Legislature(2005 - 2006)BUTROVICH 205
04/06/2005 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB125 | |
| SB150 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 125 | TELECONFERENCED | |
| *+ | SB 150 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 10 | TELECONFERENCED | |
1:37:00 PM SB 125-LICENSING MEDICAL OR CARE FACILITIES CHAIR DYSON announced SB 125 to be up for consideration. DR. RICHARD MANDSAGER, Director, Division of Public Health, said SB 125 would consolidate licensing background checks for certifications by the Department of Health and Social Services (DHSS). 1:41:51 PM SENATOR OLSON asked whether there had been complaints or a problem with licensing some facilities. DR. MANDSAGER answered that there had been no complaints, but the issue is that there is a myriad of different rules governing different care providers. Assisted living homes and for-profit hospices have most of their rules defined in statute and everything else has most of their rules defined in regulation. Since regulations are developed over time, the rules for appeals are all a little different. SB 125 simplifies and standardizes the processes. SENATOR OLSON asked whether the burdens on care providers would be greater or lesser with the passage of the bill. DR. MANDSAGER replied that care providers generally like the bill. SENATOR OLSON asked whether the bill would put some entities out of business. DR. MANDSAGER answered if the entities are competent, they would remain in business. If they end up going out of business, it would be for reasons other than this bill. 1:45:50 PM CHAIR DYSON said he heard that due to a shortage of doctors licensed to perform abortions in Alaska, doctors not licensed in Alaska were flying in to perform those services. He asked if they were in compliance with the abortion statute, AS 18.16.010, that says: Abortion may not be performed unless (1) the abortion is performed by a physician licensed by the State Medical Board; or (2) the abortion is performed in a hospital or a facility approved for the purpose by the Department of Health and Social Services. VIRGINIA STONKUS, Certification and Licensing, Division of Public Health, Department of Health and Social Services (DHSS), responded that physicians are licensed by the Board of Medical Examiners and that the division does not license the services that are provided in hospitals. The decisions about what is performed or available in the institutions are determined by its Board of Governors. 1:48:01 PM CHAIR DYSON noted that abortions performed outside of a hospital is the issue. MS. STONKUS replied that the division does not license individual physicians or individual physician clinics. DR. MANDSAGER said he didn't think the Board licensed for abortion specifically, but he would have to research whether doctors are asked what procedures they perform. CHAIR DYSON said he has raised the issue numerous times and has never been satisfied that the DHSS is in compliance with state law. He asked if it was true that doctors not licensed in Alaska were flying up here to practice and who would investigate that. MR. MANDSAGER replied that that issue would be investigated by the Board of Medical Examiners. CHAIR DYSON asked whether their investigation would happen only because of a complaint rather than just being asked by him to do it. DR. MANDSAGER responded that the board responds to complaints. MS. STONKUS added that SB 125 was intended to provide a minimal framework, which would allow the agency to work with the number of different of programs that would be subject to licensure so that facilities and programs are not accidentally excluded. An example is that they need to accommodate children differently than adults. CHAIR DYSON asked if any of the waivers or exceptions would threaten the health of the patients. MS. STONKUS replied no, accommodations would have to be made. 1:50:36 PM CHAIR DYSON asked whether he could assume that none of the waivers or exceptions would affect the health of patients undergoing care. MS. STONKUS replied that was correct. 1:52:17 PM CHAIR DYSON asked why the criminal background check includes both charges and convictions. DR. MANDSAGER replied that including the language "charged with a crime" has been discussed internally for a while and the issue is when someone is charged with a crime, often they will leave employment; it might not get prosecuted and it vanishes. In the interest of trying to a get full picture of an individual, the bill includes "charged with a crime" so the department can determine whether it should consider barring a suspect from employment. It doesn't necessary mean that they will be barred from employment if they were charged, but it might in some cases. CHAIR DYSON asked who would have access to that information. 1:53:58 PM STACIE KRALY, Senior Assistant Attorney General, Department of Law (DOL), said that criminal information is all public information if someone is an adult although juveniles have a different standard. However, the premise for information on the civil registry is that it would be restricted to the department and individuals who need it to determine whether it is pertinent to the application and should be entered onto the civil abuse registry. The department is still fleshing out the due process mechanism that would be available to people on the list for cases of a vindictive employer. 1:56:51 PM CHAIR DYSON asked if an applicant would be informed that the results of a background check could be public and placed on a registry. MS. KRALY replied that the results of the check would probably not be on the registry, but the information they relied upon would be in a repository. Applicants would be told about the background check process and the possibility that the information could be placed on a public registry. CHAIR DYSON said for the record that it is his contention that it must be clear to an applicant that such information could be placed on a public registry. 1:59:31 PM CHAIR DYSON noted that people in custody and divorce proceedings sometimes file abuse and other charges that are sometimes motivated by spite and asked how those would be considered. MS. KRALY replied that the department wants to give applicants the ability to include information that may affect an employer's perception of culpability in a given circumstance such as divorce proceedings. CHAIR DYSON asked if criminal information would be on the registry. MS. KRALY replied that criminal information is already accessible to the public, but the board will have to make decisions about an applicant being terminated when no adjudicatory act took place and that information is more difficult to get because it is not necessarily on record anywhere. 2:03:44 PM CHAIR DYSON remarked that there are lots of spurious cases these days against medical professionals and consequently medical costs are getting so expensive that many prefer to settle suits and the decision is never made whether they are guilty or not. DR. MANDSAGER responded that the civil registry language on page 28, line 5, is limited to "the applicant or the employee committed abuse, neglect or exploitation under certain statutes." It's limited to things that are pertinent to these kinds of facilities. 2:05:21 PM SENATOR ELTON said his concern was that the registry could be used by an employer to force an employee to leave. The hammer would be if you don't do it, your name could end up on the abuse registry, but, if in fact, abuse happened, instead of going through a protracted personnel kind of battle, this person might decide to leave and go to work someplace else. DR. MANDSAGER replied that cases needed to be captured where people leave employment before they are reported to the police. The question is how to get that information. He would like regulations requiring employers to report to the department if someone leaves in lieu of getting reported to the police because of some abusive act they had committed. 2:07:11 PM MS. KRALY added that he thought that Dr. Mandsager's response was carefully crafted. They want to encourage employers to make good decisions about bad employees. SENATOR ELTON commented that it is not unknown for employers to threaten their employees. DR. MANDSAGER said that he would take the Senator's comments under advice. 2:09:45 PM CHAIR DYSON asked DR. MANDSAGER if he read ASHNHA's position paper. His first question is why anyone would file on time if there weren't a penalty for not doing so. DR. MANDSAGER replied yes, he had read the paper. With respect to the concern about timely filing, the intent is that the department receives an application, but if it doesn't get its work done on time, the entity remains licensed until it does. CHAIR DYSON asked if his amendments fix that. DR. MANDSAGER replied that he thought the statute already said that, but the lawyers didn't. Another amendment says that the commissioner would have to authorize the closure of a facility and accommodations would have to be made for its residents or patients. 2:12:52 PM MS. KRALY said the ASHNHA letter said the state should not be immune from compensating for economic consequences of department actions ultimately found to be excessive in the courts. She said the immunity language on page 13 was drafted using the best of the 13 or 14 statutory frameworks for licensure. It does not expand nor diminish the immunities under current law. With respect to ASHNHA's comments, there is currently no such immunity for things like that and no statutes that would preclude the possibility of recovery. 2:15:20 PM DR. MANDSAGER said that the current definition of 'assisted living home' resulted from issues emerging from the overlap between assisted living services and medical services. He disagreed that this overlap was problematic and felt that if a family and a doctor decide that an elder should have medical care in an assisted living home and is willing to be liable for that decision, they should have a right to do so. 2:18:03 PM CHAIR DYSON asked if a federal law precludes a person being in possession of a firearm on the parking lot of a federally licensed childcare center. MS. STONKUS replied no. 2:20:04 PM SENATOR GREEN remarked that this seems to be an expansion of the prohibition of previous language regarding firearms in federally licensed childcare centers and she wanted assurance that this bill does not create a further expansion of the aforementioned prohibition. 2:21:46 PM DR. MANDSAGER asked if she thought it would be appropriate to test this language. SENATOR GREEN responded that she thought that would be appropriate. MS. KRALY said that she would take Senator Green's concerns under advisement, but emphasized that the department had taken special care not to create an expansion. CHAIR DYSON said he could not support this bill if any Alaskan who stops to pick up his child or visit a parent in a nursing home on the way to or from a hunting trip with a weapon is guilty. That included people who had been assaulted or someone who delivered someone who had just been injured to a hospital. 2:24:25 PM SENATOR ELTON said that an abuse registry creates the kinds of actions that could be heard by the Office of Administrative Hearings and therefore assumed there would be a fiscal impact and a fiscal note. MS. KRALY responded that the due process mechanism for determining placement on the civil registry had not yet been developed, so a fiscal note couldn't be determined. SENATOR ELTON asked how "volunteer of an entity" is defined on page 26. He used dog handlers for an example. DR. MANDSAGER replied that "volunteer" is not defined in the statute at this point, but the larger facilities have lists of volunteers with special training and a small organization like an assisted living home doesn't have volunteer lists and that is a good question. He said he had prepared two sets of amendments and had hoped that a CS version would have already incorporated them - most are conforming amendments. He said that conceptual Amendment 1 was written primarily because the initial draft of the law interpreted a starting date that won't happen. So, it renumbers everything to allow for a starting date after this bill would pass. 2:29:40 PM SENATOR GREEN moved to adopt conceptual Amendment 1 and then objected for discussion purposes. CONCEPTUAL AMENDMENT 1 1) Amend section 47.32.900(1)(B) [page 15, line 24] - before "services" insert "or other invasive diagnostic or therapeutic". (This would have allowed the department to license medical centers that conduct procedures that are intrusive and pose increased risk to the patient, such as cardiac catheterization.) 2) Add a new Section 47 - "Section 17 of this Act takes effect upon the effective date of the implementing regulations, or March 1, 2006, whichever occurs sooner." MS. STONKUS explained that the whole concept was to implement the bill as of July 1, 2005 and then further construct the registry and the background check piece. That timeframe was ambitious and changing that date required eight pages of conforming language. The March date was set because of their federal grant timeframe. DR. MANDSAGER explained that the second part of Amendment 1 allows flexibility in statute to accommodate improvements in technology that may allow certain procedures to be performed outside of a hospital. SENATOR GREEN asked for an example of a therapeutic service. DR. MANDSAGER replied a linear accelerator for radiation therapy or chemotherapy. In Alaska, those things exist within a hospital, a licensed entity. In other states, they have moved outside the hospital. 2:35:20 PM CHAIR DYSON asked if invasive diagnostic is considered imaging. DR. MANDSAGER replied that it could be imaging, but he didn't know if those words were exactly right yet. CHAIR DYSON asked him if barium was invasive. DR. MANDSAGER replied no and that's why he was not currently satisfied with the language of the Amendment 1. He didn't want to get into doctor's offices or ordinary X-ray units. CHAIR DYSON announced that he would hold action on Amendment 1 pending modifications by the sponsor. SENATOR ELTON moved to adopt conceptual Amendment 2. CHAIR DYSON objected for the purpose of discussion. DR. MANDSAGER explained that Amendment 2 adds a new section, (e), that requires the commissioner to be involved if the department has to take over a facility. Everything else is renumbering. The other part corrects a drafting error on the bottom of page 13, line 1. 2:38:54 PM CHAIR DYSON thanked everyone for their comments and said he would hold the bill in committee.
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