Legislature(1997 - 1998)

02/25/1998 03:21 PM House L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 383 - EXPECTED DEATHS                                                       
Number 0044                                                                    
CHAIRMAN ROKEBERG announced the committee's first item of business             
would be HB 383, "An Act relating to expected deaths that occur at             
home or in a health care facility."  He invited the bill sponsor to            
come forward.                                                                  
Number 0059                                                                    
REPRESENTATIVE GARY DAVIS came forward to present HB 383.  He                  
stated HB 383 addresses a concern that was brought to his attention            
over the interim.  He gave the situation of a person who is dying              
and whose death is considered imminent, who is known to be in a                
physical state where survival is not expected, and who is being                
cared for by an agency such as a hospice, home health care service,            
or some existing organization providing a bereaving service.  He               
noted these services assist not only the patient, but also the                 
family members.  Representative Davis stated that current statutes             
require the police department be notified when that person passes,             
and the police then come and investigate the cause of death.  He               
said it seems this process is often invasive, noting different                 
peace officers react differently.  He said it takes a tactful                  
person to enter that situation, and he wondered why there is even              
the statute requiring the person at the scene to call the police               
officer in the case of an expected death where that is agreed and              
signed by the patient and a physician.  Representative Davis                   
indicated he thought, with all the duties and work peace officer               
groups are involved in nowadays, they would welcome a reduction in             
Number 0258                                                                    
REPRESENTATIVE DAVIS stated HB 383 actually clarifies the statute              
because they have found this situation is currently treated                    
differently in different parts of the state.  In some areas the                
policeman will automatically come to the house, with sirens going,             
and do his investigation.  Representative Davis noted he was not               
sure, but he thought then the policeman pronounced death and the               
body could then be moved.  He said it is currently a bit vague in              
statute, noting there is a "may" which some treat as a "shall."  At            
this time, some police departments respond and others don't.  He               
stated HB 383 would also clarify that and that was the                         
legislation's intent.  Representative Davis referred to the                    
sectional analysis of Section 1 of HB 383.  That part of the                   
sectional analysis reads:  "Amends AS 08.68.395 "Determination of              
death by registered nurse," subsection (a) to specify that required            
documentation for anticipated death include the physician's                    
agreement to sign the death certificate if the death occurs as                 
anticipated."  Representative Davis indicated, because of the cost             
factors involved in the care of a dying person, they are currently             
offering as many opportunities as they can for that person to pass             
as peacefully as possible at home with family members, rather than             
in a more expensive hospital setting.  He stated there is an                   
"expected death form" currently utilized which is signed by the                
patient and a physician.  Representative Davis said when that form             
is in place, and there is an imminent and expected death, then this            
"no duty to call the police officer" would come into play.  He                 
noted this is the essence of HB 383.                                           
Number 0451                                                                    
CHAIRMAN ROKEBERG noted, for purposes of clarity, he appreciated               
the inclusion of copies of the relevant statutes in the bill                   
packet.  He asked where the reporting requirement was located,                 
questioning whether it was in Chapter 65.                                      
Number 0485                                                                    
REPRESENTATIVE DAVIS replied he thought the reference was in AS                
12.65.005 which reads:  "Sec. 12.65.005.  Duty to notify state                 
medical examiner.  (a) Unless the person has reasonable grounds to             
believe that notice has already been given, a person who attends a             
death or has knowledge of a death, in addition to notifying a peace            
officer, shall immediately notify the state medical examiner when              
the death appears to have" [continues with subsections (1) through             
(10), and subsection (b)].                                                     
Number 0516                                                                    
REPRESENTATIVE BILL HUDSON indicated this was a topic not many                 
people thought about unless they were personally affected, and he              
appreciated Representative Davis bringing it to his attention.  He             
referred to the copies of the statutes in the bill packet, Sec.                
12.65.010, subsection (c), which read:  "The body of a person whose            
death has been or should be reported to the state medical examiner             
under this section may not be moved or otherwise disturbed without             
the permission of the state medical examiner."  Representative                 
Hudson stated there was no change in that language, asking                     
Representative Davis if that was correct.                                      
REPRESENTATIVE DAVIS stated Representative Hudson was correct.                 
Number 0570                                                                    
REPRESENTATIVE HUDSON noted that was kind of important as they                 
looked at this.                                                                
Number 0578                                                                    
CHAIRMAN ROKEBERG asked Representative Davis how it worked if the              
police officer was not going to be notified, but the body was not              
going to be moved.                                                             
Number 0591                                                                    
REPRESENTATIVE DAVIS replied it was his understanding that the body            
could be moved after death had been pronounced.  He asked his staff            
to come forward.                                                               
Number 0631                                                                    
DEB DAVIDSON, Legislative Administrative Assistant to                          
Representative Gary Davis, came forward.  She asked Chairman                   
Rokeberg to restate the question.                                              
Number 0638                                                                    
CHAIRMAN ROKEBERG restated his question, referring to                          
Representative Hudson's question about not being able to move the              
body until the medical examiner was notified.                                  
Number 0668                                                                    
MS. DAVIDSON responded that, according to the copy of the                      
procedures she received from the state medical examiner's office,              
there is an "800" phone number which she thinks is 1 (888) DECEASE.            
She said it appears this is a 24-hour number rotated among the                 
staff or going directly to the medical examiner, which can be                  
called at any time of the day when death occurs.  Ms. Davidson                 
stated, "You tell them that the death occurred, certain information            
that's already required:  name, address, that type of thing."  She             
said at that point the medical examiner gives permission for the               
body to be moved, and then the funeral director or whoever may be              
called.  Ms. Davidson indicated the state medical examiner might be            
able to answer that question better.                                           
Number 0734                                                                    
REPRESENTATIVE JOE RYAN stated, for the record, his wife is a                  
registered nurse.  He noted he thought Representative Davis's wife             
was also a nurse.                                                              
REPRESENTATIVE DAVIS replied in the affirmative.                               
Number 0750                                                                    
REPRESENTATIVE RYAN asked if this was going to incur an added                  
liability on registered nurses' licenses, noting only a physician              
previously has had the power to sign the death certificate.                    
Number 0766                                                                    
REPRESENTATIVE DAVIS stated he would answer and then refer to his              
staff who has done more research.  He said currently registered                
nurses are authorized to pronounce death, so he doesn't think that             
would be impacted.                                                             
Number 0790                                                                    
REPRESENTATIVE JOHN COWDERY stated he has had members of his family            
expire in his home on more than one occasion, noting the police                
showed up without sirens and, in fact, he said the police had been             
comforting.  Representative Cowdery said it was a crazy world,                 
indicating somebody might sign something like an expected death                
form and then miraculously live ten more years.  He asked what                 
would happen if foul play entered this and how was that situation              
addressed, noting he thought police involvement was for the                    
assurance that no foul play is involved.                                       
Number 0864                                                                    
REPRESENTATIVE DAVIS replied he thought there were two obvious                 
questions which came to everyone's mind in this.  He noted the                 
notice of imminent death is valid for 120 days - it is not                     
unlimited, so he said there is a limit there.  Representative Davis            
commented that number is adjustable, but he thinks it is what is               
used in the current paperwork.  Representative Davis said bring up             
the possibility of foul play is a very good point, and something               
many people are concerned with these days.  He stated the                      
professionals involved are licensed and their reputations are on               
the line, noting he referred to home health care and hospice                   
personnel but there may be others.  Representative Davis stated he             
would expect these professionals to call the police if they had any            
suspicion themselves, indicating he thought just the implication of            
foul play getting to the press or the community would ruin an                  
organization and possibly that individual professional.  He said he            
didn't know whether that is enough rationale to relieve the                    
suspicion on any individual's part, but stated that is how he has              
rationalized the situation.                                                    
Number 0967                                                                    
REPRESENTATIVE COWDERY commented he would like address questions to            
representatives of the Alaska State Troopers.                                  
Number 0978                                                                    
CHAIRMAN ROKEBERG noted the presence of Representative Sanders,                
Representative Brice and Representative Kubina.  Chairman Rokeberg             
stated he had some questions, but would like to proceed first to               
the other witnesses.                                                           
Number 1074                                                                    
DR. MICHAEL PROPST, State Medical Examiner, Division of Public                 
Health, Department of Health and Social Services, testified via                
teleconference from Anchorage.  He stated he was speaking in                   
opposition to the portion of HB 383 regarding notification of                  
police officers.  Dr. Propst said he is also familiar with death at            
home, noting his mother died at home not many years ago in Oregon              
from pancreatic cancer.  He said neither he nor his father were                
upset or alarmed by the deputy sheriff who stopped by shortly after            
his mother died; he said the officer's presence was comforting.                
Dr. Propst stated that, as the state medical examiner, he practices            
forensic pathology.  His duties under the statutes are to                      
investigate deaths including deaths in suspicious or unusual                   
circumstances, and he said, in general, that includes deaths which             
occur at home.  Dr. Propst stated one of the basic principles of               
forensic pathology is that the easiest person to murder is a person            
who is expected to die, such as those registered in an expected                
death program.  He said the ability to have a brief police visit at            
the time of death provides a final check and balance in the system             
for expected home deaths.  The officer responds without a blaring              
siren or flashing red lights, evaluates the scene, confirms the                
identity of the deceased, briefly views the remains for obvious                
evidence of injury or violence and reviews the medications of the              
deceased.  Dr. Propst noted the officer's interchange with those               
present allows the officer to assess the demeanor of those present             
and (indisc.) the appropriateness of that demeanor.  If all is                 
okay, the officer's visit is relatively brief and, in Dr. Propst's             
words, "But a short intrusion."  He indicated the checks and                   
balances provided by the officer's visit includes:  1) confirming              
the identity of the deceased, and 2) confirming the lack of                    
evidence of injury or violence, whether self-inflicted or inflicted            
by another.  Dr. Propst stated the officer's presence at the scene             
allows allegations of a variety of bad actions to be addressed:                
elder abuse; covert, "Kevorkian-like" assisted suicide; and                    
maltreatment by the home health care provider.  Dr. Propst stated              
he opposes the section of HB 383 dealing with AS 12.65 for those               
reasons.  He said he thinks the passage of this has the potential              
to take away information gathering about the now-deceased patient.             
Dr. Propst said he relies, as state medical examiner, on the                   
information gathered by the police on a death at home.  It allows              
him to determine that the death was a natural one and did not                  
involve any kind of malfeasance.                                               
Number 1250                                                                    
REPRESENTATIVE RYAN stated being autopsied was a personal phobia of            
his, and he asked Dr. Propst what someone had to do when he or she             
died to avoid one.                                                             
Number 1269                                                                    
DR. PROPST said dying under a situation which was a natural disease            
process under the care of a physician in a hospital would pretty               
much guarantee that.  Unless the family wanted some sort of post-              
mortem examination, he indicated an autopsy would not be necessary             
in that situation.                                                             
Number 1290                                                                    
REPRESENTATIVE DAVIS asked Dr. Propst if he knew of any strange                
circumstances to date in any Alaskan expected home deaths.                     
Number 1302                                                                    
DR. PROPST replied that he had investigated at least one case where            
elder abuse was alleged within the last two years, and said he was             
able to prove that allegation was unfounded.                                   
Number 1314                                                                    
REPRESENTATIVE HUDSON indicated it sounded like Dr. Propst's                   
concern was Section 3 of the bill, "No duty to notify peace officer            
of an expected home death."  Representative Hudson asked about the             
bill's other provisions.                                                       
DR. PROPST responded he had no objections to those other                       
provisions, stating his objections were to Section 3.                          
Number 1331                                                                    
REPRESENTATIVE HUDSON said he understood Dr. Propst had no                     
objection to the other provisions, but he asked if Dr. Propst could            
speak to the validity of the need for the other changes.                       
DR. PROPST stated he believed that those changes are satisfactory.             
Number 1351                                                                    
REPRESENTATIVE DAVIS noted Alaska is a large place and some areas              
lack police, but there may be a hospice, home health care, or a                
registered nurse attending an expected death.  He asked Dr. Propst             
how those deaths were currently handled.                                       
Number 1373                                                                    
DR. PROPST answered there were two points.  He said that, for the              
most part, the police agency responsible for the area responds to              
every scene of death.  In areas covered by the Alaska State                    
Troopers, he believes the troopers respond to each death.  Dr.                 
Propst said other police agencies in other areas, including village            
public safety officers (VPSOs), also respond to death scenes.                  
Number 1401                                                                    
REPRESENTATIVE DAVIS asked if the statutes requiring the body not              
to be moved until a police officer has arrived and an investigation            
has taken place still applied.                                                 
DR. PROPST answered that is correct, and he said that is the way               
the current medical examiner statute is structured.                            
Number 1419                                                                    
REPRESENTATIVE RYAN noted the change in Section 3, stating, "It                
also doesn't have to be notified in case of expected home deaths               
where a person authorized to pronounce deaths was in attendance or             
has knowledge of the death.  Isn't that a physician or a licensed              
registered nurse, and if they are in attendance, or has knowledge              
and been treating this person, anticipate the death, are they not              
better trained to do this than a police officer?"                              
Number 1442                                                                    
DR. PROPST replied that police officers are trained in death                   
investigation.  The doctors and nurses present are trained in                  
treating living people and not necessarily in dealing with the                 
investigation of death.                                                        
Number 1458                                                                    
REPRESENTATIVE COWDERY related the story of an old-timer who died,             
he said, out in Western Alaska near Haines Lake.  He said a                    
Talkeetna bush pilot happened to land to check on the old guy, and             
the old-timer was dead in bed.  The last mark on the calendar was              
on September 18, 1991 and the bush pilot flew in on September 21.              
The pilot notified the Alaska State Troopers who then came out.                
Representative Cowdery said he wasn't sure how the body was                    
removed, but said it went to Fairbanks.  Representative Cowdery                
indicated he was commenting on what he understands to be the                   
current requirements, noting that guy was 96 years old and it was              
determined that he died a natural death.                                       
Number 1540                                                                    
CHAIRMAN ROKEBERG noted Dr. Propst had indicated there was one                 
incident in his experience, where, because of the investigating                
police officers he had been able track down some criminal activity.            
The chairman commented that he was receiving some head-shaking from            
the committee.                                                                 
Number 1558                                                                    
DR. PROPST clarified that there was one instance in the last two               
years where elder abuse had been alleged but his further                       
examination of that case found no evidence of abuse.                           
Number 1570                                                                    
CHAIRMAN ROKEBERG asked for rough statistics on the number of                  
deaths reported to the state medical examiner in the last two                  
DR. PROPST replied 900 to 950 deaths per year.                                 
CHAIRMAN ROKEBERG clarified that the Dr. Propst's testimony was                
that one alleged incident may have occurred out of approximately               
1,900 deaths in two years.                                                     
DR. PROPST replied that was what had come to mind.                             
Number 1596                                                                    
CHAIRMAN ROKEBERG asked if there was a requirement that a police               
officer confiscate all the medications the deceased had been taking            
when an officer came into the home after a death.                              
Number 1610                                                                    
DR. PROPST responded he did not know.  He said he imagined it had              
to do with the police agency and the police agency's specific                  
requirements for its death investigation protocol.  Dr. Propst                 
noted he did not make the rules for the police.                                
Number 1622                                                                    
CHAIRMAN ROKEBERG asked, in term of the reportage in the state of              
Alaska, did Dr. Propst notice a difference in the time frame and               
the quality of the investigative work for reports between urban                
areas such as the Municipality of Anchorage, where the Anchorage               
Police Department (APD) makes the reports, and bush areas where the            
Alaska State Troopers are making reports.                                      
Number 1635                                                                    
DR. PROPST stated that each of those police agencies are very well-            
trained, and he has come to rely on both Anchorage Police                      
Department officers and Alaska State Troopers, in terms of being an            
extension and giving reliable information about their findings at              
the death scene.                                                               
Number 1648                                                                    
CHAIRMAN ROKEBERG indicated there was clear evidence before the                
committee that a number of hospice groups and medical providers,               
for example, hospitals and assisted living facilities, were                    
examining ways to facilitate the concept of "expected death."  He              
also added the review the state has done (indisc.) Comfort One                 
Program [the Alaska DNR (Do Not Resuscitate) Program, also known as            
the Alaska Comfort One Program].  Chairman Rokeberg stated, "I                 
guess the issue that you wish to raise here is whether there is --             
the police officer investigation is necessary.  You claim it is                
necessary when there has been a - a procedure created by this                  
legislation to allow for not reporting, is that correct?"                      
Number 1685                                                                    
DR. PROPST replied that was correct.  He stated he feels the police            
officer's visit at the time of death provides a final check and                
balance on the system.                                                         
Number 1691                                                                    
REPRESENTATIVE GENE KUBINA referred to the case of alleged elder               
abuse being discussed and he asked if it had been the police                   
officer who had given Dr. Propst a report of abuse.                            
DR. PROPST answered in the affirmative.                                        
Number 1701                                                                    
REPRESENTATIVE KUBINA stated then that the police officer had seen             
something when the officer went out there that made him or her                 
think that there was some abuse.                                               
DR. PROPST answered in the affirmative.                                        
REPRESENTATIVE KUBINA said then that was found to be not the case.             
Number 1715                                                                    
REPRESENTATIVE DAVIS asked Dr. Propst if he knew of differences in             
the way police departments currently handle the situation.                     
Number 1721                                                                    
DR. PROPST answered in the affirmative, stating there are                      
differences depending on the area of the state.  To the best of his            
knowledge, the Alaska State Troopers go to the scene of a death in             
the areas they cover.  In the Anchorage area, he said the Anchorage            
Police Department goes to the scene of one of these deaths.  Dr.               
Propst said Juneau is the only area he is aware of where officers              
are not routinely sent to the scene of death.  He said the Juneau              
Police Department is notified, and may or may not send an officer.             
Number 1750                                                                    
REPRESENTATIVE DAVIS clarified for the committee that he thinks "no            
code," meaning no siren and no lights, is standard in most places,             
indicating he used the "flashing lights" analogy to indicate the               
differences in the ways different departments handled this                     
situation and that he was not personally aware of anybody using                
flashing lights or sirens as a standard practice in this situation.            
Number 1772                                                                    
CHAIRMAN ROKEBERG asked Dr. Propst to differentiate for the                    
committee what type of institutional settings are allowed to be                
exempted from a law enforcement officer investigation of a death,              
noting a hospital would probably be exempt from that requirement.              
Number 1787                                                                    
DR. PROPST added that he expected an extended care facility would              
be exempt from that requirement.  Dr. Propst stated (indisc.) area             
he was concerned about is death at home or in a residence, as                  
opposed to a place where medical care is routinely given.                      
CHAIRMAN ROKEBERG clarified that it was death at home, and any                 
institution would be exempt from the requirement basically.                    
DR. PROPST replied basically yes.                                              
Number 1808                                                                    
CHAIRMAN ROKEBERG gave the example of a small, assisted living                 
facility "with just a few that are licensed in the state of                    
Alaska," commenting that these facilities would not be required to             
have a law enforcement officer investigate.                                    
DR. PROPST replied that, quite frankly, he had not thought that                
CHAIRMAN ROKEBERG noted that there are a number of those                       
facilities, particularly in urban areas of the state.                          
Number 1826                                                                    
REPRESENTATIVE RYAN asked Dr. Propst what the cost was for the                 
state medical examiner's to perform an autopsy.                                
DR. PROPST replied it was approximately $1,000 dollars involved in             
transporting the body to Anchorage, preparing it after the autopsy             
and transporting it back to the place of death.                                
Number 1839                                                                    
REPRESENTATIVE HUDSON noted Dr. Propst had indicated approximately             
900 deaths occurred at home annually, asking if he had heard                   
Number 1850                                                                    
DR. PROPST replied that the question to which he had responded was             
how many deaths were reported to the state medical examiner in the             
last couple of years, and his answer to that question had been                 
around 900 to 950 [per year, see Dr. Propst's previous testimony].             
Number 1856                                                                    
REPRESENTATIVE HUDSON noted HB 383 was speaking about those who                
want to die at home and who complete the expected home death                   
registration form, which is signed by the attending physician and              
a copy is provided to the state medical examiner.  Representative              
Hudson said under these and only these circumstances, he presumed              
at any rate, the "no duty to notify police officer" kicked in.                 
Representative Hudson asked Dr. Propst how many of circumstances he            
was notified of were dealing with normally anticipated or pre-                 
anticipated terminal life cases.  He asked Dr. Propst, when he was             
notified, if most of the cases he was notified of were people who              
simply expired because of old age or illness, and how that fit                 
within the context of HB 383.                                                  
Number 1906                                                                    
DR. PROPST replied that the 900 to 950 did not include the roughly             
200 to 250 deaths the state medical examiner's office is notified              
of that are expected deaths.  He said that of the 900 to 950, about            
a third are people who have died suddenly and unexpectedly "from               
apparent causes that investigation has no suspicion whatsoever and             
no reason to further examine."                                                 
Number 1926                                                                    
REPRESENTATIVE HUDSON commented that HB 383 would not exempt police            
officer notification in these cases; it would be only those people             
who wanted to die at home, who had a limited life expectancy and               
literally signed a form and filed a copy with the state medical                
examiner's office.  Representative Hudson asked Dr. Propst if he               
still felt notification of a police officer was still necessary                
under those circumstances.                                                     
Number 1950                                                                    
DR. PROPST replied he did.                                                     
Number 1958                                                                    
CHAIRMAN ROKEBERG asked if the state medical examiner's office                 
already had a procedure in place of for expected deaths, and what              
form did that take.                                                            
Number 1965                                                                    
DR. PROPST answered that an expected home death program has                    
basically been in operation since the Office of the State Medical              
Examiner was created by the legislature in 1993.  He said the                  
program has varied somewhat by geographic area.  Dr. Propst noted              
the Alaska Comfort One Program passed by the legislature a couple              
of years ago has now been implemented and the state medical                    
examiner's office is utilizing the paperwork generated in that                 
program as the expected home death registration material.                      
Number 1993                                                                    
CHAIRMAN ROKEBERG asked what the purpose and value of the medical              
examiner's office's expected death program was if it was not to                
warn the medical examiner's office about these circumstances.                  
Number 2002                                                                    
DR. PROPST replied that was exactly the purpose of the expected                
home death program.  If there is no suspicion of foul play when the            
person dies and the police officer does his brief investigation,               
that means the medical examiner's office does not have to                      
investigate further, saving the state money.                                   
Number 2019                                                                    
CHAIRMAN ROKEBERG stated, "Therefore, Dr. Propst, you would prefer             
to see a police officer in the loop so that you don't have to be in            
the loop, is that right?"                                                      
Number 2025                                                                    
DR. PROPST commented that the number of police officers statewide              
was probably in the "tens" and his entire office staff was ten                 
people covering the entire state.  He stated he would like to                  
(indisc.) that not everybody who is reported to the medical                    
examiner's office receives an autopsy.  Dr. Propst stated each                 
death is investigated, but some deaths are sufficiently                        
investigated either by the police officer or by his office's                   
medical examiner investigators.                                                
Number 2050                                                                    
CHAIRMAN ROKEBERG stated Dr. Propst was welcome to stand by if                 
there were further questions when the committee considered HB 383.             
Number 2059                                                                    
DEL SMITH, Deputy Commissioner, Department of Public Safety (DPS),             
came forward to testify.  Mr. Smith said that to echo most of what             
Dr. Propst had said, DPS does have some concerns about this because            
of the checks and the balances.  Mr. Smith said, noting he  thought            
Representative Cowdery had referred to this, when he was at the                
Anchorage Police Department in the late 1980s the department                   
established what was called the no-code death response for the very            
reasons that have been brought up that day.  He said  a family who             
has just suffered an expected death is still having problems with              
that, and he stated, "To have a squad car come skidding the last               
half a block with red lights on and people leap out with guns is               
not an appropriate response."  Mr. Smith said the Anchorage Police             
Department still has that response today; they do respond to every             
one of those deaths, but they are aware that this is going to                  
happen so they do the cursory check Dr. Propst referred to.  The               
Alaska State Troopers do the same.  He noted he spoke to Captain               
DeCapua of the Juneau Police Department, they do, they don't                   
necessarily go out to the hospice on all of these situations, but              
certainly if it was an unexpected death they would respond, but he             
noted the Juneau Police Department is the one agency he found that             
doesn't respond to necessarily every one.  If they've been notified            
by the hospice and they're comfortable with the circumstances,                 
Captain DeCapua said they don't respond to every one.  Mr. Smith               
said Captain DeCapua did tell him they felt they ought to be                   
notified that it was going to occur in all situations, indicating              
this was so they could prevent inappropriate responses.  Mr. Smith             
said he is certainly sensitive from his experience over the years              
to responding to these kinds of situations, having his officers at             
APD and the Alaska State Troopers respond.  He said he guesses, "If            
you're going to change that, I just want you to be aware that that             
is a check and balance that occurs, and although they may be rare,             
there may be a circumstance where somebody's expedited on the way              
out that would not necessarily have occurred so quickly."  He said             
maybe it was his suspicious mind from his business, but he thinks              
it is helpful to have the officer respond.                                     
Number 2150                                                                    
REPRESENTATIVE COWDERY said then Mr. Smith would basically oppose              
this legislation.                                                              
MR. SMITH said he thought yes, in the legislation's current form.              
REPRESENTATIVE COWDERY asked Mr. Smith if the deletion of some                 
areas in the bill would satisfy him.                                           
Number 2165                                                                    
MR. SMITH stated the only area he has discussed is Section 3 of the            
bill, noting he had discussed it the previous day with the bill                
sponsor and staff.  Mr. Smith said he realized there were some                 
situations where police officers have not appropriately responded,             
noting he was not exactly sure how to deal with that.  He said he              
thought there were seven or so different forms around the state:               
the Comfort One Program form, the DNR form, commenting it took him             
a while to figure out it meant do not resuscitate, not the                     
Department of Natural Resources.  Mr. Smith indicated this meant               
there are things that could be done, but said he is ultimately                 
concerned, as a police officer, that there might be something                  
important at the scene that would tip the police officer off that              
this person did not go as easily as he or she might have.  He noted            
Dr. Propst's people based in Anchorage do not get a look.                      
Number 2211                                                                    
CHAIRMAN ROKEBERG related he had the unfortunate circumstance of               
witnessing his father expire at his father's home in Anchorage a               
few years previously, after Mr. Smith had left the APD.  Chairman              
Rokeberg stated the mortuary showed up and they had to wait                    
approximately 1 1/2 hours for the police department because the                
death watch was busy that morning.  He said the officers did not               
show up with sirens or lights, apologized for the delay, but                   
indicated their presence was intrusive.  He said they interviewed              
everyone in the household and confiscated his father's medications             
and related supplies.  Chairman Rokeberg indicated his father had              
been suffering from cancer for several years so his death was                  
expected situation; he said it clearly did not warrant any kind of             
overview by law enforcement.  He stated (indisc.) totally                      
unwarranted, and he thought that is what this bill calls for.  To              
Representative Davis, Chairman Rokeberg noted HB 383 probably did              
not even belong in the House Labor and Commerce Standing Committee,            
but said he had some concerns about some of the language in even               
Sections 1 and 2 of the bill.  He stated was not sure he quite                 
understood those and asked the sponsor what he would like the                  
committee to do.                                                               
Number 2298                                                                    
REPRESENTATIVE DAVIS stated he had been surprised to see HB 383                
referred to Labor and Commerce as well.  Representative Davis said             
he was a proponent of law enforcement and did not want to interfere            
to a degree law enforcement was reasonably uncomfortable with.                 
Representative Davis noted HB 383's next committee of referral was             
the House Judiciary Standing Committee and stated he would like to             
see the bill moved.  Representative Davis said he wanted to work               
with the Department of Public Safety, addressing the reasonable                
concerns the department might have.  He indicated he thought moving            
the bill might help bring about a reasonable solution.                         
Number 2357                                                                    
CHAIRMAN ROKEBERG noted he was not sure he understood Section 2.               
In response to a note delivered by the teleconference moderator,               
Chairman Rokeberg announced that there were seven people who wished            
to testify on HB 383 via teleconference and the committee had been             
unaware of these witnesses until that moment.  Chairman Rokeberg               
referred back to his question about Section 2, stating it seemed               
like the ability of a registered nurse to sign a death certificate             
was being taken away, and he asked if that was the sponsor's                   
Number 2381                                                                    
REPRESENTATIVE DAVIS answered in the negative.  He noted they were             
changing the existing statute from wording that says, "The nurse               
shall sign the death certificate," to, "The nurse shall provide the            
necessary information to the person signing the death certificate,"            
which would be a physician.  Section 2 of the bill reads:                      
     AS 08.68.395(b) is amended to read:  (b) A registered                     
     nurse who has determined and pronounced death under this                  
     section shall document the clinical criteria for the                      
     determination and pronouncement in the person's medical                   
     or clinical record and notify the physician who                           
     determined that the prognosis for the patient was for an                  
     anticipated death.  The registered nurse shall provide to                 
     the person who will sign the death certificate [, WHICH                   
     MUCH INCLUDE] the (1) name of the deceased; (2) presence                  
     of a contagious disease, if known; and (3) date and time                  
     of death.                                                                 
Number 2390                                                                    
CHAIRMAN ROKEBERG asked if that wouldn't take the ability of a                 
registered nurse to sign a death certificate away.                             
Number 2434                                                                    
MS. DAVIDSON stated wording was changed because the "expected home             
death case report" forms currently used by the state medical                   
examiner, which may be provided in the background information, have            
a statement that the doctor signs.  This statement says the doctor             
agrees to sign the death certificate in the event that this home               
death occurs as expected.  Ms. Davidson noted the statute said that            
if the nurse in this situation pronounces death she will sign the              
death certificate, yet the form sent to the medical examiner's                 
office says that the physician signs the death certificate.  Ms.               
Davidson indicated they decided to change the language in the                  
statute to make it consistent with the form.                                   
Number 2427                                                                    
CHAIRMAN ROKEBERG questioned whether the nurse, in the (a) section,            
still had the right to sign the death certificate in those                     
MS. DAVIDSON asked if the Chairman meant in other circumstances.               
REPRESENTATIVE KUBINA stated, "'In the following circumstances,' is            
the way I read it."                                                            
Number 2441                                                                    
MS. DAVIDSON stated that the physician would sign the death                    
certificate under the expected home death circumstance.  In answer             
to Chairman Rokeberg's question, she said it appears they would be             
taking away the nurse's right to sign the death certificate.  She              
stated, "We certainly didn't mean to take anything away that they              
didn't want, it was more to make the requirement consistent with               
the way the procedure is now."                                                 
Number 2458                                                                    
CHAIRMAN ROKEBERG stated, "In many areas, particularly rural areas,            
they wouldn't be able to ..."                                                  
MS. DAVIDSON responded, "As it now stands, the doctor has to sign              
a form authorizing ..." [TESTIMONY INTERRUPTED BY TAPE CHANGE]                 
TAPE 98-18, SIDE B                                                             
Number 0001                                                                    
CHAIRMAN ROKEBERG stated, "... So Representative Davis, I - I have             
some time here real quickly, if you want to take some testimony."              
REPRESENTATIVE DAVIS answered in the affirmative, suggesting                   
perhaps a time limit so the witnesses could condense any testimony.            
Number 0018                                                                    
CHAIRMAN ROKEBERG apologized to the teleconferenced witnesses,                 
indicating the committee had not been notified they were waiting to            
testify.  Due to the next scheduled bill, he requested the                     
witnesses limit their testimony to less than a minute, noting they             
would not be cut-off.  He indicated written testimony could be sent            
to the committee from the Kenai Legislative Information Office                 
Number 0036                                                                    
CYNTHIA ELLIOT, Staff Registered Nurse; First Choice Home Health               
Care, Incorporated, testified via teleconference from Kenai in                 
support of HB 383.  Ms. Elliot read from her prepared statement:               
     I am a home health nurse.  I have over five years                         
     experience as a hospice nurse working with people who are                 
     dying at home and being cared for by their family                         
     members.  I also have experienced the deaths of three of                  
     my own family members at home in three different states.                  
     Nowhere have I encountered the kind of situation we have                  
     here in Alaska at an expected home death.  It is unusual                  
     that law makers and law enforcers in this state feel                      
     compelled to involve police in naturally occurring,                       
     expected home deaths.  Having police present in the home                  
     at the time of death is unnecessary and traumatic to                      
     family members.                                                           
     Death is a normal life transition.  It is not a crime if                  
     it occurs naturally.  Dying at home of natural causes is                  
     not police business, nor is it suspicious or unusual.                     
     Here in Alaska on the Kenai Peninsula, it has become a                    
     crime to die at home.  ... Police are called to what they                 
     refer to as the "scene" and conduct a death                               
     investigation.  They collect evidence by asking                           
     questions, confiscating medications and taking                            
     photographs of the deceased ... at the home.                              
     Death is a sacred life event, a once-in-a-lifetime                        
     experience for the family.  This precious time should not                 
     be intruded upon by officers of the law, or anyone who is                 
     not directly involved with assisting the family to take                   
     care of the deceased and facilitate the grieving process.                 
     To ask a family member who has just witnessed the passage                 
     of their beloved to answer questions and stand by while                   
     photographs of the deceased are taken by a uniformed                      
     officer with a gun and handcuffs on his or her belt is                    
     intimidating and upsetting, and only complicates the                      
     grief process.                                                            
     Change the law here in Alaska to allow families to care                   
     for their loved ones at home without having to report a                   
     natural occurrence to the police.  Legalize expected home                 
Number 0113                                                                    
TOM WILKINSON, Staff Nurse, Central Peninsula General Hospital                 
(CPGH), testified next via teleconference from Kenai in support of             
HB 383.  Mr. Wilkinson stated he was a certified critical care                 
nurse at CPGH.  He thanked Representative Davis for sponsoring this            
bill.  He related he has unique experience in that he does                     
pronounce people [dead] at the hospital; he said they notify the               
medical examiner and there is no investigation by the Alaska State             
Troopers.  However, he related he attended the death of a personal             
friend at home the previous week who was 87 years old with end-                
stage leukemia.  Mr. Wilkinson said the Alaska State Troopers and              
EMS (emergency medical service) did have to show up.  He said he               
had pronounced his friend and was with the family.  Mr. Wilkinson              
stated the responding trooper was very sensitive; the trooper                  
basically entered the room and viewed the deceased from a distance             
without pulling back the covers.  Mr. Wilkinson stated, "So if                 
that's an investigation,  I - I find it hard to believe that                   
anything could have been found out by that,"  Mr. Wilkinson said it            
was more of an observation and anything more would have been an                
intrusion and inappropriate.  The EMS knew Mr. Wilkinson, and said             
they didn't need to see the body because of his presence.  He said             
the EMS took some information and left, noting they were also very             
sensitive.  Mr. Wilkinson said he personally thinks it would be                
very difficult to prove murder in the case of his friend, stating,             
"End-stage leukemia -- short of a knife sticking out of his chest              
or - or a bullet wound, it would have been to prove anything or                
question it.  I think that ... the people most qualified to                    
pronounce death are also those who are licensed to note life or the            
existence of life, and I think that registered nurses are trained              
to note the absence of life -- so I think that they're probably the            
best.  They also have a rapport with the family, whether it be a               
hospice nurse, home health nurse, or a nurse in a facility.  We -              
we develop a close relationship with the families, and the families            
bring us into that inner circle, and then bringing somebody in                 
shortly thereafter is fairly intrusive.  So I - I'd like to see                
this changed and allowed to move forward."                                     
Number 0218                                                                    
DEBRA SHUEY testified next via teleconference from Kenai in support            
of HB 383.  She stated her 14-year-old son had died 3 1/2 weeks                
previously.  He had been battling cancer for two years, and she                
said they were very fortunate they were able to be back home in                
Alaska because they had traveled all across the United States for              
her son's medical care.  She said he had wanted to be around his               
friends and at home.  Ms. Shuey said the police really were                    
invasive when they responded.  She stated, "They asked for all of              
his prescriptions, and I was standing there, 'You want two years of            
his prescriptions?'  You know, 'What kind of medication do you want            
of his, his latest or whatever?'  And they took several pictures of            
him, and I just felt it was really unnecessary.  Everybody in this             
community knew my son, was medically involved, in the emergency                
room once or twice a week.  We had the home health nurse there, and            
it seems to me like if they thought that that there was any problem            
with his death, that they would have been able to call that.  We               
had the ... Comfort One form there, we thought everything was all              
prepared, and we tried to make it -- Jared (ph) died very                      
peacefully and with dignity and he accepted his death, and I think             
it's very important to that, but I also think it is important to               
have the family members that are left afterwards.  And in this                 
particular situation, we had been through a tremendous ordeal in               
two years, trying to do all that we could, ask all the questions               
imaginable, and when this trooper showed it was like, 'Well, did I             
do everything?  Should of I done more?  What did I do wrong here?'             
And I don't think I needed to ask those questions an hour after my             
son died.  And I fail now -- when I look back at that, I like to               
think about him dying peacefully, laying in his bed, and that he's             
at rest now, but what also comes in, is the trooper standing there             
taking pictures, asking me for his drugs, and I didn't need that at            
that point.  Everybody knew how ill Jared (ph) was and everybody               
accepted it, and it was very difficult for me to go through that,              
and it's a memory I do not like."                                              
Number 0315                                                                    
CHAIRMAN ROKEBERG asked if there were any questions for Ms. Shuey,             
and stated their hearts went out to her.                                       
Number 0321                                                                    
LIZ SCHUBERT, Executive Director, Hospice of the Central Peninsula,            
testified next via teleconference from Kenai in support of HB 383.             
She stated she has been the hospice's executive director since                 
1991.  Ms. Schubert stated, following her prepared statement,                  
"Traditionally hospice care has focused on terminally ill patients             
and their loved ones.  ... We focus on the fact that care and                  
comfort measures will neither hasten nor postpone a death.  That               
pain control, pain management, be it physical, emotional, spiritual            
or psychosocial, will be treated aggressively.  That clients and               
families can choose where they would like to die and who will be               
present at the time of their death.  That the client's physician               
consents to hospice care and agrees to sign the client's death                 
certificate, which allows them to remain at home, a choice that                
most of us would prefer, should we be allowed to choose this.                  
Also, ... families feel that by completing, signing, filling out               
in-home expected death Comfort One forms, enrolling in Comfort One,            
being enrolled with either a home health care or hospice program,              
having the needed support from hospice ... that they'll need to                
experience an in-home death with dignity with the least amount of              
trauma to their already bereaved family does not include a police              
officer arriving at the scene, photographs and an EMS that needs to            
be called to pronounce the death, when a registered nurse is                   
already able to do that - is already in the home."                             
Number 0381                                                                    
MS. SCHUBERT said she would like to address a comment Dr. Propst               
made about people who are terminally ill, people who are expected              
to die, being the easiest persons to murder.  She stated, from her             
experience with hospice care and hospice involvement with families,            
that these families are very prepared for the death of their loved             
ones, that the families would do nothing to hasten their loved                 
one's death.  She said the dying person does not want to burden his            
or her family any further by knowing that pictures will have to be             
taken of his or her body and that the person's family members will             
be interrogated by a police officer.  Ms. Schubert stated she was              
in support of all sections of HB 383.                                          
Number 0420                                                                    
CHIEF SHIRLEY WARNER, Soldotna Police Department, testified next               
via teleconference from Kenai.  She stated she would be brief                  
because Dr. Propst and Deputy Commissioner Smith already addressed             
some of her concerns.  Chief Warner stated she is concerned with               
the "no duty to notify peace officer" portion of HB 383.  Chief                
Warner indicated the reason HB 383 has so much support concerns                
her.  She informed the committee that Ms. Shuey had left the LIO.              
Chief Warner stated she felt very badly for Ms. Shuey's experience,            
but said, "The one thing that she will never see, and - and I'm not            
saying that would happen, but if there was ever an allegation in               
the community that there was some foul play, the officers are there            
... to reassure and confirm that there is not."  She thinks that               
does happen with these cases, and she is concerned about the                   
safeguards, and Chief Warner wondered if that was perhaps in the               
content of the forms that would be developed.  She said, "But if               
there is abuse, who calls?  Who calls if there's a question on foul            
play?  The home care person?  ... I don't think so."  Besides the              
previously expressed concern about observation of the area, and                
noting what drugs were available, Chief Warner commented about                 
providing protection for a person's property.  She indicated she               
was had not been in Soldotna long enough, but said when she was in             
Anchorage it seemed like she dealt quite a bit with the property of            
deceased people, and she commented she wasn't sure who stepped in              
in that respect when the police did not.                                       
Number 0509                                                                    
DAVID CORAY testified next via teleconference from Kenai.  He said             
his brother had passed away in December of pancreatic cancer,                  
noting his recent experience with the issue at hand.  Mr. Coray                
stated that all forms relating to the expected death were filled               
out, and, at the time the death occurred, the paramedics, according            
to current procedure, did make a cursory appearance to determine               
that death had occurred, followed by a city policeman who made the             
same determination, and who then asked detailed questions of all               
those present.  Mr. Coray said, "And while these particular police             
officers were tactful and sensitive, my position is that this                  
doesn't always run across the board, and that there might be a                 
variance in the particular police individuals involved in terms of             
how they approach these delicate family matters, so I'm in favor of            
freeing up the police from having to make these home visit and                 
vesting these powers with the home health care agencies that are               
professionally trained to actually determine ... when death has                
occurred and to look for any evidence of foul play.  ... I stated              
earlier, they are with the families during this transition and have            
a history of dealing with the transition process ... with the                  
survivors.  ... The presence of police is often viewed as a                    
domestic disturbance, which potentially creates a social problem               
for the survivors in terms of dealing with - with neighbors and                
that sort of thing; it just ... seems invasive.   It seems like                
we're re-inventing the wheel here by having so many agencies                   
involved, and that a streamlining effect could take place by having            
just one agency determine that death did occur, and it would lend              
itself to a ... more stable transition for the survivors, and with             
that, I'd like to voice my support for HB 383."                                
Number 0586                                                                    
LORI BROWN, Administrator; First Choice Home Health Care,                      
Incorporated, testified next via teleconference from Kenai in                  
support of HB 383.  She stated she understood Dr. Propst's and the             
police departments' concerns.  However, she said she has seen                  
several instances where it has really interfered with the families.            
She noted although the police try to be comforting, et cetera, she             
said she personally would feel it very invasive if her loved one               
died and a stranger came into her home.  Ms. Brown stated she                  
supported HB 383 and understood the concern.  If any changes were              
to be made, she suggested the addition of something like the                   
wording "unless there is suspect of abuse" to Section 12.65.007, no            
duty to notify peace officer in an expected home death.  Otherwise,            
she would like to support the bill as it currently reads.  Ms.                 
Brown stated they have highly-trained, state-licensed nurses, and              
the "Kevorkian" reference really bothered her, noting Dr. Propst               
had mentioned it, and it had been mentioned to her by one of the               
local police officers.  She said, "I'm sorry, we are highly                    
regulated, the nurses have worked very hard to receive their                   
licenses and I don't think that they would step out on any ... type            
of a limb to lose their licenses.  And as a home health care                   
agency, I don't think any of you have any idea the regulations that            
we have to go through, both state and federal."                                
Number 0653                                                                    
REPRESENTATIVE COWDERY asked if the impact of HB 383 on social                 
security or insurance claims had been explored.  He stated that if             
Representative Davis did not know, Representative Cowdery would                
like to have that information before he voted on the bill.                     
Number 0668                                                                    
REPRESENTATIVE DAVIS replied he did not have any information.                  
CHAIRMAN ROKEBERG added, "Social security pays $250 ..."                       
REPRESENTATIVE COWDERY replied he knew that, but said a certain                
criteria was also required.                                                    
Number 0678                                                                    
REPRESENTATIVE KUBINA made a motion to move HB 383 out of committee            
with individual recommendations and the zero fiscal note.                      
Number 0690                                                                    
CHAIRMAN ROKEBERG objected to comment that he was a little                     
concerned about some of the language, particularly in the second               
section.  He noted perhaps he wasn't reading it right.  The                    
Chairman indicated he hoped Representative Davis would work with               
the DPS to clean this up before it came to the House Judiciary                 
Standing Committee.                                                            
Number 0705                                                                    
REPRESENTATIVE DAVIS indicated the make-up of the House Judiciary              
Standing Committee would ensure the bill would not pass if the DPS             
objected highly to it.                                                         
Number 0730                                                                    
CHAIRMAN ROKEBERG withdrew his objection.  He noted again to the               
teleconference witnesses from the Kenai LIO that the committee had             
not been aware of them until just after 4:00 p.m., apologizing for             
"trying to rush them along," noting that was not his intent.                   
Number 0742                                                                    
CHAIRMAN ROKEBERG stated they needed to add the term of art "with              
the committee's zero fiscal note attached" to HB 383, asking if the            
committee was all in order on the motion.  Hearing no objections,              
Chairman Rokeberg stated HB 383 was so moved.                                  

Document Name Date/Time Subjects