Legislature(1997 - 1998)
03/06/1998 01:07 PM House JUD
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 395 - CIVIL LIABILITY FOR EMERGENCY AID Number 0591 CHAIRMAN GREEN announced the next item of business would be HB 395, "An Act relating to civil liability resulting from the use of a defibrillator in providing emergency aid." Number 0599 PATRICIA SWENSON, Legislative Assistant to Representative Con Bunde, Alaska State Legislature, read the sponsor statement into the record as follows: "Every day nearly 1,000 people in the United States die unnecessarily due to sudden cardiac arrest. Most people die before they reach the hospital, usually within two hours. Research shows that early defibrillation, delivering an electric current to the heart within minutes after sudden cardiac arrest, can raise survival rates to 30 percent of higher. That's 25 percent more lives than the current national survival rate of 5 percent. "The American Heart Association estimates that 20,000 or more unnecessary deaths could be prevented each year if automatic external defibrillators [AEDs] were more widely available. Implementation of a plan that allows both traditional and nontraditional targeted first responders to have access to and use of an AED in medical emergencies is needed. "House Bill 395 expands our state's Good Samaritan statute to provide protection from liability for people who are properly trained in the use of an AED. As a general rule, the American legal system does not require someone to rescue a victim. However, all states currently have Good Samaritan statutes that protect a volunteer who is aiding another in good faith. These statutes mainly apply to physicians and other health care providers who assist somebody voluntarily and do not expect any reimbursement for their services, but passersby who happen upon an accident and provide emergency assistance are also protected from liability. House Bill 395 clearly sets the standard for training and proper use of an automatic external defibrillator. Increased availability of automatic external defibrillators along with proper training will save lives. House Bill 395 will help make Alaska a safer place." Number 0712 REPRESENTATIVE BERKOWITZ made a motion to adopt Version E [0- LS1560\E, Ford, 3/5/98] as a work draft. There being no objection, it was so ordered. MS. SWENSON explained that Version E adds the use of manual electric cardiac defibrillators to the so-called Good Samaritan statute, AS 09.65.090. REPRESENTATIVE BERKOWITZ asked what "manual electric" means, suggesting it sounds almost contradictory. MS. SWENSON answered that it is an automatic external defibrillator. Number 0755 REPRESENTATIVE CROFT asked, "Manual electric as opposed to what? " MS. SWENSON told members she hadn't anticipated that question and has been out of the field for a while. REPRESENTATIVE ROKEBERG suggested they could say "old-fashioned" instead of "manual." He said as he reads it, people using manual defibrillators in emergency rooms, such as on television shows, are not immune under subsection (b). Number 0934 REPRESENTATIVE JAMES suggested Representative Rokeberg's concern was because it says this immunity does not apply except to a person authorized by law to do it. A passerby who didn't know how to do it wouldn't be exempt, which she thinks is the intent. MS. SWENSON said further on, it sets out standards for training. "The training will say when people can use them and when they can't," she added. Number 0958 REPRESENTATIVE CROFT expressed his understanding that everybody is immune if they meet the criteria. For the more complicated kind, the criteria is that the person must be authorized by law; he suggested that would mainly be nurses or doctors in a hospital. For subsection (e), the criteria is that people must be trained. Representative Croft pointed out that subsection (d) had been retained, which says, "(d) This section does not preclude liability for civil damages as a result of gross negligence or reckless or intentional misconduct." MS. SWENSON offered to show members documentation of support. Number 1072 MARK JOHNSON, Chief, Community Health and Emergency Medical Services, Division of Public Health, Department of Health and Social Services, introduced paramedic Matt Anderson, who was with him to answer questions. Mr. Johnson said they were here to speak in favor of this legislation. MR. JOHNSON told members there are approximately 350,000 sudden cardiac arrests in the United States every year; in Alaska they estimate that translates to roughly 600 to 700. Numerous studies have been done over the last 15 or more years, many in Seattle, Washington. Mr. Johnson pointed out that HB 395 is quite similar to a bill working its way through the Washington State legislature now; he indicated they had worked with the sponsor of that bill to incorporate much of it here. Number 1115 MR. JOHNSON stated, "According to the American Heart Association, they've adopted what's called the emergency cardiac care systems concept, and they call it the chain of survival. And it has four elements. When someone collapses with cardiac arrest and it's witnessed, the first thing to do is notify the EMS [emergency medical services] system, usually by 911 or some other means. Second, initiate CPR [cardiopulmonary resuscitation]. Third, get early defibrillation, as quickly as possible. And fourth, get advanced cardiac life support via paramedics, hospital emergency department, whatever." MR. JOHNSON said some studies have shown that when the EMS system is notified within approximately one minute, CPR is initiated within about two minutes, defibrillation is provided within about four minutes, and advanced cardiac life support is provided within about eight minutes, the survival rate can be approximately 30 percent. By contrast, if there is no CPR and defibrillation is delayed for approximately ten minutes, the survival rate drops to roughly zero to 2 percent. Clearly, the key is to get the CPR and defibrillation as early as possible. Number 1217 MR. JOHNSON reported that the American Heart Association and other national groups have, over the last year or two, been advocating "public access defibrillation." The new automated external defibrillators (AEDs) are computerized; when the defibrillator is hooked up to the patient, the computer detects whether there is a life-threatening dysrhythmia of the heart and then determines whether to shock the patient. These new machines, available on the market today for $3,000, will only shock when there is a life- threatening dysrhythmia. Mr. Johnson pointed out that manual defibrillators can cost upwards of $10,000, adding that those are the types of machines paramedics and hospital emergency departments use, and those people currently are licensed under state law to perform those kinds of functions. Number 1273 MR. JOHNSON explained that this bill would affect people with approved CPR training and AED training, which is significantly less training than is currently required to become authorized to use defibrillators. Those people could become legally authorized under this statute, and they could include police officers, firefighters who are not EMS providers and perhaps security guards. The American Heart Association recommends placing these devices wherever there are both a likelihood of significant numbers of people and a likelihood of cardiac arrests. A recent study out of Seattle found that the number one public place was in the airport. "And, in fact, I just spoke with the Anchorage fire department today, and they're working to put defibrillators at the Anchorage airport," Mr. Johnson added. MR. JOHNSON said they had worked with the sponsor, and they believe the provisions to ensure that people have minimum training requirements could potentially lead to hundreds more authorized people in Alaska; there are about 1,200 in the state now, including emergency medical technicians (EMTs), paramedics or first responders currently certified by Mr. Johnson's department to legally provide defibrillation. Over the next few years, that increase could potentially translate into dozens of lives saved. Mr. Johnson noted that the bill also addresses protections for people who do the training and who own the devices. He offered to answer questions, noting that Matt Anderson could answer specific questions about the devices. He concluded by expressing strong support for the bill. Number 1380 REPRESENTATIVE ROKEBERG expressed concern about the requirement that a person be trained and carry a card. He asked what would happen if no one else was around, and a person either didn't have a card or had left it at home. MR. JOHNSON replied that as a Good Samaritan bill, the protection here is from liability. The state won't be asking someone for a card at the scene. The real issue is whether there is a protection from liability for these individuals. Although not trained in law, he said he would think that as long as someone had the appropriate training required under the bill, that person would be protected. Number 1474 ROSE MARIE CITTI, Director of Training, Respond Systems, testified via teleconference from Anchorage. She first indicated she had been sending material almost daily since February 1, and that Mr. Johnson had addressed some items in her prepared comments. Ms. Citti offered a quotation from Dr. Richard Cummins, professor of medicine at the University of Washington, who is a leader in treatment of sudden cardiac arrest. Dr. Cummins had said there is now both national and international acceptance of the "principle of early defibrillation," which contends that whoever arrives first at the scene of a cardiac arrest should have a defibrillator. He had gone on to say that anyone who can learn CPR can also learn to use an AED and should be allowed to use one and be protected from repercussions. MS. CITTI reminded members that 30 years ago, CPR was considered an advanced medical skill. "Now we teach school kids how to use it," she said, adding that there are numerous documented cases where people have been saved due to CPR performed by bystanders, buying the patients time until EMS personnel arrived. MS. CITTI indicated she was testifying out of frustration because although the technology exists that can save countless lives, laws prohibit the use. Her interest comes from eight years of being a CPR instructor; she teachers pre-EMS personnel from a wide variety of occupational settings who are designated by their employers and expected to respond to medical emergencies, or else they are willing bystanders. Ms. Citti said public access use of AEDs should target pre-EMS responders, who are trained individuals with a willingness, designation or responsibility to treat the public and to assist co-workers in medical emergencies. These people should be free to perform this potentially life-sustaining action without fear of violating the law. She said the Good Samaritan law must be extended beyond paramedics, firefighters, police officers, lifeguards and those with a duty to respond, to include those who are doing it on a willing basis or because of their employer's requirement. Number 1615 MS. CITTI cited examples of companies with trained personnel which should be able to use AEDs in an emergency without risk of breaking existing laws. She cited additional examples of people who should have use of this technology without repercussion, including trained motor coach or bus drivers, Alaska Railroad conductors, utility workers, pilots, charter boat operators, people who have remote lodges and in-town hotel or motel staff. MS. CITTI said Alaska has always been on the leading edge of making important changes to established medical procedures because of unique needs and remote locations. Alaska led the way with defibrillator-trained technicians when the equipment was manually operated, and AED technology has moved so fast that Alaska is no longer keeping pace with regulations or statutes. MS. CITTI concluded by saying she applauds the energy and thoughtfulness that have gone into preparing HB 395. She said she finds the approach taken in this bill addresses most of her main personal concerns. She encouraged the committee to move this issue forward. Number 1692 CRAIG LEWIS, Director, Interior Region Emergency Medical Services Council, testified via teleconference from Fairbanks in support of the proposed committee substitute for HB 395. He noted that a number of his prepared comments had already been addressed by Mr. Johnson and Ms. Citti. MR. LEWIS told members the development and proliferation of automated external defibrillators across the nation and in Alaska warrant the amendment to Alaska's Good Samaritan Act. The American Heart Association, the American Red Cross and a number of corporate American companies recognize the value of AEDs, and states either have or are passing similar legislation. Major corporations across the nation and in Alaska are already purchasing and positioning AEDs in their places of business. Princess Tours has them on its buses, and Alaska Airlines has them on its planes. "It only makes sense that we adjust our legislative process to recognize the technology," Mr. Lewis said. MR. LEWIS advised members that the state of the art regarding defibrillation has changed significantly and will continue to change. The size, shape and capabilities of these machines will improve, "most likely to where the next time you see one, it will be a third the size of a briefcase and be next to the first-aid station on the wall." Mr. Lewis said the sophistication of the devices is incredibly fast-moving, and right now they do the analyses that used to be done by hand. MR. LEWIS explained that the difference between manual and automated has to do with the capability on a manual defibrillator to adjust the amount of electric flowage by hand, with a pre- approved protocol and standard, to the patient. Automated defibrillators adjust all of those things within the computer system of the machine, with a number of fail-safe mechanisms that have been tested over time. He urged passage of this legislation. Number 1854 CHAIRMAN GREEN asked that both Ms. Citti and Mr. Lewis submit any written testimony for the record. Number 1875 REPRESENTATIVE CROFT offered an amendment to page 2, line 15, to substitute "possess" for "carry". He explained, "I don't think we meant that you carry it around the whole time." REPRESENTATIVE BERKOWITZ suggested "maintain". REPRESENTATIVE CROFT mentioned then getting rid of "evidence." REPRESENTATIVE BERKOWITZ suggested "maintain current evidence". CHAIRMAN GREEN asked what the amendment is. REPRESENTATIVE stated, "My amendment is 'maintain'." Number 1982 REPRESENTATIVE ROKEBERG suggested they could delete the last part of the sentence, following the semicolon ["a user of a defibrillator shall carry current evidence of demonstrated proficiency in defibrillator use and cardiopulmonary resuscitation;"], unless the implication is to have not current training but recurrent training. He said all it means is the person is carrying a card around. CHAIRMAN GREEN said the problem may be people who don't have their cards with them. Number 2057 REPRESENTATIVE CROFT stated, "It couldn't be there to mean to be current. You take the course, 'shall receive reasonable instruction' - I did that ten years ago or whatever - 'and shall stay current.'" REPRESENTATIVE PORTER agreed. REPRESENTATIVE ROKEBERG said if that is the implication, it should be spelled out. Number 2074 MS. LEWIS told members that people have to redo their training every year or two. Number 2098 REPRESENTATIVE JAMES said it could stop after "proficiency". She explained, "I think you do need to have this bit about being current with it, because the first part doesn't say that you are." Number 2125 CHAIRMAN GREEN referred to the motion on the table and asked whether there was any objection to substituting "maintain" for "carry" on page 2, line 15. There being no objection, that amendment was adopted. REPRESENTATIVE ROKEBERG asked Ms. Swenson what is meant by "current," suggesting the need to stipulate that in the bill. Number 2150 MS. SWENSON answered that "current" means that the card must be kept up and the training must be there, through an approved course. People must redo their training every year or two and get an updated card. She explained that there are basic life support and advanced cardiac life support, which have changes over the years. As the changes occur, people have to update their training. In addition, a lot of nurses and other people use it for continuing education, so that they keep their cards current. Number 2204 REPRESENTATIVE ROKEBERG said he appreciates that and thinks it is laudable, but when they put in the statute that a person must have a current permit, they need to define what "current" is. CHAIRMAN GREEN asked whether "active" would satisfy it. REPRESENTATIVE ROKEBERG suggested that if there are different training forums, there may be differing standards. Number 2283 MS. SWENSON told members, "The cards all have an expiration date on them, when you renew your training, and it varies by program what that expiration date is and the length of time before they have to retrain. So 'current' would be before the expiration date." CHAIRMAN GREEN said it is like CPR, for which the card has an expiration date, and he asked again whether "active" would be appropriate. MS. SWENSON stated her belief that "current" is the standard. CHAIRMAN GREEN pointed out that the committee was having difficulty with it. Number 2298 REPRESENTATIVE PORTER suggested it isn't the evidence they want current, but the proficiency. He asked whether perhaps they should say, "shall maintain evidence of current demonstrated proficiency". CHAIRMAN GREEN suggested perhaps just "proficiency". Number 2366 REPRESENTATIVE CROFT said he would amend the amendment so the sentence will read, starting at line 15, "a user of a defibrillator shall maintain a current proficiency in defibrillator use and cardiopulmonary resuscitation". He specified that he was taking out "evidence of demonstrated" and making essentially the substitution made before. CHAIRMAN GREEN asked whether there was any objection to the modified amendment. There being no objection, it was adopted. Number 2395 REPRESENTATIVE CROFT advised members of one more legal problem, which he and Kevin Jardell had been working on. He said he would describe the problem and perhaps Mr. Jardell had a solution. Section 1 says "authorized by law," and testifiers have said, if he understands correctly, that this is limited to a certain class of people; it was illegal for other people to do this. What they are changing here is simply the Good Samaritan law, not the law that said it is illegal for someone to do it. Representative Croft stated, "So, we could have, 'you're not liable for it, as long as you don't use gross negligence,' but you're actually still technically violating the law ...." TAPE 98-32, SIDE A Number 0001 MR. JOHNSON said he is not sure exactly how it affects this bill, but the way to address the problem described is with a one-word insertion under AS 18.08.090(1). Previously in that statute, it says a person has to be certified or licensed in order to do advanced life support. Mr. Johnson read from subsection (1), which says, "'advanced life support' means emergency care techniques provided under the written or oral orders of a physician that include, but are not limited to, electric cardiac defibrillation ...." Number 0092 MR. JOHNSON suggested if they inserted "manual" there, it would simply say a person has to be appropriately licensed or certified to use a manual defibrillator. "But that would not require automated defibrillators to come under this requirement," he pointed out. Number 0128 REPRESENTATIVE PORTER asked Ms. Swenson whether she would accept a conceptual amendment to include that in the bill. MS. SWENSON said that would be fine. Number 0150 KEVIN JARDELL, Legislative Administrative Assistant to Representative Joe Green, spoke as the committee aide, noting that it may or may not require a title change. CHAIRMAN GREEN said they are still talking about civil liability for use of a defibrillator. Number 0210 REPRESENTATIVE CROFT suggested a conceptual amendment to make the same things they are talking about here partially immunized and not illegal. Number 0234 MR. JARDELL stated his understanding that the conceptual amendment includes that this is not an illegal act, that the liability is immunized and the actual activity is legal and allowable. CHAIRMAN GREEN noted that is under the statute cited in Title 18. Number 0279 REPRESENTATIVE PORTER said as he understood Mr. Johnson's reading of that statute, the only required amendment is to add "manual" in front of "electrical"," as they have here, but in the other statute [AS 18.08.090]. CHAIRMAN GREEN asked whether everyone understood the conceptual amendment and whether there was any objection. Hearing no objection, he announced that it was adopted. Number 0335 REPRESENTATIVE BERKOWITZ, noting that his grandmother is an English teacher, suggested that on page 2, line 20, it would be better to say "consistently" instead of "consistent." CHAIRMAN GREEN agreed it is an adverb. REPRESENTATIVE ROKEBERG said he believes adverbs are discouraged by the drafting manual. Number 0437 REPRESENTATIVE ROKEBERG made a motion to move HB 395, Version E [0- LS1560\E, Ford, 3/5/98], as amended, from committee with individual recommendations and with the attached zero fiscal note. CHAIRMAN GREEN asked whether there was any objection. There being none, CSHB 395(JUD) moved from the House Judiciary Standing Committee.
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