Legislature(1993 - 1994)

03/07/1994 03:00 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
  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.                 

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