A 2.25.2020.pdf |
SHSS 3/9/2020 1:30:00 PM SHSS 3/23/2020 1:30:00 PM |
SB 229 |
| SB 229 Fiscal Note Dept of Law 3.6.20.pdf |
SHSS 3/9/2020 1:30:00 PM SHSS 3/23/2020 1:30:00 PM |
SB 229 |
| SB 229 ASMA Support 3.9.20.pdf |
SHSS 3/9/2020 1:30:00 PM SHSS 3/23/2020 1:30:00 PM |
SB 229 |