Legislature(1995 - 1996)
03/19/1996 02:09 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 529 - APPROVE CENTRALIZED PUBLIC HEALTH LAB Number 1041 CO-CHAIR BUNDE announced that the next item on the agenda was HB 529, an act giving notice of and approving the entry into, and the issuance of certificates of participation in, a lease-purchase agreement for a centralized public health laboratory. KAREN PERDUE, Commissioner, Office of the Commissioner, Department of Health and Social Services, supported HB 529 because it resolves the serious problem regarding the public health laboratory system. She said public health laboratories are an essential component of any state system which promotes public health. She said every state in the nation promotes public health and has a public health laboratory system. Number 1216 COMMISSIONER PERDUE said a strong public health system to (indiscernible), detect outbreaks of disease and controls public health threats. She said the state currently has three public laboratories that were established as regional laboratories prior to statehood. She said they were developed when transportation linkages and technology was less sophisticated. She said these three laboratories specialize in services and they are no longer regional laboratories. She said samples travel from all over the state to a certain laboratory, based on the function of that laboratory. COMMISSIONER PERDUE said as air travel and global connections occur with more frequency today, protecting the public health becomes more difficult. She said Alaska is often the place where people are traveling in and out. She said a strong public health system must be in place to protect the state from biohazards and other emerging diseases. COMMISSIONER PERDUE said the public health laboratories are in lease facilities. She said the Anchorage and Juneau facilities have been in their locations for a long time. She said Anchorage established their lab location in 1962, and the Juneau lab was established in 1971. She said the Juneau and Anchorage laboratories do not meet health and safety codes. She said the laboratories present risks to staff and, potentially, to the public. She said the Fairbanks facility is adequate for the near term and functions as a very fine laboratory. COMMISSIONER PERDUE said HB 529 would incorporate a state medical examiner which is a strong piece of the state's public health effort. She said the state medical examiner is currently housed in a crime lab where space is limited. COMMISSIONER PERDUE said there are very few responsibilities she has in the state constitution or in the statutes. She said that one of her responsibilities is to protect public health and added that was the first responsibility that the territory of Alaska incorporated for their department. She said the Executive Branch and the Legislature share this responsibility and it is a core function of government. She said, as the Commissioner of Public Health, she is responsible for making sure that the public health system is strong, that the employees work in safe places and that she does not knowingly ignore risks. She said as public servants, we cannot ignore conditions created by state government operations that present health and safety risk to the public. Number 1239 COMMISSIONER PERDUE said it would be irresponsible if the state did not act on this issue. She stated that this has been an issue of concern for over a decade. She said she did not want to minimize that it is a difficult regional issue and said that because it has been difficult issue nothing has occurred. She said 14 separate studies have concluded that the state must act on this issue. She said a centralized laboratory function will provide the most economical, permanent solution to the state's critical facility problems. Number 1266 COMMISSIONER PERDUE said a system is needed that is accessible to health providers statewide, can achieve efficiencies and can enable the state to improve services and reduce operating costs. She said it is for this reason that she is asking support for HB 529. Number 1280 COMMISSIONER PERDUE said it was difficult to propose this solution as it adversely affects the economies, the lives, and the jobs of some of the state employees in Juneau and in Fairbanks. She said, in the year 2000, those employees would be asked to move to Anchorage under HB 529. She stated her belief in regional government and did not think that everything should be housed in Anchorage. She believed that the imparity of the public health system outweighed those concerns, at this point. She said there is an unsafe situation in Juneau and in Anchorage and that the state must act. COMMISSIONER PERDUE said there is another bill in the legislature, which would close the Juneau laboratory precipitously. She said this bill is unwise, impacts the lives of the employees and jeopardizes the current situation. She said the department wants a planned transfer not a precipitous one. Number 1343 COMMISSIONER PERDUE said she respects the differences that people have regarding this issue, but said she felt responsible for addressing this issue. Number 1369 CO-CHAIR BUNDE asked the witnesses to summarize their points as there were time constraints. REPRESENTATIVE ROBINSON expressed that this issue is important to the community of Juneau and Fairbanks and asked that there be an opportunity to bring all the relevant information forward. GREGORY V. HAYES, DrPH, Chief, Laboratories, Division of Public Health, Department of Health and Social Services, was next to testify. He said, as compared to private health laboratory, the state public health laboratory is directed towards the prevention and control of disease in the community. He said the public health laboratory provides an assessment, develops policy and plays an assurance role. He said the testing that no longer meets this role is given back to the private sector to perform. He said he could provide examples of where this is the case. He said the public labs do not perform routine clinical chemistry testing, but focused on communicable disease testing. DR. HAYES said the core functions of a public health laboratory include disease control and prevention programs, maternal, child, family health programs and epidemiological programs. The lab supports surveillance activities, outbreak investigations and monitors for the emergence of new infectious agents or the re- emergence of infectious agents of public health importance. He said the lab also focuses on the development of methods for testing and then assists with the transfer of the new technology to the private sector. The lab performs diagnostic product evaluations, collects data, performs high quality testing at a reasonable cost, and provides training, laboratory expertise and reference services to the private laboratory community in the laboratory diagnosis of diseases of public health significance. Number 1487 DR. HAYES said he had been with the state of Alaska for two years. He said, under his role of chief, it is his function to use the available resources such as personnel, instrumentation and finances. He said he uses these resources in the most effective, productive and cost effective manner possible and does it in a manner which protects the health and safety of staff. He said it has been extremely difficult to do this under the current structure. Number 1500 DR. HAYES said he has a staff of 41 in four different locations which include the chief's office, a lab in Juneau, a lab in Fairbanks, and a lab in Anchorage which performs 60 percent of the total testing. He said the labs are specialized. The Juneau lab performs primarily Mycology and Water Bacteriology while Anchorage lab specializes in Tuberculosis (TB) testing, the Fairbanks lab performs almost exclusively Virology testing. DR. HAYES said the staff is dedicated and professional and have to meet very stringent federal regulations. He said he would not go into detail regarding these regulations, but said it makes staff recruitment difficult. Number 1572 DR. HAYES said the major issue regarding the labs is their urgent need of repair. He said there are mechanical and structural inadequacies which makes it difficult to conduct testing. Two of the labs were constructed as office space and have major problems. He said the Fairbanks lab was constructed as a laboratory in 1967, so it is somewhat dated. All three of the laboratories have poor facility layouts and space limitations for future growth. DR. HAYES said the state public health labs are licensed by the federal government under the clinical laboratory improvement amendments. He said, during the last survey, the state labs were found to be out of compliance and forced to stop doing TB testing in the Juneau lab. The samples were then sent out of state, until "band-aid" renovations could be done on the Anchorage facility. He said the surveyors will be coming back in August and will be looking at how the state is addressing the long range plan to solve both the health and safety problems of the public health laboratories. DR. HAYES said efficient transportation, reliable communications, and advances in laboratory technology now enable the state to reconsider the need for having three separate laboratories. He said, currently, in many instances specimens received in one laboratory must be split, and sent to one or both of the other laboratories which dramatically increases turn-around-time. Number 1625 DR. HAYES said the new technology, that the department is looking to bring into the laboratory, tests at the molecular level and includes DNA probes and Polymerase Chain Reaction. He said these are very expensive technologies which have very specific space requirements. He said the technology can be used if the organism is a bacterium or a virus. He said it doesn't make sense to establish this technology in two or three different locations. He said it also makes little sense today to have three sets of similar equipment: autoclaves, microscopes, specialized ventilation systems, biological safety cabinets, isolation rooms and triplicate supply orders. DR. HAYES said that the laboratory, with its varied disciplines, must work together as a team and also work as a team with the state's epidemiologist. He said this teamwork would be greatly enhanced if all the laboratories were physically located together. DR. HAYES said that when an outbreak occurs of unknown origin, it would be extremely helpful, to have all of the laboratory professionals with their expertise together. He cited an example of a food borne outbreak where the cause could be bacterium, viral, or parasitic. He said, currently, the samples would have to be sent to two or three different labs for analysis which dramatically slows the resolution of the outbreak. Number 1679 DR. HAYES said, in conclusion, the state has identified the problems the laboratories face, the state knows how to solve them, the state has engaged in long-range planning and has developed a comprehensive workable solution. He said centralization of the state's public health laboratories in a new facility maintains an essential public health service more cheaply, more effectively and more efficiently. He said this centralization solves health and safety problems and provides for future growth. Number 1698 REPRESENTATIVE BRICE said the Fairbanks laboratories are old, but said the Center for Disease Control (CDC) recently certified the laboratory for Biohazard 3. Number 1720 DR. HAYES said the facilities are dated and the layout of the facilities is not optimal. He said the laboratories are on several different floors with supplies located at a great distance from where they are utilized. He said the director's office is several halls away from the labs. Number 1744 REPRESENTATIVE BRICE clarified that the layout presented no danger to the people that are working at the Fairbanks location. He then asked if the level and type of equipment needed was really at the level that Dr. Hayes had listed. He referred to a report written by the "Strategic Health Plan" and said that apart from a small reduction in clerical staff most of the scientific staff would remain. He said the staff was going to need all their individual equipment such as microscopes. Number 1800 JOHN MIDDAUGH, MD, Chief, Division of Public Health, Department of Health and Social Services, thanked the legislators for their assistance in helping the state public health laboratory monitor for TB. He said the laboratory has helped keep TB under control by accepting and analyzing the sputum specimens which has helped the state detect people infected with TB. He said the reason for the original TB outbreak was that part of public health infrastructure "broke." He said the department's section of labs are "broke" in terms of facilities and the ability to maintain, over the next decades, the capacity to provide an essential function of state government. He said there is no question that state public health labs are different than private labs and that the types of expertise they contain are different. He said the staff are qualified professionals, who have done incredible work. He said the state needs to maintain facilities which enable staff to apply emerging technology of both equipment and collegial interaction in order to maintain an ability to detect and diagnosis epidemics efficiently, accurately and enable the state to know how to respond. Number 1879 DR. MIDDAUGH said teams have just come back from St. Lawrence Island with 600 sputum samples that "we dropped on the lab" in a day in Anchorage doing smears, looking under the microscope as well as to doing a culture from those specimens. He said the staff has done thousands of those specimens since the department requested the assistance from the legislature last year. He referred to the epidemic from last summer at Burwash Landing, where hundreds of tourists were getting sick, including the elderly. He said the public health laboratory had no understanding, initially, of the cause of the outbreak and the lab had to get many specimens. He said it, turned out the etiology, was a Norwalk virus which is difficult to detect or control. He said the superb lab work from the state lab personnel, under trying conditions, was able to detect the outbreak and were able to control it. He said this type of outbreak, from contaminated water, is almost impossible to contain. He said many options were discussed including shutting down the tour bus operations, between Haines and Fairbanks, in the middle of the tourist season. Number 1912 DR. MIDDAUGH said that during this outbreak there was some new publicity about Hanta virus, which came out of some surveys of voles in the Yukon. He said this information created some sensationalistic media coverage which tended to imply that this virus might be a threat to the tourists in Alaska. He said superb work, done by Don Ritter over many decades, gave the state information about the long presence of this Hanta strain in mice, but no evidence of infection in humans. Number 1931 DR. MIDDAUGH said, in summary, the expertise that the state public health laboratory has must be supported by adequate facilities. He said, when he came to Alaska, huge problems existed in shipping specimens from point A to point B, especially when specimens went from one region to another. He said, today, specimen shipment usually comes into the Anchorage area and the ability to rapidly interface multiple biological specimens in a lab is an important component of the response. DR. MIDDAUGH said to get a group of physicians to agree on anything is difficult and mentioned that while a consensus did not exist, the state medical association fully endorsed and supported the department's efforts to develop a central, single laboratory facility. He said this decision to build a central facility was not done lightly. He said his close friends, who he worked with for 20 years in Fairbanks, Juneau and Anchorage, are near and dear to his heart. He added that, scientifically, it is not sound to maintain, in the long-term, separate facilities. He urged the committee to help build a public health facility for the future that will maintain the state's ability to protect the public health for several decades to come. Number 1983 CO-CHAIR BUNDE said it was the intent to hold HB 529 over to another meeting, but wanted to give the committee members the option to ask the witnesses questions. Number 1992 REPRESENTATIVE BRICE referred to the comment about "scientifically sound to keep them separated" and asked if information of how the state has been unscientifically sound since statehood. Number 2007 DR. HAYES said the new technology that the public lab is using, Polymerase Chain Reaction, does not look at a virus or a parasite, it looks at something on a molecular level. He said it is this type of testing that the state needs to bring into the public health laboratory. He said it does not make sense to set this type of technology up in three separate places as it is expensive. He said the use of Polymerase Chain Reaction technology will allow the lab to identify something in a matter of hours as opposed to putting the specimen into a viral culture which would take a week or weeks to identify. He said the cirologic assay is another example of how the technology would best utilized in a central facility. Number 2035 REPRESENTATIVE ROKEBERG received information that the central facility would be 47,000 square feet. Number 2054 REPRESENTATIVE GARY DAVIS clarified that the three labs perform specific, specialized functions. Number 2067 DR. HAYES said the labs have specialized themselves over the years. He said in Juneau the primary specialization is Water Bacteriology and Mycology as well as other routine bacteriology. He said the Anchorage lab does routine bacteriology and specializes in TB testing. He said there was a big effort by the federal government, who is funding the state TB program, to centralize the TB program as the state can achieve better statistical analysis of the specimens. He said the Fairbanks specialization is virology. Number 2090 REPRESENTATIVE ROKEBERG cited a personal experience with food poisoning and cited the excellent work that the state public health laboratory did. Number 2109 REPRESENTATIVE ROBINSON said that the Anchorage and the Juneau laboratories were in need of maintenance work. She asked if this centralization process were being driven more by finances rather than being the best policy. She said the state obtained three labs initially and asked for information regarding why three labs were developed. She asked if the state went to one lab, would the state would eventually revert back to three labs. She also asked for information regarding the timeliness of getting specimens under one centralized facility. Number 2155 DR. HAYES said, under the territorial days when these labs were set up, transportation was very poor and it made sense to have three labs spread out in a state the size of Alaska. He said each lab provided the same, whole range of testing. He said, currently, there are not the same transportation problems. He said Anchorage is the hub of the transportation system in the state of Alaska. DR. HAYES said he, currently, has problems with virology specimens being sent from Bethel that don't make it there because they are frozen or die before they make it to the Fairbanks lab. He said putting the lab in Anchorage is the best location to receive those samples in a timely manner and to give the best turn around time. He said, in checking with the airlines regarding communities such as Petersburg, Tok and Kenai, factors have been worked out as part of the long range plan. Number 2197 DR. MIDDAUGH said that when he came to Alaska as a commissioned officer, he was met by Frank Pauls, who founded the Juneau lab, and said that Frank told him that it would be valuable for the state to move toward a single lab in Anchorage. He said, here we are, trying to do that again. DR. MIDDAUGH said the state did not build the lab in Fairbanks, it was built by the federal government as part of a huge research operation in the 1950s and 1960s. He said we are still benefitting from the work done by Dr. Rausch and his colleagues. He said that facility was built, at the time, with state-of-the-art work and that is why the rabies and virology work is done there. He said, when he arrived in Alaska, the Fairbanks lab did microbiology and all of the specimens would be flown to Fairbanks and then the plane would come to Anchorage. He said, 10 to 15 years ago, those planes started to fly to Anchorage and then the specimen would be shipped back up to Fairbanks to be analyzed. DR. MIDDAUGH said, one of the problems, is that usually the etiology of the disease is not known at first so diagnostic specimens need to be taken and analyzed for both viruses and bacteria. He said as technology grew and merged together, there is no justification for one lab doing virology and one lab doing microbiology and bacteriology. He said these specializations are coming together because of the technology. DR. MIDDAUGH said the department is looking to maintain the best science and the ability for the lab to function within the next several decades. He said this plan is not necessarily the best message for politics or for his close colleagues, but added that professionally, these staff are in accordance that science dictates a central facility. Number 2297 TOM LANE, Facilities Manager, Division of Public Health, Department of Health and Social Services, said the centralized facility would have a 55 year life. Number 2306 GREG HERREFORD, Manager, Juneau Laboratory, Division of Public Health, Department of Health and Social Services, said he was in favor of a consolidated facility. He said he has lived in Juneau for ten years and that he likes living here, but that for the good of the state and the good of the people in the state of Alaska, there needs to be a high quality, high resource laboratory. He said the current situation, with the three laboratories, is untenable. He said he supports the building of a combined facility. MR. HERREFORD said, because of the financial situation, the state cannot support three state-of-the-art laboratories and that the state of Alaska deserves a state-of-the-art laboratory. Number 2346 CO-CHAIR TOOHEY said everyone will need to know what will be done to the personnel in the laboratories. Number 2355 REPRESENTATIVE ROBINSON said there has been some discussions in the budgetary process to eliminate the Juneau lab immediately, she asked what would happen if this were to occur. MR. HERREFORD said, if the Juneau lab were to move immediately, the biggest problem would be that the Anchorage facility is very stressed now with the specimen load and the space constraints. TAPE 30, SIDE B Number 0000 MR. HERREFORD said, "...add additional testing and testing areas that move, say from Juneau to Anchorage, I've honestly don't know where they would find the place to put some of the testing that we have to do." He mentioned that the Mycology testing required a biological safety cabinet and its own enclosed room. He said anything like outbreak protection is not needed but, he said to do this type of testing, you want to minimize the amount of foot traffic. He said an immediate move would have a negative impact. Number 0062 DR. HAYES said he was working on this issue right now. CO-CHAIR BUNDE said the committee would take that answer as a "no." Number 0066 REPRESENTATIVE ROBINSON asked what Southeast will lose as a result of losing the Juneau laboratory if a consolidated facility is built or the Juneau laboratory is closed. Number 0075 MR. HERREFORD said that if a consolidated, state-of-the-art facility is built and if various clinics are told what services are going to be offering then he did not think that Southeast will lose much. He said the turn around time will be increased, but there are ways to mitigate that impact such as instituting a Goldstreak or a courier pick-up. He said, if there is a precipitous closure of the Southeast lab, this area will lose quite a bit. He said the turn around time will be much longer than the doctors and clinics in this area will find acceptable and they might stop utilizing the state laboratory. He said this will result in a loss of baseline data which is needed to detect outbreaks before they infect hundreds of people. Number 0118 NOLAN WATSON, said he has been involved with the public health laboratories in the state of Alaska since 1993. He said he conducted one of the studies referred to by Commissioner Perdue. He said this study was an assessment of the public laboratory facility. He said he was a consultant to the Anchorage lab and was responsible for "band-aiding" the facility, especially the TB lab. He said the laboratories in the state of Alaska are among the worst that he has been. He referred to his experience in the states of Washington, Arizona, Hawaii and California. He said he wrote a book which will be distributed by the CDC on the design of public health laboratory facilities. He said for the safety of the personnel and for the specimens that come through, assessment is a big issue. Number 0208 MR. WATSON said the protocols and the high quality of the technical people, minimize the risks in the Anchorage laboratory and in all the laboratories. He said trying to do high quality biological safety Level 3 facility in a wooden office building is very difficult. He said he could only commend the people who work in the facility. He concluded by saying that he supported HB 529. Number 0208 CO-CHAIR BUNDE said HB 529 would be held over for testimony on Thursday, March 21, 1996. Number 0214 REPRESENTATIVE BRICE asked if Mr. Watson was involved with the financial side of the studies or whether he was involved with the design side. Number 0232 MR. WATSON said his background was in facilities and before joining the architectural practice his background was as a laboratory scientist. He said he is involved in the scientific aspects, not the financial side.
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