Legislature(2001 - 2002)
04/10/2002 01:18 PM JUD
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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.