Legislature(1997 - 1998)

04/07/1997 09:09 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
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               SB  96 REGULATION OF HOSPICE CARE                             
                                                                              
 Number 530                                                                    
                                                                               
  CHAIRMAN WILKEN  announced that  SB 96  would be the next order of           
 business before the committee.  Chairman Wilken noted that the K              
 version of the bill was before the committee.                                 
                                                                               
  BEN BROWN , Staff to Senator Kelly, discussed the changes that               
 version K includes.  On page 8, line 21 after "which" the word                
 "including" was deleted and "may include" was inserted.  That                 
 language was inserted because sometimes a volunteer hospice would             
 not include all the items listed for bereavement services.  Page 9,           
 line 14 the reference to 24 hour, seven days a week was deleted               
 because in a volunteer context that would not occur.  That language           
 is on page 5 under the definition of nursing services as provided             
 by nonvolunteer hospice programs.                                             
                                                                               
  CHAIRMAN WILKEN  asked Ms. Sonner to provide her testimony and noted         
 that the packet included her letter.                                          
                                                                               
  RITCHIE SONNER , Hospice & Home Care of Juneau, supported SB 96 as           
 written.  With the changes to SB 96, Ms. Sonner did not believe it            
 to be burdensome administratively or financially.  Hospice & Home             
 Care of Juneau is a small volunteer hospice with few funds.  SB 96            
 is written to protect the consumer.  Ms. Sonner noted that she was            
 not a supporter of regulation, but in this situation she                      
 recommended the passage of SB 96.                                             
                                                                               
  SENATOR LEMAN  asked Ms. Sonner if her notion that SB 96 was not             
 burdensome was the general consensus among volunteer hospices.                
  RITCHIE SONNER  believed so, but noted there were folks on line who          
 could speak to that.   SENATOR LEMAN  did not want to burden such             
 organizations unnecessarily.                                                  
                                                                               
  CHARLES QUARRE , President of the Central Peninsula Hospice, stated          
 that he maintained his previous testimony regarding concerns of the           
 administrative and financial burdens of SB 96.  Mr. Quarre noted              
 that many industries are regulated by market forces.  The volunteer           
 hospices adhere to the guidelines of the National Hospice                     
 Organization which are almost identical to those specified in the             
 bill.  Mr. Quarre suggested reviewing the advisability of incurring           
 additional expense and regulations in this area.  Mr. Quarre                  
 questioned if there are current statutes that address abuses in               
 this system.  In response to Chairman Wilken, Mr. Quarre agreed               
 that he was speaking in opposition to SB 96.  Mr. Quarre requested            
 that the volunteer hospice may be noted in the bill, but be                   
 excluded from the provisions if not entirely.                                 
                                                                               
  CHAIRMAN WILKEN  asked Mr. Quarre if he had any suggestions                  
 regarding how to accomplish that within SB 96.   CHARLES QUARRE               
 suggested that if the bill is to pass, the volunteer hospice could            
 be recognized but excluded from the provisions of the bill.                   
                                                                               
 Number 427                                                                    
                                                                               
  BEN BROWN  explained that if hospices are to be regulated, there             
 must be a standard that applies to any organization using the term            
 hospice.  In the Commonwealth of Virginia, a bill excluding the               
 volunteer hospices was passed which resulted in volunteer hospices            
 being unable to use the term hospice in their name.  Mr. Brown                
 acknowledged that language could be used to avoid that problem.               
 However, that would result in regulating only a portion of the                
 industry providing hospice services.  Mr. Brown recognized that the           
 volunteer hospices in Alaska are exceeding the standards specified            
 in the bill, but that may not continue as time passes.  Eliminating           
 the reference to the volunteer programs in SB 96 would not                    
 accomplish the primary goal and the remainder of the hospice                  
 community may not want that to go forward.                                    
                                                                               
  RITCHIE SONNER  noted that there are shams, although not in Alaska           
 currently.  Thirty-eight states have had to regulate hospices in              
 even a more restrictive manner.  SB 96 is a proactive bill to                 
 protect consumers who are in a vulnerable state.  Ms. Sonner feared           
 the possibility of an opportunist.  Ms. Sonner pointed out that               
 eliminating the reference to volunteer hospices would allow anyone            
 to refer to themselves as a hospice.  SB 96 should be passed as is            
 or not at all.                                                                
                                                                               
  SENATOR WARD  inquired as to the number of cases of abuse in Alaska          
 this year.   BEN BROWN  did not believe there was a situation of              
 abuse in Alaska currently.   SENATOR WARD  suggested that regulation          
 could harm the process that is currently working.   BEN BROWN                 
 referred to Article 2 when saying that the Administrator of Health            
 Facilities Licensing & Certification will be reviewing mainly                 
 nonvolunteer hospices a couple days a year.  The volunteer programs           
 have a lower standard to adhere and the department has no intention           
 of charging volunteer hospices.  Mr. Brown reiterated that the                
 volunteer hospices are already exceeding the standards in SB 96.              
 Mr. Brown noted that nurses and doctors have associations that                
 regulate them, only attorneys regulate themselves.  Mr. Brown did             
 not know what more could be done to lighten the burden without                
 making the legislation meaningless.                                           
                                                                               
 Number 366                                                                    
                                                                               
  SENATOR WARD  agreed that there was no middle ground.  Senator Ward          
 inquired as to the public safety reasons for SB 96 within Alaska.             
  BEN BROWN  could not give an example within the hospice community.           
 There was a problem in an assisted living home which lead to                  
 changes in law.  Mr. Brown noted that an assisted living home was             
 a comparable field.                                                           
                                                                               
  BARBARA RICH , Hospice of the Tanana Valley, said that she was               
 speaking for the Board of Directors.  Ms. Rich noted that all of              
 the concerns regarding the bill initially speaking only to                    
 volunteer hospices when relevant were addressed.  Ms. Rich noted              
 that she was concerned with the administrative and financial costs            
 of SB 96.  Mr. Shelby of the Department of Health & Social Services           
 assured Ms. Rich that it would be very minimal: a yearly on-site              
 inspection would occur with a report following.  The standards in             
 the bill are minimal.  SB 96 would protect vulnerable patients and            
 families.  Ms. Rich said that there has never been a problem in               
 this area and the impetus is to continue that record.                         
                                                                               
 In response to Senator Ward, Ms. Rich said that the Hospice of the            
 Tanana Valley has not experienced any problems.  Ms. Rich was                 
 concerned that others may not do so.  With regard to the expansion            
 of the regulations, Ms. Rich did not believe there could be                   
 expansion.  Ms. Rich said that she had heard of others who have               
 lower standards as well as problems with this in other states.                
                                                                               
  SENATOR WARD  was not sure that regulation was necessary for a               
 problem that does not exist.   BARBARA RICH  believed that the                
 certified hospices would be regulated due to the presence of                  
 nursing staff and such.                                                       
                                                                               
  JOY JANSSEN , representing the forming Petersburg Hospice, informed          
 the committee that Petersburg was in the process of forming a                 
 hospice beginning with neighbor to neighbor care.  Ms. Janssen                
 asked if neighbor to neighbor care was given without using the name           
 hospice, would the organization still be regulated under this bill.           
                                                                               
  BEN BROWN  replied no.  SB 96 applies only to groups representing            
 themselves as hospices.  Mr. Brown said that it would be a                    
 judgement call for the Department of Law upon the request of the              
 Department of Health & Social Services.  Mr. Brown pointed out the            
 definition of "hospice services" when noting that providing only              
 one service at home or not meeting all the needs listed could                 
 possibly eliminate Ms. Janssen's concerns.  Identifying an                    
 organization as a hospice is the triggering mechanism and the                 
 secondary definition is providing hospice services.                           
                                                                               
 Number 251                                                                    
                                                                               
  MAXINE WORHATCH , testifying from Petersburg, asked if insurance,            
 personal or group, would be necessary if a group fell under this              
 bill as a volunteer.   BEN BROWN  said that was not covered by SB 96.         
 Mr. Brown believed that most volunteer hospices carried insurance.            
 SB 96 does not mandate liability insurance.  Mr. Brown referred Ms.           
 Worhatch to Ms. Sonner or Ms. Rich.   MAXINE WORHATCH  commented that         
 it does not seem necessary to regulate volunteer hospices.  Why               
 would someone volunteer and then take advantage of a patient?                 
                                                                               
  ERICA WORHATCH  asked if a hospice became licensed would the hospice         
 be liable if a neighbor who was not a hospice volunteer wanted to             
 help.   BEN BROWN  said that if a person wanted to help a dying               
 neighbor, of course that can be done.  As long as that neighbor did           
 not say he/she was affiliated with a particular hospice, that                 
 hospice would not be liable for his/her actions.                              
                                                                               
  CHAIRMAN WILKEN  suggested that those in Petersburg could consult            
 the many successful volunteer hospices such as those represented by           
 Ms. Sonner and Ms. Rich.                                                      
                                                                               
  SHELBERT LARSEN , Administrator of Health Facilities Licensing &             
 Certification for DHSS, said that his agency would probably develop           
 and enforce the regulations if this statute were to pass.  Mr.                
 Larsen believed that SB 96 was a good bill, providing minimum                 
 standards for hospice programs.  Mr. Larsen did not believe SB 96             
 would be burdensome for either the for profit or volunteer                    
 hospices.                                                                     
                                                                               
  CHAIRMAN WILKEN  referred to Article 2, page 7, line 18 when asking          
 if other volunteer organizations were required to show proof of               
 auto insurance and valid drivers license.   BEN BROWN  said that he           
 had asked Terri Lauterbach about that matter.  Ms. Lauterbach was             
 unaware of other volunteer organizations requiring such.  That                
 requirement was included because it was in the main statute and               
 seemed appropriate to put in SB 96.  This has not been a concern              
 for anyone.  Mr. Brown said that it would not be appropriate for an           
 individual to be driving around a terminally ill patient without              
 auto insurance and a valid drivers license.  This is one reason for           
 a hospice to have liability insurance.  Liability would be                    
 increased if the two requirements were not met.                               
                                                                               
  SENATOR GREEN  informed everyone that her husband was employed by            
 the Auto Insurance Provider.  Senator Green recalled that when she            
 drove for Scouts or her church, she was required to have proof of             
 insurance.  Senator Green did not believe that those requirements             
 were unique to hospices.                                                      
                                                                               
  SENATOR WARD  requested that SB 96 be held until Kenai could provide         
 an amendment to eliminate the volunteers from the bill.  Senator              
 Ward did not know when the amendment would be ready.  Senator Ward            
 said that he did not want to move SB 96 out of committee; people              
 should not be regulated for a problem that does not exist.                    
                                                                               
  CHAIRMAN WILKEN  said that he would prefer not to hold SB 96 beyond          
 Wednesday.  There being no further business before the committee,             
 the meeting was adjourned at 10:35 a.m.                                       

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