Legislature(1993 - 1994)
03/07/1994 03:00 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
CHAIR TOOHEY brought HB 478 to the table and indicated that Anchorage, Barrow, Delta Junction, Fairbanks, McGrath, Galena, Ketchikan, and Soldotna were on teleconference. HB 478 - EMTs AUTHORITY TO PRONOUNCE DEATH Number 083 REP. GENE THERRIAULT, Prime Sponsor of HB 478, addressed his bill by reading from the sponsor statement. He stated that HB 478 proposes to allow mobile intensive care paramedics and Emergency Medical Technicians (EMT) to determine and pronounce death under certain circumstances. He indicated that certified paramedics and EMTs who are active members of a certified emergency medical service may make a determination and pronouncement of death if a physician is not immediately available upon determining that the person has suffered irreversible cessation of circulatory and respiratory functions. REP. THERRIAULT said currently when EMTs begin CPR they are required to continue resuscitation either until the person recovers or the EMT is relieved by either a medical facility or physician, or the responding parties become physically exhausted and are no longer able to continue, or their physical safety is seriously threatened, or a physician pronounces the person dead. REP. THERRIAULT indicated that many times emergency medical response members are required to continue unproductive resuscitation for several hours because physicians and medical facilities are not immediately available. REP. THERRIAULT stated that HB 478 would allow an emergency medical response member to declare death in situations where a physician is not available and would help emergency response teams respond to the emergency medical needs of Alaska. He asked for questions from the committee. Number 174 CHAIR TOOHEY asked for teleconference testimony. She also asked those testifying to limit their testimony to three minutes. Number 176 STEVEN O'CONNOR, Assistant Chief, Central Emergency Services, Soldotna, testified via teleconference in support of HB 478. He stated that he had concerns regarding page 2, line 19, of the bill. He suggested that the line be deleted and recommended that the emergency medical technician should only provide information pertaining to the death to a physician who would actually sign the death certificate. He also indicated that there are areas of the state that have Home No Code Death policies and was concerned that the legislation might conflict with that established protocol. Number 250 CHAIR TOOHEY said Mr. O'Connor's concern was understandable. Number 252 BILL KRIEGSMAN, Captain, Emergency Medical Service (EMS), Ketchikan Fire Department, testified via teleconference in support of HB 478. He stated that he was in agreement with Steven O'Connor's suggestions. He indicated that the term advanced cardiac life support techniques is referred to several times in the bill and suggested that the word cardiac be deleted. CHAIR TOOHEY asked Rep. Therriault if specific regulations would be brought up by the Department of Health and Social Services (DHSS) or the Department of Public Safety. She asked what the guidelines would be for EMSs. REP. THERRIAULT stated that there would be some regulatory "fleshing out" and he felt that statutes would not be able to address that level of detail. He then said he had an amendment that would delete the language that requires the EMS provider to sign the death certificate and would change the language to require the EMS to provide information regarding the circumstances of death to the person who signs the death certificate. REP. BUNDE made a motion to adopt the amendment to HB 478. REP. VEZEY objected. (CHAIR TOOHEY stated for the record that Rep. Brice arrived at 3:10 p.m. and Rep. Nicholia arrived at 3:13 p.m.) REP. VEZEY asked if the amendment was numbered A.1 (8-LS1678/A.1). He was told by a number of members that it was. REP. THERRIAULT said that the change would require the EMS to provide the information to the person who signs the death certificate. REP. VEZEY said the amendment did not read well and asked for someone to read it in context. Number 382 CHAIR TOOHEY read page 2, line 18, as amended: "The paramedic or emergency medical technician shall provide to the person who signs the death certificate the... name of the deceased; presence of a contagious disease, if known; and..." REP. VEZEY said it sounded like an incomplete sentence. REP. THERRIAULT further indicated that the words which must be include were deleted. He said that it is an incomplete sentence that is completed with 1, 2, or 3. REP. BRICE read the sentence again. CHAIR TOOHEY asked if Rep. Vezey understood the question. REP. VEZEY said yes. He then asserted that the physician would be held liable for the information provided by the EMS who hadn't signed anything. He asked why it would be preferable not to have the paramedic sign. CHAIR TOOHEY said the only information being provided was the name of the deceased, the presence of a contagious disease, if known, and the date and time. REP. VEZEY indicated that the aforementioned information was very critical legal information with tremendous legal consequences. REP. THERRIAULT said it was his intention to have the EMS provider sign the death certificate, but indicated there is a system already in place through which that information is provided. REP. OLBERG clarified that any death not attended by a physician would require a physician to sign a death certificate, even though the physician would be required to take a third party's word for it. He also said it was his understanding that a death, not attended by a physician, would result in an autopsy. CHAIR TOOHEY agreed with Rep. Olberg. REP. VEZEY said he was not comfortable with the amendment, but would listen to further testimony. CHAIR TOOHEY asked Mark Johnson to address the question. Number 500 MARK JOHNSON, Chief, Emergency Medical Services Section, Division of Public Health, Department of Health and Social Services, testified in Juneau in support of HB 478. He stated that there is a medical examiner system in place and also that the new State Medical Examiner, Dr. Probst, was opposed to the concept of EMS providers signing death certificates. He maintained that the thrust of the bill is to enable EMS providers to pronounce death as to avoid extremely prolonged resuscitative efforts. He also indicated that there were some administrative questions that he needed clarified. Number 541 REP. VEZEY asked if the amendment was still being debated. CHAIR TOOHEY said yes. She called for a vote. REP. G. DAVIS asked that the vote be held until further testimony was heard, and said that Rep. Vezey's concerns and questions may be answered during that time. CHAIR TOOHEY agreed. Number 576 THOMAS SWAN, Paramedic, testified via teleconference in support of HB 478. He stated that the question of who would have the authority to pronounce a patient dead in the absence of a physician came up during a class that he was teaching last year. He said he has been pursuing the issue ever since as there was no clear answer in state law. He said the passage of HB 478 would ensure that proper medical procedures would be performed, that the EMS provider could pronounce the patient dead, and that the EMS provider would avoid any unnecessary exposure to a psychologically debilitating situation. He also said that the measure would preserve resources that may be needed in another emergency. Number 640 CRAIG LEWIS, President, Alaska Emergency Medical Association, testified via teleconference in support of HB 478. He stated that the aforementioned concerns should not stand in the way of the passage of the bill. He felt the concerns could be addressed in regulation. He urged the committee to support the legislation. Number 670 THOMAS NAROW, Chief of Service, Interior Ambulance and Rescue Squad, testified via teleconference in support of HB 478. He stated that the bill would help address situations where EMS providers are several hours away from a hospital. He also indicated that the term advanced cardiac life support is overly specific and explained that the Interior Ambulance and Rescue Squad is licensed as an advanced life support agency in the state of Alaska. Number 713 RONNI SULLIVAN, Executive Director, Southern Region Emergency Medical Services Council, Anchorage, testified via teleconference in support of HB 478. She stated that the issue has been a major concern of hers for several years. She explained the danger that EMSs face and sometimes put other people in when they continue emergency care on people that are not "viable" because CPR has been too prolonged or they were almost dead upon their arrival. She further explained that her nightmare is that an ambulance would slide off a slippery road as it was rushing an obviously nonviable patient to the hospital and perhaps killing all those inside and maybe others on the road. She said the bill would allow for the best patient care possible and would also remove a lot of the risk involved for the EMS providers. She mentioned that the bill refers to paramedics as registered and indicated that they are, indeed, licensed. Number 758 DAVID POTASHNICK, Assistant Chief, North Slope Fire Department, testified via teleconference in support of HB 378. He stated that it was his understanding that the proposal would require EMS providers to initiate care first and then determine whether the patient should be declared dead. He felt there should be provisions for the initial withholding of care, especially in instances involving crime scenes. He indicated that on page 1, lines 5-10, the inclusion of physician's assistants and registered nurses should be considered. He explained that the aforementioned do provide care in pre-hospital settings. He further indicated that on page 2, line 6, the term active member is unclear and questioned how it applied to the EMS providers. Number 808 JASON ELSON, Batallion Chief/Training Officer, Kenai Fire Department, testified via teleconference in support of HB 478. He stated that he agreed with the amendment. He also mentioned that an active member implies that the member is under current physician sponsorship and has a continuing medical education program. Number 820 JOEY PAYTON, Emergency Medical Technician, Delta Rescue, testified via teleconference in support of HB 478. He stated that the 1990's have been dedicated to the research and development of quality treatment and equipment. He said that he has, at times, had to work for up to three hours on nonviable patients. He indicated that there is much emotional suffering endured by EMS providers that have to provide unnecessarily prolonged emergency treatment to a nonviable patient. He further indicated that Dr. Jeffrey Mitchell has clearly documented the mental trauma endured by EMS providers from a prolonged resuscitation. He maintained that the bill would give an EMS provider the ability to declare death, would reduce unnecessary trauma to providers, and would allow the "obviously deceased to remain dead with dignity." Number 900 CHAIR TOOHEY asked if there was further teleconference testimony. Number 905 BRENT URSEL, Physician's Assistant, McGrath Health Center, testified via teleconference in support of HB 478. He stated that villages in rural areas do not have state troopers or physicians that can pronounce people dead. He said that the EMTs and the health providers in the community are obligated to perform whatever life saving techniques are warranted, even when the case is obviously hopeless. He felt the proposal would address some of the needs of rural villages and would take the pressure off EMTs and health providers in those situations. Number 925 CHAIR TOOHEY said she agreed with Mr. Ursel and thanked him for his testimony. REP. BRICE asked Mr. Ursel if, as a physician's assistant (PA), he could pronounce a person dead or sign a death certificate. MR. URSEL replied that he has been in touch with the local magistrate who informed him that he can pronounce people dead and sign death certificates. Number 940 REP. G. DAVIS referred to the procedure of providing information to go along with a body to a physician who would then sign the death certificate and asked what his current procedure was in regards to the aforementioned procedure. MR. URSEL said that much of the information is provided to the coroner or state troopers. He indicated that in a small village a state trooper can pronounce death and then those who were providing emergency care would give the information to the trooper. Number 973 CHAIR TOOHEY asked for testimony from Galena. Number 975 JANET NORTH, Physician's Assistant, Galena Health Center, testified via teleconference in support of HB 478. She stated that PAs, nurse practitioners, and health aids are often the only EMS providers in rural communities. She related an experience that happened over the weekend where a patient died after undergoing 40 minutes of CPR in the back of an ambulance. She indicated that she was under the impression that only the coroner could declare a patient dead and that they spent five hours trying to find the coroner. She asserted that the situation was distressing to the family of the deceased. She felt the proposed legislation would make her job easier. Number 995 CHAIR TOOHEY said she empathized with Ms. North's situation. She then asked for further testimony. Number 997 GEORGE GILMORE, Physician's Assistant, Ft. Yukon, testified via teleconference in support of HB 478. He asked if the proposal would allow EMTs to declare death at the scene. CHAIR TOOHEY indicated that after appropriate training EMTs will have that authority. MR. GILMORE stated that he heartily endorsed the intent of HB 478. He explained that in the rural area he is in there has been no one who is certified to pronounce death. He said the issue has caused many problems and referred to the disposition of the deceased and the hardship endured by the family. Number 045 CHAIR TOOHEY asked for further testimony. Number 047 WENDY HLADICK, Physician's Assistant, Galena Health Center, testified via teleconference in support of HB 478. She stated her belief that if a coroner with no medical background can pronounce death, certainly an EMS provider, who is highly trained in emergency care, could also declare death. Number 064 CHAIR TOOHEY asked if there was further teleconference testimony. There was none. REP. BUNDE made a motion to adopt the proposed amendment. CHAIR TOOHEY asked Rep. Vezey if his objection still stands. REP. VEZEY said no, and withdrew his objection. CHAIR TOOHEY, hearing no objections, stated that the amendment was so moved. She asked if there were any further amendments or questions. Number 090 REP. BRICE indicated that he would move to pass the bill out, unless Rep. Kott had an amendment to make. REP. KOTT stated that he had a letter of intent that he would like to have accompany the passage of HB 478 to the next committee of referral. He felt the letter of intent would be better addressed in the next committee. REP. BUNDE stated that HB 478 as amended had a zero fiscal note and asked if the letter of intent would have any fiscal impact. REP. KOTT responded no, but asked that perhaps a member of the department should address the question. Number 100 MR. JOHNSON stated it was his understanding that there would be no additional fiscal note added as a result of the accompanying letter of intent. Number 116 REP. BRICE made a motion to pass HB 478 as amended out of committee. REP. B. DAVIS asked what the focus of the letter of intent was. REP. KOTT stated that the letter of intent would require additional training for all EMS providers as to recognize the signs of death, and would also require that there be extensive notification to all emergency medical services providers and agencies as soon as possible after the bill becomes law. TAPE 94-38, SIDE B Number 000 CHAIR TOOHEY asked if the EMS providers have to be trained. MR. JOHNSON answered yes and said a notice would be sent to all the emergency medical services and medical directors in the state informing them of the new law. Then it would be the responsibility of the directors to ensure that the EMS providers under their sponsorship are appropriately trained. He said the DHSS would probably send guidelines as to how the training should be done. REP. G. DAVIS indicated that the letter from the Alaska State Medical Association recommends that the word or be changed to and on page 3, line 2, of the bill. He asked Mr. Johnson to respond to the suggestion. MR. JOHNSON said he felt the change would be going further than necessary. He said he preferred the language as written. Number 086 REP. BUNDE asked that there be a technical change to substitute the word licensed for the word registered. REP. THERRIAULT said he was unsure as to whether the term should be licensed or registered. MR. JOHNSON explained that the regulations for paramedics uses the word license. He also indicated that the words licensed and registered are "almost interchangeable words in our state." He said the word licensed is used on the certificate given to paramedics in the state. REP. THERRIAULT said that he would agree with any language that the legal department suggests. Number 133 CHAIR TOOHEY asked if the second item was addressed in the letter of intent. REP. KOTT said yes. CHAIR TOOHEY asked the pleasure of the committee. REP. BUNDE made a motion to pass HB 478 as amended out of committee with individual recommendations and accompanying fiscal note. CHAIR TOOHEY asked if there were any objections. Number 154 REP. VEZEY objected. He referred to page 2, lines 29-31, and said he found it incredulous that EMS providers would be expected to perform life saving measures under those circumstances. He asked if there was a valid reason the line was in the bill. MR. JOHNSON agreed with Rep. Vezey, but felt it doesn't hurt to have the language included. However, he said that some of the conditions listed leave room for judgement. REP. VEZEY said, "what brought it out of my mind is the Alaska State Medical Association was advocating changing the word or after (the) semicolon to and. And, I would interpret that coming after the semicolon that it applied to all the previous subsections, which I think would just be ludicrous." REP. VEZEY further commented that perhaps it would be better to delete the entire sentence on page 2, lines 18-22. He asked if there was more information that goes on the death certificate than is listed on those lines. MR. JOHNSON said there is additional information that pertains to the cause of death. He felt it would be best to have those already trained in signing death certificates to continue doing so. Number 257 CHAIR TOOHEY asked if Rep. Vezey's objections still stands. REP. VEZEY withdrew his objection. REP. KOTT objected and asked that the maker of the motion to pass HB 478 as amended out of committee amend the motion to include the letter of intent. REP. BUNDE said that it was his intent to make that the next motion. He felt it should be done in two steps. REP. KOTT withdrew his objection. Number 283 CHAIR TOOHEY called for the vote to pass HB 478 as amended out of committee with accompanying fiscal note. Representatives Bunde, G. Davis, Vezey, Kott, B. Davis, Nicholia, Brice and Toohey voted Yea. There were no Nay votes. REP. BUNDE made a motion to include the accompanying letter of intent with HB 478 as amended. CHAIR TOOHEY, hearing no objections, said that HB 478 as amended was so moved. She then brought HB 506 to the table.