Legislature(2009 - 2010)CAPITOL 106

04/01/2010 08:00 AM House STATE AFFAIRS

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
<Bill Hearing Canceled>
Moved Out of Committee
Heard & Held
Moved Out of Committee
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
              SB 215-PIONEERS HOME RX DRUG BENEFIT                                                                          
[Contains mentioned of HB 284.]                                                                                                 
9:48:46 AM                                                                                                                    
CHAIR LYNN  announced that the next  order of business  was SENATE                                                              
BILL  NO. 215,  "An Act  requiring  the Department  of Health  and                                                              
Social Services  to accept federal  prescription drug  benefits or                                                              
to  provide  comparable  benefits  for  residents  of  the  Alaska                                                              
Pioneers' Home."                                                                                                                
9:49:40 AM                                                                                                                    
SENATOR  WIELECHOWSKI,  Alaska   State  Legislature,  as  co-prime                                                              
sponsor, noted  that HB  284 is  a companion bill.   He  offered a                                                              
history of  the problem,  which SB  215 proposes  to address.   He                                                              
noted that  in April 2009, veterans  living in the  Alaska Pioneer                                                              
Homes,  who were  not able  to administer  their own  medications,                                                              
stopped receiving  the free  or low-cost  medications they  earned                                                              
through the  Veterans Administration  and were forced  to purchase                                                              
their  medication through  the Alaska  Pioneer Homes'  pharmacies.                                                              
The problem,  Senator Wielechowski  explained, is that  the Alaska                                                              
Pioneer  Homes' pharmacies  prepare medication  in blister  packs,                                                              
and the  Veterans' Administration does  not have the  equipment to                                                              
do  so.    The  staff at  the  Alaska  Pioneer  Homes  refused  to                                                              
administer  drugs  from bottles,  and  was  not  able to  put  the                                                              
medication in blister packs.                                                                                                    
SENATOR  WIELECHOWSKI  said  the  Department of  Health  &  Social                                                              
Services, the Alaska  Pioneer Homes, the Veterans  Administration,                                                              
veterans'  advocates,  and  several  members  of  the  legislature                                                              
worked  together for  several months  to solve  the problem.   The                                                              
Alaska Pioneer  Homes were cooperative,  and the  chief pharmacist                                                              
of the  Alaska Veterans Association  and chief of  staff conducted                                                              
in-service visits to  the Alaska Pioneer Homes to  ensure that the                                                              
nurses were properly  administering medications directly  from the                                                              
original bottles from the Veterans Association.                                                                                 
SENATOR  WIELECHOWSKI stated  that  SB 215  seeks  to ensure  that                                                              
this  problem does  not  surface in  the future.    He stated  his                                                              
understanding  that  "this isn't  the  first  time that  this  has                                                              
happened."   He  said the  change  of administrations  could be  a                                                              
time when this happens,  and that is why "we're  seeking to codify                                                              
this."   Senator Wielechowski  related  that the  bill has  a zero                                                              
fiscal note  and no  known opposition.   The proposed  legislation                                                              
is  supported by  the  Office  of Veteran  Affairs  and  is a  top                                                              
legislative  priority for  the Vietnam  Veterans of  America.   He                                                              
offered to answer questions from the committee.                                                                                 
9:53:10 AM                                                                                                                    
REPRESENTATIVE  JOHNSON stated his  understanding that  the reason                                                              
for  using  blister  packs  is to  eliminate  the  possibility  of                                                              
dosing error.   He asked if  the state would be  subjecting itself                                                              
to liability by saying it's okay to use bottles.                                                                                
9:55:00 AM                                                                                                                    
SENATOR   WIELECHOWSKI  responded   that   those  who   administer                                                              
medications at the  Alaska Pioneer Homes were concerned  about the                                                              
possibility of  error, but after  consideration have  decided that                                                              
they can administer  medication safely from bottles,  which is why                                                              
they are  "supportive of  this compromise."   He noted  that there                                                              
are  only  about  a  dozen  people   to  which  the  proposed  the                                                              
legislation would apply.                                                                                                        
9:56:26 AM                                                                                                                    
REPRESENTATIVE   SEATON  said   when  the   committee  heard   the                                                              
companion  bill, HB 284,  he had  relayed that  he has  a relative                                                              
who  "was in  this  situation."   He  expressed  concern that  the                                                              
proposed  legislation would  be  "putting things  in statute  that                                                              
are already taken  care of."  He said one issue  that has not been                                                              
addressed  is the  waste resulting  in  using blister  packs.   He                                                              
explained  that blister  packs are  made  for 31  days, and  those                                                              
medications  not used  during months  with fewer  days are  thrown                                                              
out,  and  the  value  of  those   discarded  medications  is  not                                                              
reimbursed  to  the  person  in whose  name  the  prescription  is                                                              
9:57:20 AM                                                                                                                    
REPRESENTATIVE  P. WILSON  said  as a  nurse,  she has  "dispensed                                                              
drugs like this."   She said veterans deserve the  free drugs from                                                              
the Veterans  Association;  they should  not have  to pay  for the                                                              
same drug  because it's in  a blister pack.   She said  she thinks                                                              
SB 215 is a good bill.                                                                                                          
9:58:38 AM                                                                                                                    
REPRESENTATIVE GRUENBERG  echoed Representative  Johnson's concern                                                              
about possible liability to the state under SB 215.                                                                             
9:59:22 AM                                                                                                                    
SENATOR  WIELECHOWSKI  responded  that  "anyone can  sue  for  any                                                              
reason at all."   He stated, "At  some point you have  to put some                                                              
…  confidence  in  the  professionals  that  are  working  at  the                                                              
[Alaska  Pioneer] Homes  -  the nurses  that  are working  there."                                                              
Regarding whether  or not there  would be increased  liability, he                                                              
said, "I guess someone could administer the wrong blister pack."                                                                
9:59:54 AM                                                                                                                    
REPRESENTATIVE GRUENBERG  asked the bill sponsor if  he thinks the                                                              
legal aspect of the bill had been sufficiently addressed.                                                                       
10:00:03 AM                                                                                                                   
SENATOR WIELECHOWSKI responded:                                                                                                 
     Personally, …  as an attorney myself, I don't  see it as                                                                   
     burdensome.     I  don't  see   it  as  an   additional,                                                                   
     potential liability.   You have a professional  nurse in                                                                   
     a  professional  organization  who's been  working  with                                                                   
     the  [Alaska  Pioneer]  Homes, whose  working  with  the                                                                   
     Department of  Health & Social Services to  figure out a                                                                   
     method  to do  this.   It  really is  just  a matter  of                                                                   
     taking  a pill  out of  a bottle  and giving  it to  the                                                                   
     person.   And so, obviously  if a nurse doesn't  do that                                                                   
     correctly, there's  potential liability there.   I don't                                                                   
     think there's  any way  you can get  around that.   If …                                                                   
     they give the  person the wrong medicine from  a blister                                                                   
     pack, there's potential liability there.                                                                                   
REPRESENTATIVE  GRUENBERG  expressed   satisfaction  with  Senator                                                              
Wielechowski's answer.                                                                                                          
10:01:09 AM                                                                                                                   
VERDIE BOWEN, Director,  Office of Veteran Affairs,  Department of                                                              
Military &  Veterans' Affairs (DMVA),  testified in support  of SB
215.   He  said  several  times last  year  patients  had to  stop                                                              
receiving their medication  from the VA.  He stated,  "Each time a                                                              
solution was  brought forward, then  something new would  creep up                                                              
from some administrative  order or something that  would not allow                                                              
the  patient to  receive the  medication."   Mr.  Bowen said  what                                                              
made the  situation worse was that  many of the  patients involved                                                              
could not  speak up  for themselves  because they had  Alzheimer's                                                              
and dementia,  and so their families  had to go to  their defense.                                                              
He  affirmed  that  Senator  Wielechowski  was  correct  that  the                                                              
number of  patients affected  last year  was about  a dozen.   Mr.                                                              
Bowen  stated that  the  intent of  the bill  is  to prevent  this                                                              
situation  from  happening again  years  from  now.   He  credited                                                              
Commissioner  Hogan as the  person who "stood  up" and  "put forth                                                              
the  fixes  in place."    Regarding  bottled medicine,  Mr.  Bowen                                                              
explained that  the pills are taken  out of the bottle  and placed                                                              
into "ready  packs," which  he said look  like blister  packs, but                                                              
are  packaged for  Monday through  Sunday.   He said  he does  not                                                              
know what  liability there  would be to  the state, but  does know                                                              
that "this is  something that those people have  earned and should                                                              
continue to receive."                                                                                                           
10:03:16 AM                                                                                                                   
CHAIR LYNN closed public testimony.                                                                                             
10:03:24 AM                                                                                                                   
REPRESENTATIVE  PETERSEN said  he  thinks it  is unfortunate  that                                                              
some  veterans were  denied  their medication  last  year, and  he                                                              
stated his support of SB 215.                                                                                                   
10:04:02 AM                                                                                                                   
CHAIR LYNN reopened public testimony.                                                                                           
10:04:15 AM                                                                                                                   
DAVE COTE,  Director, Central Office,  Division of  Alaska Pioneer                                                              
Homes, stated  that the  department is  neutral regarding  SB 215,                                                              
because "we are  basically already doing this  anyway."  Regarding                                                              
safety,  he  relayed  that  while   certified  nurses'  aides  are                                                              
allowed to  dispense from  the blister  packs, the department  has                                                              
asked  that  only  nurses  dispense   the  VA  and  Indian  Health                                                              
Services  medications.   Mr.  Cote stated  that  those people  who                                                              
were  charged for  the period  of  May through  November were  all                                                              
refunded and credited  back all the money that  they were charged.                                                              
Mr.  Cote, in  response to  Representative  Johnson, said  blister                                                              
packs  increase  the  amount  of   money  and  time  required  for                                                              
dispensing medication  and "the VA doesn't do that."   In response                                                              
to  a follow-up  question,  he said  the  state  uses the  blister                                                              
packs for safety reasons.                                                                                                       
10:07:12 AM                                                                                                                   
MR.  CODY, regarding  Representative  Seaton's  concern about  the                                                              
wasted medication  in a 31-day blister pack,  indicated that there                                                              
are rules  related to whether or  not medications can  be returned                                                              
to pharmacies.   He indicated that important factors  are whether,                                                              
since  its release  from the  pharmacy, the  medication stayed  at                                                              
the proper  temperature and  was not damaged  or tampered  with in                                                              
any  way.   He  said the  department  and the  pharmacies  believe                                                              
"this is the right way to go with this."                                                                                        
10:08:11 AM                                                                                                                   
REPRESENTATIVE GRUENBERG  moved to report SB 215  out of committee                                                              
with individual  recommendations and the accompanying  zero fiscal                                                              
notes.  There being  no objection, SB 215 was reported  out of the                                                              
House State Affairs Standing Committee.                                                                                         

Document Name Date/Time Subjects