Legislature(2001 - 2002)

04/10/2002 01:18 PM JUD

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 197 - HEALTH CARE SERVICES DIRECTIVES                                                                                      
                                                                                                                                
Number 0056                                                                                                                     
                                                                                                                                
CHAIR ROKEBERG announced  that the first order  of business would                                                               
be  HOUSE  BILL NO.  197,  "An  Act  relating to  directives  for                                                               
personal  health  care  services   and  for  medical  treatment."                                                               
[Before the committee  was committee substitute (CS)  for HB 197,                                                               
version 22-LS0712\O,  Bannister, 2/26/02, which was  adopted as a                                                               
work draft and amended on 3/20/02.]                                                                                             
                                                                                                                                
Number 0103                                                                                                                     
                                                                                                                                
REPRESENTATIVE  JAMES moved  to adopt  committee substitute  (CS)                                                               
for HB  197, version 22-LS0712\P,  Bannister, 3/20/02, as  a work                                                               
draft.   There  being  no  objection, Version  P  was before  the                                                               
committee.                                                                                                                      
                                                                                                                                
Number 0124                                                                                                                     
                                                                                                                                
MELANIE LESH,  Staff to Representative Bill  Hudson, Alaska State                                                               
Legislature, sponsor,  speaking on  behalf of the  sponsor, noted                                                               
that Version P allows for  the reenactment of the current statute                                                               
regarding the  protocol for  responding to  the "Comfort  One Do-                                                               
Not-Resuscitate (DNR) program."   She also noted  that a proposed                                                               
amendment would provide the final  touch, with one exception, for                                                               
that provision.   When HB  197 was first created,  she explained,                                                               
the intent was  to take all of the current  provisions related to                                                               
end-of-life healthcare  decisions and place them  in one chapter.                                                               
These provisions  include the Organ Donation  program, the Living                                                               
Will   [program],  the   Comfort  One   Do-Not-Resuscitate  (DNR)                                                               
program, and an "expanded healthcare  durable power of attorney."                                                               
However, during the drafting process,  the repeal and reenactment                                                               
of  the  Comfort One  Do-Not-Resuscitate  (DNR)  program did  not                                                               
occur  as planned.   Version  P  reenacts that  program in  full,                                                               
although it still needs revision via [Amendment 1]                                                                              
                                                                                                                                
Number 0293                                                                                                                     
                                                                                                                                
CHAIR ROKEBERG  said that  he would entertain  a motion  to adopt                                                               
Amendment 1.                                                                                                                    
                                                                                                                                
MS.  LESH  pointed out  that  Amendment  1  is  also in  need  of                                                               
revision.  On  page 3, line 3, of Amendment  1, the Department of                                                               
Health & Social Services (DHSS)  recommends changing the language                                                               
so that  it will  read:   "(c) An individual  who is  a qualified                                                               
patient, including an individual for whom a physician".                                                                         
                                                                                                                                
Number 0391                                                                                                                     
                                                                                                                                
CHAIR  ROKEBERG  made  a  motion   to  adopt  the  aforementioned                                                               
language as an amendment to Amendment 1.                                                                                        
                                                                                                                                
REPRESENTATIVE BERKOWITZ objected for  the purpose of discussion.                                                               
He opined  that the amendment  to Amendment 1 seems  to "preclude                                                               
an  individual  from having  this  kind  of conversation  with  a                                                               
doctor prior to becoming a qualified [patient]."                                                                                
                                                                                                                                
MS. LESH said that a qualified  patient can only be determined by                                                               
a doctor, so there is only  a very small window of opportunity in                                                               
which one  [can become] that  qualified patient; "You have  to be                                                               
in  a  terminal  condition,  which  has  to  substantiated  by  a                                                               
physician."                                                                                                                     
                                                                                                                                
REPRESENTATIVE BERKOWITZ  asked:   "If I were  to have  a do-not-                                                               
resuscitate order  now, and I'm  in relatively good  health, that                                                               
wouldn't seem to be permitted  under this amendment [to Amendment                                                               
1], is that correct?"                                                                                                           
                                                                                                                                
Number 0487                                                                                                                     
                                                                                                                                
SHELLY K.  OWENS, Community Health &  Emergency Medical Services,                                                               
Division  of  Public  Health,  Department   of  Health  &  Social                                                               
Services (DHSS),  clarified that if one  has a do-not-resuscitate                                                               
order  it is  because he/she  has  already been  determined by  a                                                               
physician  to be  terminally ill.    She said  that [the  DHSS's]                                                               
concern with  Amendment 2 as it  is currently written is  that it                                                               
might provide  an individual who  is not terminally ill  and does                                                               
not  have  a  DNR  order  to  refuse  lifesaving  treatment;  for                                                               
example,  if someone  attempted suicide  and failed,  that person                                                               
could refuse help.                                                                                                              
                                                                                                                                
REPRESENTATIVE  BERKOWITZ   asked  whether   he  could   [have  a                                                               
physician] make that determination now,  if, for example, he were                                                               
concerned about  the possibility of  getting in an  accident that                                                               
degrades his quality of life.                                                                                                   
                                                                                                                                
MS. OWENS pointed  out that under current law,  a physician could                                                               
not prepare  a DNR order for  someone who is not  terminally ill,                                                               
and the same restrictions would apply under [version P].                                                                        
                                                                                                                                
CHAIR ROKEBERG asked  why the language about  a qualified patient                                                               
should be  added to Amendment 1  if it is already  assumed that a                                                               
physician only  prepares a DNR  order for someone who  is already                                                               
qualified.                                                                                                                      
                                                                                                                                
MS.  OWENS explained  that the  additional language  is necessary                                                               
because  the inclusion  of the  clause  offset by  commas in  the                                                               
current language  of Amendment 1  might leave that section  to be                                                               
interpreted  to mean  "an  individual  has the  right  to make  a                                                               
decision regarding  the use of" life-sustaining  procedures.  She                                                               
said that such  an interpretation might allow a  person to refuse                                                               
life-sustaining  treatment   regardless  of  whether   he/she  is                                                               
terminally ill.                                                                                                                 
                                                                                                                                
REPRESENTATIVE  BERKOWITZ said  he  could envision  circumstances                                                               
for which he would like  to have a do-not-resuscitate order, even                                                               
though  he is  currently in  relatively  good health.   He  asked                                                               
whether there is any procedure by which that could happen.                                                                      
                                                                                                                                
MS.  OWENS said  no;  if  a physician  were  to  write a  do-not-                                                               
resuscitate  order for  someone  who is  not  terminally ill,  it                                                               
would  be  in  contravention  of exiting  law  and  the  proposed                                                               
legislation.  She pointed out  that the purpose of the healthcare                                                               
directive  is   to  address  the   type  of  concerns   posed  by                                                               
Representative Berkowitz.   A person's wishes, in the  event of a                                                               
serious  accident,  could  be provided  for  via  the  healthcare                                                               
directive, but only a patient who  is terminally ill can obtain a                                                               
do-not-resuscitate order.                                                                                                       
                                                                                                                                
Number 0692                                                                                                                     
                                                                                                                                
REPRESENTATIVE BERKOWITZ withdrew his  objection to the amendment                                                               
to  Amendment  1.     He  added,  however,   that  since  passing                                                               
legislation is an iterative process,  he would hope that the next                                                               
iteration of HB 197 would go further in addressing his concerns.                                                                
                                                                                                                                
MS. LESH said that it is  the sponsor's intent to allow people to                                                               
broadly  state their  wishes  regarding [end-of-life]  treatment,                                                               
but  in the  situation of  a  severe accident,  for example,  the                                                               
Emergency  Medical technicians'  lifesaving  protocol would  take                                                               
precedence.   She  noted that  [Version  P and  Amendment 1]  are                                                               
merely reenacting current protocol.                                                                                             
                                                                                                                                
Number 0800                                                                                                                     
                                                                                                                                
CHAIR  ROKEBERG, noting  that there  were no  further objections,                                                               
stated that the amendment to Amendment 1 was adopted.                                                                           
                                                                                                                                
Number 0813                                                                                                                     
                                                                                                                                
CHAIR  ROKEBERG  asked  whether  there  were  any  objections  to                                                               
adopting  Amendment 1,  as amended.   There  being no  objection,                                                               
Amendment 1, as amended, was adopted.                                                                                           
                                                                                                                                
Number 0850                                                                                                                     
                                                                                                                                
REPRESENTATIVE MEYERS  moved to report committee  substitute (CS)                                                               
for HB 197, version 22-LS0712\P,  Bannister, 3/20/02, as amended,                                                               
out  of   committee  with  individual  recommendations   and  the                                                               
accompanying zero  fiscal note.   There being no  objection, CSHB
197(JUD)  was   reported  from   the  House   Judiciary  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                

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