Legislature(2003 - 2004)

04/28/2003 03:20 PM House L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 260-IMMUNITY FOR PROVIDING FREE HEALTH CARE                                                                                
CHAIR ANDERSON announced  that the first order  of business would                                                               
be HOUSE  BILL NO.  260, "An  Act relating  to immunity  for free                                                               
health care  services provided by certain  health care providers;                                                               
and providing for an effective date."                                                                                           
Number 0053                                                                                                                     
REPRESENTATIVE PAUL  SEATON, Alaska  State Legislature,  spoke as                                                               
the sponsor of HB  260.  He explained that the  purpose of HB 260                                                               
is  to encourage  licensed health  care professionals  to provide                                                               
free services  through clinics, health  fairs, et cetera.   These                                                               
services  would encourage  better  health care  services and  the                                                               
prevention and treatment  of illness.  Currently,  Alaska faces a                                                               
[shortage]  of physicians  and these  physicians are  also aging,                                                               
which is also the case of  other health care professionals.  This                                                               
legislation   allows  a   physician  to   participate  [volunteer                                                               
services] in a  free clinic without having  to purchase expensive                                                               
malpractice insurance.   The  aforementioned would  be especially                                                               
important  for  those  retired physicians  who  can't  afford  to                                                               
maintain malpractice insurance in  order to provide free services                                                               
in the  community.  The services  can only be provided  under the                                                               
following requirements:   the health care provider  has a current                                                               
state license; the services provided  are within the scope of the                                                               
provider's  licenses;  the  services  are  provided  at  clinics,                                                               
municipal-  or state-  or U.S.-owned  facilities, or  a nonprofit                                                               
facility;  and  the  services  were   provided  free  of  charge.                                                               
Representative Seaton related his belief  that HB 260 is good for                                                               
the  people  of  Alaska  because  this  legislation  would  allow                                                               
Alaskans who  would not otherwise  be able to access  health care                                                               
to do so.                                                                                                                       
REPRESENTATIVE  CRAWFORD  said  this   sounds  great.    However,                                                               
physicians and health care providers  make mistakes.  He asked to                                                               
whom will  patients harmed  by these  physicians and  health care                                                               
providers with  blanket immunity  turn.  He  related that  he was                                                               
told  this  legislation is  similar  to  the situation  in  which                                                               
[military  personnel] who  are harmed  in treatment  provided [by                                                               
military health  care professionals] can't sue  those health care                                                               
professionals.  Although the government  would still be liable in                                                               
the  aforementioned  situation,   this  legislation  would  leave                                                               
someone  harmed   by  these  volunteer  doctors   providing  free                                                               
services without any recourse.                                                                                                  
REPRESENTATIVE  SEATON  said  this  legislation  doesn't  exclude                                                               
gross negligence,  for which the  doctor providing  free services                                                               
would be liable.                                                                                                                
REPRESENTATIVE CRAWFORD  inquired as  to the  remedy if  the harm                                                               
isn't at the level of gross negligence.                                                                                         
REPRESENTATIVE  SEATON related  that "what  we're talking  about"                                                               
are  acts of  omission in  which a  free clinic  wouldn't perform                                                               
such  things as  a  CAT  scan or  X-Ray.   Representative  Seaton                                                               
remarked, "I  think that  what we're looking  at is  a difference                                                               
between  no health  care and  good health  care, but  without the                                                               
liability for the doctor."                                                                                                      
REPRESENTATIVE CRAWFORD commented,  "Somewhere, somebody ought to                                                               
be liable."                                                                                                                     
Number 0587                                                                                                                     
REPRESENTATIVE  LYNN turned  to  the definition  of "health  care                                                               
provider" and pointed  out that the definition  doesn't include a                                                               
nurse practitioner,  although it  does include an  advanced nurse                                                               
practitioner and a practical nurse.                                                                                             
REPRESENTATIVE SEATON deferred to witnesses.                                                                                    
REPRESENTATIVE LYNN  related his  understanding that  a practical                                                               
nurse performs  the more mundane activities  while the registered                                                               
nurse is  under the direct supervision  of a doctor, and  a nurse                                                               
practitioner can do  certain things above the level  of a regular                                                               
nurse and advanced nurse.  He asked if a category was left out.                                                                 
REPRESENTATIVE  SEATON  said he  wasn't  opposed  to including  a                                                               
category if it  was left out.  He reiterated  that the purpose of                                                               
HB  260  is  to  encourage   health  care  workers  to  volunteer                                                               
REPRESENTATIVE  LYNN   inquired  as   to  the  definition   of  a                                                               
REPRESENTATIVE SEATON deferred to witnesses on-line.                                                                            
Number 0709                                                                                                                     
REPRESENTATIVE GUTTENBERG asked if the  clinic would be liable if                                                               
a  retired  physician  working  for free  omits  a  procedure  or                                                               
performs an untimely test that causes harm.                                                                                     
REPRESENTATIVE  SEATON informed  the committee  that the  medical                                                               
definition  of  gross  negligence  refers  to  "not  adhering  to                                                               
standard   procedures  in   a  situation   as  identified   by  a                                                               
professional."  "If  we get into the situation  where somebody is                                                               
providing treatment that is either  outside of their specialty or                                                               
what their license covers, or  outside of standard practice, then                                                               
we are getting into the other factor," he said.                                                                                 
Number 0822                                                                                                                     
LINDA  FINK,  Assistant  Director,   Alaska  State  Hospital  and                                                               
Nursing Home Association (ASHNHA),  announced ASHNHA's support of                                                               
HB  260.   At  this time,  workforce development  is  one of  the                                                               
critical concerns  in the health  care field.   Therefore, ASHNHA                                                               
strongly supports anything  that can be done to  retain people in                                                               
the professions  and increase the  workforce.  Ms.  Fink informed                                                               
the  committee  that  she  learned   from  information  from  the                                                               
American  Hospital Association  (AMA) that  malpractice insurance                                                               
for hospitals has increased 158  percent over the last two years.                                                               
Therefore,  she  supported  not   [requiring]  liability  on  the                                                               
retired [health  care professional] who probably  doesn't have an                                                               
REPRESENTATIVE SEATON  informed the  committee that under  HB 260                                                               
facilities aren't granted immunity.   Therefore, this legislation                                                               
provides for personal  immunity for people with  licenses and not                                                               
Number 0905                                                                                                                     
CHAIR ANDERSON  noted that he agreed  with the merits of  HB 260.                                                               
However, he  expressed concern  with regard  to Section  3, which                                                               
provides immunity  for a multitude  of health care  providers who                                                               
aren't physicians.   Although 43  states have  limited liability,                                                               
he pointed  out that  [those states  have limited  liability] for                                                               
retired physicians not for health  care providers.  Therefore, he                                                               
surmised that  this legislation deals  with all  practitioners in                                                               
the [health care] field.                                                                                                        
REPRESENTATIVE SEATON  informed the committee that  Alaska is one                                                               
of  only seven  states that  doesn't have  limited liability  for                                                               
health care providers.   He explained that  the Legislative Legal                                                               
and   Research  Services   Division  recommended   expanding  the                                                               
definition  of  "health care  provider"  so  that the  extent  of                                                               
health care  providers would be  apparent.  He  acknowledged that                                                               
the expansion of the definition  does cause some problems because                                                               
the  legislation   only  covers   those  health   care  providers                                                               
currently licensed in the state.                                                                                                
CHAIR  ANDERSON surmised  then that  physicians  who retire  keep                                                               
their license,  and in order to  [come under HB 260],  the health                                                               
care provider  would have to have  an active license in  order to                                                               
be exempt from liability.                                                                                                       
MS. FINK  replied yes,  and specified  that the  individual would                                                               
have to qualify.                                                                                                                
Number 1082                                                                                                                     
REPRESENTATIVE GUTTENBERG  asked if a  facility is liable  when a                                                               
health  care provider  does something  that doesn't  rise to  the                                                               
level of gross negligence, reckless, or intentional misconduct.                                                                 
MS. FINK answered that she didn't  know.  However, she did inform                                                               
the committee  that facilities do  provide a lot of  charity care                                                               
and other free services, but she  didn't know how that related to                                                               
the facility's liability.                                                                                                       
REPRESENTATIVE LYNN inquired as to what retired means.                                                                          
REPRESENTATIVE  SEATON  responded  that this  legislation  merely                                                               
means  that  the  [health  care   provider]  retired  or  not  is                                                               
providing services for free.                                                                                                    
Number 1195                                                                                                                     
HEDRIC HANSON, Obstetrician/Gynecologist,  informed the committee                                                               
that  he  has practiced  in  this  state  since  1972.   He  also                                                               
informed  the committee  that he  is 61  years old.   Dr.  Hanson                                                               
opined that  the health of  our community  is a major  problem in                                                               
this country.   The health  of the community cannot  be optimized                                                               
unless everyone  is taken  care of, which  isn't the  case today.                                                               
Although he  said he  didn't know the  solution, he  related that                                                               
there is  a vast untapped  resource [retired physicians]  in this                                                               
state.   He  stated that  the number  of retired  physicians will                                                               
increase in  the next decade.   He related his belief  that [many                                                               
retired  physicians] would  volunteer in  the community  if there                                                               
wasn't the need for malpractice  insurance.  The question is will                                                               
[the legislature] tap into this wealth of knowledge.                                                                            
DR. HANSON remarked that when  laws to protect the physician have                                                               
been passed in  other states it has been a  win-win situation for                                                               
the  physicians and  the patients.   He  suggested that  it works                                                               
because  perhaps it  returns to  the once-practiced  standards in                                                               
medicine.  With regard to  the concerns expressed about injuries,                                                               
Dr. Hanson  related that there have  been very few suits  of free                                                               
clinics in which  physicians volunteer.  He  highlighted that the                                                               
[care   being  discussed]   isn't  hi-tech   surgery,  diagnostic                                                               
procedures, or  invasive testing rather it's  basic, primary care                                                               
and  [often to  older patients].   Dr.  Hanson emphasized  that a                                                               
retired   physician    can't   afford    malpractice   insurance.                                                               
Furthermore, the  free clinic can't afford  malpractice insurance                                                               
either.    He reiterated  that  the  [legislature] will  have  to                                                               
decide whether it wants to tap  into this resource.  He explained                                                               
that he  wants to  be able  to help the  community and  he didn't                                                               
particularly want to perform missionary  work in another country.                                                               
He  also  explained  that  the   reason  the  other  health  care                                                               
providers are  included in this  is because the  physicians can't                                                               
do it alone.  He concluded  by emphasizing that this proposal has                                                               
worked in other communities and states.                                                                                         
Number 1474                                                                                                                     
CHAIR ANDERSON  directed attention to  page 2 of  the legislation                                                               
where the definition of "health  care services" doesn't delineate                                                               
or distinguish  the type of  treatment.  The definition  seems to                                                               
be fairly  open.   Furthermore, he recalled  that Dr.  Hanson had                                                               
targeted retired  physicians.  However,  the first  criteria that                                                               
one  would  have  to  meet  in  order  to  receive  immunity  for                                                               
providing free health care services  is to be licensed in Alaska.                                                               
He asked if  retired physicians would still be  licensed or would                                                               
renewal be required.                                                                                                            
DR.  HANSON related  his  understanding that  one  would have  to                                                               
renew  his/her license,  pay for  the license  fee, and  meet the                                                               
requirements for  re-licensing, which  is the  continuing medical                                                               
Number 1592                                                                                                                     
REPRESENTATIVE LYNN  asked if this [immunity]  would include work                                                               
[free services] in an abortion clinic.                                                                                          
DR. HANSON  answered that  he didn't know.   However,  he related                                                               
that  the  free clinics  that  he  knows  about were  started  by                                                               
churches  and  state  grants.     Providing  free  clinics  is  a                                                               
[nationwide] movement that hasn't had  a specific agenda like the                                                               
abortion  issue.     He   related  his   doubt  that   one  would                                                               
economically be able to run a free abortion clinic.                                                                             
REPRESENTATIVE LYNN  clarified that his question  was targeted at                                                               
volunteering services at a preexisting clinic.                                                                                  
DR. HANSON  reiterated that he  didn't know.   He noted  that the                                                               
models he  has seen haven't addressed  that.  [The models  he has                                                               
reviewed] address  health maintenance,  screening, and  care that                                                               
wouldn't  be   [classified]  as  an  intervention   as  would  an                                                               
abortion.     Dr.   Hanson  again   highlighted  Alaska's   older                                                               
population  who  can't  access physicians  because  there  aren't                                                               
enough  physicians  to   take  care  of  them   or  the  Medicare                                                               
reimbursements are so  low that no physicians  will take Medicare                                                               
patients, or the patient has no insurance at all.                                                                               
REPRESENTATIVE LYNN  asked if, under  this legislation,  a health                                                               
care provider could perform an abortion  on their own at a clinic                                                               
and escape any liability.                                                                                                       
DR. HANSON answered that he didn't know.                                                                                        
Number 1755                                                                                                                     
MICHAEL   HAUGEN,  Executive   Director,   Alaska  Physicians   &                                                               
Surgeons, Inc. (APS), informed the  committee that APS represents                                                               
approximately  170   physicians.    He  specified   that  he  was                                                               
testifying in  strong support of HB  260.  Mr. Haugen  echoed Dr.                                                               
Hanson's  comments  regarding  the   access  crisis  that  is  of                                                               
particular concern for the elderly  population in the state.  For                                                               
example, a  little over  a year ago  Anchorage had  28 practicing                                                               
interns  that took  care  of the  elderly  population.   However,                                                               
eight of those  interns have been lost and two  more are expected                                                               
to  leave.   Mr.  Haugen mentioned  that  Alaska has  experienced                                                               
difficulty  attracting   and  keeping   high-quality  physicians.                                                               
Therefore, he  viewed this legislation  as [part of  the solution                                                               
that  would help]  retired physicians  who  want to  stay in  the                                                               
state  and   help  the   community.     He  indicated   that  the                                                               
aforementioned is the impetus for APS supporting HB 260.                                                                        
Number 1854                                                                                                                     
STEPHEN  CONN,   Special  Projects  Coordinator,   Alaska  Public                                                               
Interest Research  Group (AkPIRG), expressed concern  with regard                                                               
to the  breadth of the  legislation, specifically given  the time                                                               
frame  of the  legislative  process.   Mr.  Conn  said he  didn't                                                               
believe that  anyone would want to  deny Dr. Hanson the  right to                                                               
continue serving  people in this  state.  However, he  noted that                                                               
he didn't view  HB 260 as legislation that  would encourage those                                                               
already  quitting  practices  because  they  aren't  paid  in  an                                                               
effective and  efficient manner to  become volunteers.   Mr. Conn                                                               
specified  concern with  the  breadth of  the  term "health  care                                                               
provider."   He  related his  assumption that  the state  license                                                               
[requirement]  would   apply  to  all  those   listed  under  the                                                               
definition  of  health care  provider.    However, the  level  of                                                               
licensing and regulation  of each category is an  issue, he said.                                                               
Mr.  Conn also  specified concern  with the  breadth of  the term                                                               
nonprofit  facility.    He  questioned  whether  the  [nonprofit]                                                               
facility is being held to a  level of screening and whether there                                                               
are  adequate  resources for  the  physicians.   Apparently,  the                                                               
facility could  be sued, but  he questioned whether  the facility                                                               
would  be  obliged to  carry  [insurance]  coverage or  resources                                                               
should there  be a  problem.   If the  health care  providers are                                                               
immune  and the  facility lacks  the resources  to deal  with the                                                               
immediate needs resulting from a  civil liability, everyone would                                                               
bear those costs because those costs  would be thrust back on the                                                               
market.   Therefore,  Mr.  Conn recommended meeting  Mr. Hanson's                                                               
request without  using it as  blanket immunity for any  number of                                                               
categories  [of health  care providers]  with  various levels  of                                                               
regulations and working  at various unknown facilities.   The net                                                               
result of  the aforementioned  would be  unintended consequences.                                                               
Mr. Conn concluded by specifying that  he is in support of a form                                                               
of legislation,  but not HB 260  as it is currently  drafted.  In                                                               
regard to the earlier issue  of civil liability surrounding gross                                                               
or  intentional  negligence, Mr.  Conn  characterized  that as  a                                                               
lesser issue because it's fairly well defined.                                                                                  
Number 2035                                                                                                                     
REPRESENTATIVE CRAWFORD  referred to page  2, line 6, of  HB 260.                                                               
He asked  if the  "limiting liability" language  in the  other 43                                                               
states  that  have  enacted legislation  limiting  liability  for                                                               
retired  physicians  refers  to  blanket  immunity  up  to  gross                                                               
negligence.   He also asked  if the  43 other states  include the                                                               
list of health care providers that [HB 260 specifies].                                                                          
MR. CONN responded  that he didn't know, and  remarked that those                                                               
are  important questions.   As  was  stated by  the sponsor,  the                                                               
legislative intent is limiting liability for retired physicians.                                                                
MR. HAUGEN informed the committee  that in these 43 other states,                                                               
the liability extended to physicians  comes in two forms:  either                                                               
it provides a blanket exemption  and indemnifies a physician like                                                               
a  state  employee,  or,  like   Oregon,  changes  the  liability                                                               
standard  to gross  negligence.   He  noted his  belief that  the                                                               
language of  HB 260  is modeled  on North  Dakota's [provisions].                                                               
He highlighted  that the list  of health care providers  that are                                                               
immunized varies  greatly throughout the  43 states.   He related                                                               
his  belief that  the intent  of HB  260 was  to be  as broad  as                                                               
possible in order  to encourage as much  citizen participation as                                                               
Number 2159                                                                                                                     
REPRESENTATIVE  SEATON  pointed  out that  the  committee  packet                                                               
contains  a  listing  of  all  the states  and  what  that  state                                                               
provides  [in the  area of  volunteer health  care providers  and                                                               
civil  immunity  laws].    The   listing  is  from  the  National                                                               
Conference of  State Legislatures  (NCSL).  The  committee packet                                                               
also  includes Public  Law  105-19-June 18,  1997,  which is  the                                                               
federal Volunteer Protection Act of  1997.  He explained that the                                                               
purpose of  the Volunteer  Protection Act of  1997 is  to promote                                                               
interested   social  service   programs  and   beneficiaries  and                                                               
taxpayers to  sustain the availability of  programs and nonprofit                                                               
organizations, et cetera [that provide]  health [services].  This                                                               
Act preempts the  laws in any state to the  extent that such laws                                                               
are inconsistent with  the Act, except the Act  shall not preempt                                                               
any state providing additional  protection from liability related                                                               
to  volunteers  or  to  any   categories  of  volunteers  in  the                                                               
performances  or  services  of   the  nonprofit  organization  or                                                               
governmental agency.  Therefore, this  is a model law and without                                                               
any state law, the federal law is in place.                                                                                     
CHAIR ANDERSON related  his view that Alaska would  have the most                                                               
expansive legislation  with regard  to [the definition  of health                                                               
care provider].                                                                                                                 
REPRESENTATIVE SEATON  said that  Legislative Legal  and Research                                                               
Services  wanted to  narrow the  legislation  by specifying  [the                                                               
definition of health  care provider].  He  informed the committee                                                               
that most  of [the  43 states  doing this]  refer to  health care                                                               
providers  or professionals,  which includes  "all of  the people                                                               
that are licensed that have anything to do with health care."                                                                   
Number 2305                                                                                                                     
REPRESENTATIVE   CRAWFORD   recalled   Mr.   Haugen's   testimony                                                               
regarding the  indemnification of the volunteers  [that occurs in                                                               
some  of the  43  states  doing this],  and  inquired  as to  who                                                               
indemnifies  them  when  someone  is  damaged  and  there  is  no                                                               
malpractice insurance in place.                                                                                                 
MR.  HAUGEN  related  his  belief  that  the  state  passing  the                                                               
legislation   would  indeminify   [the   volunteer  health   care                                                               
REPRESENTATIVE  CRAWFORD surmised  that Mr.  Haugen would  prefer                                                               
that no  one be  liable if  someone was  damaged [by  a volunteer                                                               
health care provider].                                                                                                          
MR.  HAUGEN  replied no  and  pointed  out that  the  legislation                                                               
includes a  liability standard of  gross negligence.   Mr. Haugen                                                               
reiterated   that  [the   legislature]  must   determine  whether                                                               
encouraging providers to provide  health care when they otherwise                                                               
would  not, to  meet a  very large  need, is  worth reducing  the                                                               
liability exposure  to the provider.   He noted that  many states                                                               
and the federal government have decided it's worth it.                                                                          
REPRESENTATIVE CRAWFORD asked  if Mr. Haugen felt  that the state                                                               
indemnifying the provider isn't workable.                                                                                       
MR. HAUGEN responded that the legislature] can debate that.                                                                     
TAPE 03-42, SIDE B                                                                                                            
CHAIR ANDERSON, upon  determining no one else  wished to testify,                                                               
closed public testimony.                                                                                                        
Number 2350                                                                                                                     
REPRESENTATIVE GATTO moved that  the committee adopt Amendment 1,                                                               
which read:                                                                                                                     
     Page 2, line 27, following "dentist,":                                                                                     
          Insert "dental hygienist,"                                                                                            
REPRESENTATIVE GATTO informed the committee  that when he goes to                                                               
the  dentist,  he  almost  always   sees  the  dental  hygienist.                                                               
Therefore, he expressed the need  to include dental hygienists in                                                               
the list of health care providers.                                                                                              
REPRESENTATIVE GUTTENBERG informed the  committee that there is a                                                               
legitimate  and  licensed  definition of  dental  hygienist,  and                                                               
therefore it is covered in statute.                                                                                             
CHAIR  ANDERSON,  upon  determining  there  were  no  objections,                                                               
announced that Amendment 1 was adopted.                                                                                         
Number 2283                                                                                                                     
REPRESENTATIVE   DAHLSTROM  moved   that   the  committee   adopt                                                               
Amendment 2, which read:                                                                                                        
     Page 2, line 21:                                                                                                           
          Delete "and"                                                                                                          
     Page 2, line 22, following "the services":                                                                                 
          Insert "; and                                                                                                         
               (5)  provider                                                                                                    
               (A)  obtains informed consent from the                                                                           
     person receiving the health care services as described                                                                     
          under AS 09.55.556, except in the case of an                                                                          
     emergency; and                                                                                                             
               (B)  provides the person receiving the                                                                           
      health care services written notice of the immunity                                                                       
     provided under this section"                                                                                               
CHAIR ANDERSON objected for the purposes of discussion.                                                                         
REPRESENTATIVE  DAHLSTROM clarified  that AS  09.55.556 says  the                                                               
     Sec. 09.55.556.  Informed consent.      (a)   A  health                                                                  
     care  provider  is liable  for  failure  to obtain  the                                                                    
     informed  consent   of  a   patient  if   the  claimant                                                                    
     establishes  by a  preponderance of  the evidence  that                                                                    
     the provider  has failed to  inform the patient  of the                                                                    
     common  risks   and  reasonable  alternatives   to  the                                                                    
     proposed treatment or procedure,  and that but for that                                                                    
     failure the  claimant would not  have consented  to the                                                                    
     proposed treatment or procedure.                                                                                           
REPRESENTATIVE  DAHLSTROM explained  that the  above is  a common                                                               
sense   understanding  that   the  provider   is  providing   the                                                               
information to  the patient  receiving the  care and  everyone is                                                               
signing off on it.                                                                                                              
CHAIR ANDERSON removed his objection.                                                                                           
REPRESENTATIVE GUTTENBERG asked if  the informed consent notifies                                                               
the patient that there is no liability.                                                                                         
REPRESENTATIVE  SEATON   said  that   he  has  no   objection  to                                                               
[Amendment 2].                                                                                                                  
There being no further objection, Amendment 2 is adopted.                                                                       
Number 2200                                                                                                                     
REPRESENTATIVE  LYNN moved  that the  committee adopt  Conceptual                                                               
Amendment 3, which read:                                                                                                        
     Nothing in this bill  shall remove civil liability from                                                                    
     any health care provider  that performs or participates                                                                    
     in the performance of an elective abortion.                                                                                
REPRESENTATIVE GUTTENBERG  objected and remarked, "It's  just the                                                               
whole  larger   issue  of  liability  for   everybody,  not  just                                                               
separating one out."                                                                                                            
REPRESENTATIVE GATTO asked if  Representative Guttenberg would be                                                               
more comfortable with the language "any elected procedure."                                                                     
REPRESENTATIVE  GUTTENBERG  explained  that   the  issue  is  the                                                               
liability question.                                                                                                             
CHAIR  ANDERSON  related  his understanding  that  Representative                                                               
Lynn's  amendment  is getting  at  a  physician who  retires  and                                                               
maintains  his/her  medical  license,   goes  to  a  clinic  that                                                               
performs  abortions,  and  offers  to  work for  free.    In  the                                                               
aforementioned  situation, the  physician wouldn't  have to  have                                                               
liability insurance.   He said he  understood Representative Lynn                                                               
to mean  that he  didn't want it  to be easy  for a  physician to                                                               
retire  and  not have  liability  insurance  for malpractice  and                                                               
perform [abortions].                                                                                                            
REPRESENTATIVE LYNN agreed with Chair Anderson's understanding.                                                                 
REPRESENTATIVE  CRAWFORD said  he believes  [Conceptual Amendment                                                               
3] is  discrimination and isn't  fair and equal treatment.   With                                                               
regard   to  using   the   language   "any  elected   procedure,"                                                               
Representative Crawford  pointed out  that could refer  to having                                                               
one's teeth cleaned.  Therefore, he  said he didn't see how there                                                               
could  be a  law that  discriminates against  one form  of health                                                               
care, when that health care is legal under the constitution.                                                                    
REPRESENTATIVE GATTO  related his belief that  having one's teeth                                                               
cleaned is a medical procedure, which  is why it's performed by a                                                               
licensed  individual.   He  suggested  that  perhaps any  elected                                                               
procedure  shouldn't be  covered  when the  intent  is to  simply                                                               
release the  physician when  doing free work.   Perhaps  the free                                                               
work  could  be  limited  to  free  and  essential  or  free  and                                                               
necessary  [services].    Therefore,  procedures  such  as  teeth                                                               
whitening,  plastic surgery,  and  removing  tattoos wouldn't  be                                                               
Number 1975                                                                                                                     
REPRESENTATIVE GUTTENBERG said that  the definition of "elective"                                                               
would be  troubling for a lot  of people.  Comparing  an elective                                                               
teeth cleaning to an elective abortion  is troubling.  He posed a                                                               
situation in  which someone has an  accident and there is  a life                                                               
and death  situation [between the  mother and her  unborn child],                                                               
and questioned  whether the decision  of whether one or  both die                                                               
would be considered elective.                                                                                                   
REPRESENTATIVE  LYNN  clarified  that  [Conceptual  Amendment  3]                                                               
doesn't go to  the abortion issue itself rather  it addresses the                                                               
liability issue.                                                                                                                
REPRESENTATIVE SEATON  reiterated that the  purpose of HB  260 is                                                               
to provide legal voluntary health care.   If attempts are made to                                                               
allow  certain  procedures  and   disallow  others,  he  said  he                                                               
believes it will  probably [thwart this attempt  to provide free]                                                               
needed medical care.                                                                                                            
CHAIR  ANDERSON asked  if Representative  Seaton was  saying that                                                               
the language on  page 3, line 1, "to treat  or prevent illness or                                                               
injury", doesn't include abortion.                                                                                              
REPRESENTATIVE SEATON replied, "Right."                                                                                         
REPRESENTATIVE LYNN disagreed.                                                                                                  
REPRESENTATIVE  GATTO  clarified that  any  female  can go  to  a                                                               
physician and  say that it  stresses her  or would injure  her to                                                               
have a  baby in which case  a mental illness would  be associated                                                               
with the delivery of the  baby.  Representative Gatto opined that                                                               
ignoring  it  would mean  that  it's  covered, and  therefore  he                                                               
supported Conceptual Amendment 3.                                                                                               
Number 1811                                                                                                                     
A roll  call vote was  taken.  Representatives  Dahlstrom, Gatto,                                                               
Lynn,  and Anderson  voted in  favor of  Conceptual Amendment  3.                                                               
Representatives  Guttenberg   and  Crawford  voted   against  it.                                                               
Therefore, Conceptual Amendment 3 was adopted by a vote of 4-2.                                                                 
REPRESENTATIVE   CRAWFORD  highlighted   his  belief   that  it's                                                               
important  to recognize  that [this  legislation] issues  blanket                                                               
immunity  up to  the  point  of gross  negligence.   Some  states                                                               
indemnify the volunteer health care  providers.  He said he would                                                               
hate to see  people [unable to seek damages] when  they have been                                                               
injured by  these health care  providers.   He noted that  he was                                                               
leery  about providing  blanket  immunity.   Therefore, he  noted                                                               
that  he would  be in  favor of  putting the  state in  charge of                                                               
indemnifying these volunteer health care providers.                                                                             
CHAIR ANDERSON recalled  Mr. Conn's point that  the licensure for                                                               
the various health care providers  varies.  Furthermore, there is                                                               
some  ambiguity  with regard  to  the  liability of  a  nonprofit                                                               
facility.   Chair  Anderson pointed  out that  the committee  has                                                               
reviewed  this legislation  per  the purview  of this  committee.                                                               
Therefore,  he   said  he  believes  the   legislation  could  be                                                               
forwarded to the next committee  of referral, the House Judiciary                                                               
Standing Committee,  where the more  definitive aspects  could be                                                               
REPRESENTATIVE   LYNN  pointed   out   that  indemnifying   these                                                               
volunteer health  care providers  could cost the  state millions.                                                               
Further, he questioned whether the  state would have to carry the                                                               
REPRESENTATIVE CRAWFORD  posed a  situation in which  an indigent                                                               
is  harmed, and  indicated that  the state,  as the  last resort,                                                               
would be responsible for this person.                                                                                           
REPRESENTATIVE LYNN  stated that he totally  supports the concept                                                               
of HB 260 as it has been amended.                                                                                               
Number 1611                                                                                                                     
REPRESENTATIVE  GUTTENBERG  noted  that  he, too,  liked  HB  260                                                               
conceptually.  However, he was  also interested in Representative                                                               
Crawford's  suggestion to  explore some  blanket indemnification.                                                               
Some of the  definitions of health care providers  are broad, and                                                               
therefore  defining health  care providers  is smart.   Still  he                                                               
noted  his concerned  with the  liability of  the legislation  as                                                               
well as the license requirements.                                                                                               
CHAIR ANDERSON offered to contact  Rick Urion, Director, Division                                                               
of  Occupational Licensing,  Department  of  Commerce &  Economic                                                               
Development,  and  request  an interpretive  and  opinion  letter                                                               
regarding  licensure  to  be submitted  to  the  House  Judiciary                                                               
Standing Committee.                                                                                                             
REPRESENTATIVE CRAWFORD  said he  hates to send  legislation with                                                               
problems to  the next committee  of referral.  He  emphasized his                                                               
concern with providing blanket immunity.                                                                                        
Number 1493                                                                                                                     
REPRESENTATIVE DAHLSTROM moved to report  HB 260, as amended, out                                                               
of   committee   with    individual   recommendations   and   the                                                               
accompanying fiscal notes.                                                                                                      
REPRESENTATIVE  GUTTENBERG objected.   Representative  Guttenberg                                                               
requested a list of physicians and their licensing requirements.                                                                
A roll  call vote was  taken.  Representatives  Dahlstrom, Gatto,                                                               
Rokeberg, Lynn, and Anderson voted  in favor of reporting HB 260,                                                               
as  amended, out  of committee.   Representatives  Guttenberg and                                                               
Crawford  voted  against  it.     Therefore,  CSHB  260(L&C)  was                                                               
reported out of  the House Labor and  Commerce Standing Committee                                                               
by a vote of 5-2.                                                                                                               

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