Legislature(2021 - 2022)BUTROVICH 205

05/03/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 183 HOME AND COMMUNITY-BASED SERVICES TELECONFERENCED
<Bill Hearing Canceled>
*+ HB 382 INSULIN COVERAGE:INSURANCE;MEDICAID TELECONFERENCED
<Bill Hearing Canceled>
<Pending Introduction & Referral>
-- Invited & Public Testimony --
*+ HB 392 EXPAND ADV PRC REG NURSE, PHYS ASSIS AUTH TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
*+ HB 297 MILITARY MEMBER CHILD PROTECTION TELECONFERENCED
<Pending Referral>
<Bill Hearing Canceled>
-- Invited & Public Testimony --
*+ SB 191 REPEAL COVID 19 DISASTER EMERGENCY TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                     ALASKA STATE LEGISLATURE                                                                                 
       SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                   
                           May 3, 2022                                                                                          
                            1:35 p.m.                                                                                           
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Mia Costello                                                                                                            
Senator Lora Reinbold                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 392(HSS) AM                                                                             
"An  Act  relating to  advanced  practice  registered nurses  and                                                               
physician assistants; and relating  to death certificates, do not                                                               
resuscitate orders, and life sustaining treatment."                                                                             
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 191                                                                                                             
"An Act repealing emergency powers  of the commissioner of health                                                               
and  social  services  and  certain  provisions  related  to  the                                                               
response to the  novel coronavirus disease; and  providing for an                                                               
effective date."                                                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 183                                                                                                             
"An  Act  relating  to home  and  community-based  services;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
     - BILL HEARING CANCELED                                                                                                    
                                                                                                                                
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 297(HSS)(TITLE AM)                                                                      
"An  Act  relating  to home  and  community-based  services;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
     - BILL HEARING CANCELED                                                                                                    
                                                                                                                                
CS FOR HOUSE BILL NO. 382(HSS)                                                                                                  
"An Act relating to insurance coverage for pharmacy services."                                                                  
                                                                                                                                
     - BILL HEARING CANCELED                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 392                                                                                                                  
SHORT TITLE: EXPAND ADV PRC REG NURSE, PHYS ASSIS AUTH                                                                          
SPONSOR(s): REPRESENTATIVE(s) SNYDER                                                                                            
                                                                                                                                
02/22/22       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/22/22       (H)       HSS, L&C                                                                                               
03/24/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
03/24/22       (H)       -- MEETING CANCELED --                                                                                 
03/29/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
03/29/22       (H)       Heard & Held                                                                                           
03/29/22       (H)       MINUTE(HSS)                                                                                            
03/31/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
03/31/22       (H)       -- MEETING CANCELED --                                                                                 
04/14/22       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
04/14/22       (H)       Moved CSHB 392(HSS) Out of Committee                                                                   
04/14/22       (H)       MINUTE(HSS)                                                                                            
04/20/22       (H)       HSS RPT CS(HSS) NEW TITLE 4DP                                                                          
04/20/22       (H)       DP: FIELDS, SPOHNHOLZ, SNYDER, ZULKOSKY                                                                
04/20/22       (H)       L&C AT 3:15 PM BARNES 124                                                                              
04/20/22       (H)       Heard & Held                                                                                           
04/20/22       (H)       MINUTE(L&C)                                                                                            
04/22/22       (H)       L&C AT 9:00 AM BARNES 124                                                                              
04/22/22       (H)       Moved CSHB 392(HSS) Out of Committee                                                                   
04/22/22       (H)       MINUTE(L&C)                                                                                            
04/25/22       (H)       L&C RPT CS(HSS) NEW TITLE 3DP 1NR                                                                      
04/25/22       (H)       DP: SNYDER, FIELDS, SPOHNHOLZ                                                                          
04/25/22       (H)       NR: SCHRAGE                                                                                            
05/02/22       (H)       TRANSMITTED TO (S)                                                                                     
05/02/22       (H)       VERSION: CSHB 392(HSS) AM                                                                              
05/03/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 191                                                                                                                  
SHORT TITLE: REPEAL COVID 19 DISASTER EMERGENCY                                                                                 
SPONSOR(s): SENATOR(s) REINBOLD                                                                                                 
                                                                                                                                
02/15/22       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/15/22       (S)       HSS, FIN                                                                                               
05/03/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE LIZ SNYDER                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of HB 392.                                                                                        
                                                                                                                                
ALLIANA SALANGUIT, Staff                                                                                                        
Representative Liz Snyder                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional analysis for HB 392.                                                              
                                                                                                                                
CHRISTINE KRAMER, DNP and APRN                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified by invitation on HB 392.                                                                        
                                                                                                                                
CHRISTOPHER DITTERICH, PA, Past President                                                                                       
Alaska Academy of Physician Assistants                                                                                          
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Testified by invitation on HB 392.                                                                        
                                                                                                                                
CINDY FULLER, representing self                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 191.                                                                           
                                                                                                                                
RICH ANDERSON, representing self                                                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 191.                                                                           
                                                                                                                                
Elize Gavitt, representing self                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 191.                                                                           
                                                                                                                                
LISA WARD, representing self                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 191.                                                                           
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:35:57 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:35 p.m.  Present at the                                                               
call to  order were Senators  Costello, Hughes,  Begich, Reinbold                                                               
and Chair Wilson.                                                                                                               
                                                                                                                                
        HB 392-EXPAND ADV PRC REG NURSE, PHYS ASSIS AUTH                                                                    
                                                                                                                                
1:36:52 PM                                                                                                                    
CHAIR WILSON  announced the  consideration of  CS FOR  HOUSE BILL                                                               
NO. 392(HSS) am "An Act  relating to advanced practice registered                                                               
nurses   and  physician   assistants;  and   relating  to   death                                                               
certificates,  do not  resuscitate  orders,  and life  sustaining                                                               
treatment."                                                                                                                     
                                                                                                                                
1:37:12 PM                                                                                                                    
REPRESENTATIVE LIZ SNYDER, Alaska State Legislature, Juneau,                                                                    
Alaska, sponsor of HB 392, introduced the legislation speaking                                                                  
to the sponsor statement that read as follows:                                                                                  
                                                                                                                                
     HB 392 updates statute  so Advanced Practice Registered                                                                    
     Nurses  (APRNs)  and  Physician  Assistants  (PAs)  can                                                                    
     provide more  support for the  seriously ill  and their                                                                    
     families.  APRNs are  Registered  Nurses  (RNs) with  a                                                                    
     master's degree  in nursing and  additional specialized                                                                    
     education and training.  Physician Assistants also have                                                                    
     a master's degree and additional clinical training.                                                                        
                                                                                                                                
     In 1984, Alaska became one  of the very first states to                                                                    
     give  APRNs  full  practice  authority.  Full  practice                                                                    
     authority means APRNs can  use their expanded knowledge                                                                    
     and skillset to prescribe,  diagnose, or treat patients                                                                    
     independently  within  their specialization.  A  common                                                                    
     example of this is Nurse  Practitioners (NP), a type of                                                                    
     APRN,  working as  primary care  providers for  many of                                                                    
     us.                                                                                                                        
                                                                                                                                
     APRNs are  authorized to  independently oversee  end of                                                                    
     life care, including assisting  with Do Not Resuscitate                                                                    
     (DNR)  orders  and  the   Physician's  Order  for  Life                                                                    
     Sustaining Treatment  (POLST). Similarly,  PAs examine,                                                                    
     diagnose, and  treat patients,  including participating                                                                    
     in end-of-life  care discussions,  as part of  a health                                                                    
     care  team. However,  statute does  not allow  APRNs or                                                                    
     PAs   to  sign   and   finalize  these   documentsonly                                                                     
     physicians  can. This  can cause  administrative delays                                                                    
     and  unnecessary additional  stress for  families if  a                                                                    
     physician is unavailable.                                                                                                  
                                                                                                                                
     Additionally,  current  statute   allows  a  registered                                                                    
     nurse  to  declare a  death  but  only if  a  physician                                                                    
     documents  the  anticipated  reason for  the  death.  A                                                                    
     registered  nurse can  also sign  a death  certificate,                                                                    
     but  it must  be  certified by  a  physician within  24                                                                    
     hours.  HB 392  revises statute  so APRNs  and PAs  can                                                                    
     also  certify a  death certificate.  While the  bill is                                                                    
     narrow in scope, it helps  many and especially those at                                                                    
     vulnerable times.                                                                                                          
                                                                                                                                
     Passage of HB  392 brings Alaska in line  with 34 other                                                                    
     states and  the District  of Columbia where  APRNs have                                                                    
     full  practice authority  and are  allowed to  sign DNR                                                                    
     and POLST  form; 37  other states  and the  District of                                                                    
     Columbia where  APRNs have full practice  authority and                                                                    
     can sign  death certificates;  30 states where  PAs can                                                                    
     sign DNR and  POLST forms; and 28 other  states where a                                                                    
     PA can sign a death certificate.                                                                                           
                                                                                                                                
1:41:19 PM                                                                                                                    
ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska                                                                     
State Legislature, Juneau, Alaska, presented a summary of the                                                                   
sectional analysis for HB 392 that read as follows:                                                                             
                                                                                                                                
     Sec. 1:  Amends AS 08.68.700(a) Determination  of death                                                                  
     by  registered nurse  by  allowing  a Registered  Nurse                                                                    
     (RN) to pronounce  or determine a death of  a person if                                                                    
     a physician  or an  advanced practice  registered nurse                                                                    
     (APRN) or  physician assistant  (PA) has  documented in                                                                    
     the  person's  medical  or  clinical  record  that  the                                                                    
     person's death is anticipated.                                                                                             
                                                                                                                                
     Sec. 2:  Amends AS  08.68.700(b) by  allowing an  RN to                                                                  
     sign a determination of death  if a physician, APRN, or                                                                    
     PA has previously documented the person's condition.                                                                       
                                                                                                                                
     Sec. 3: Amends  AS 08.68.700(c) by allowing  an APRN or                                                                  
     PA to  certify a  death determined by  an RN  within 24                                                                    
     hours of the determination of death.                                                                                       
                                                                                                                                
     Sec. 4:  Amends to 08.68.700(d) by  adding "an advanced                                                                  
     practice  registered nurse,  or a  physician assistant"                                                                    
     and  physician  assistant  as a  conforming  change  to                                                                    
     statute regarding health  care facilities' policies and                                                                    
     procedures  for  determination   and  pronouncement  of                                                                    
     death by a registered nurse.                                                                                               
                                                                                                                                
     Sec.  5:   Amends  AS  13.62.065  Do   not  resuscitate                                                                  
     protocol   and  identification   requirements  (a)   by                                                                    
     allowing APRNs  and PAs to  issue a do  not resuscitate                                                                    
     order.                                                                                                                     
                                                                                                                                
MS. SALANGUIT noted that Section 5 was further amended on the                                                                   
House floor requiring the written consent of the patient or the                                                                 
parent or guardian of a minor for a DNR order to be issued.                                                                     
                                                                                                                                
     Sec. 6  & 7: Adds  conforming language to  AS 13.62.065                                                                  
     Do   not   resuscitate  protocol   and   identification                                                                    
     requirements  to ensure  APRNs and  PAs are  subject to                                                                    
     the same rules and protocols as physicians.                                                                                
                                                                                                                                
     Sec.  8:  Adds  language  to  AS  13.62.065(f)  Do  not                                                                  
     resuscitate  protocol  and identification  requirements                                                                    
     allowing APRNS and  PAs to revoke a  do not resuscitate                                                                    
     order.                                                                                                                     
                                                                                                                                
     Sec.  9:  Adds  "or  an  advanced  practice  registered                                                                  
     nurse,  or a  physician  assistant" to  13.52.080(a)(5)                                                                    
     Immunities as a conforming change.                                                                                         
                                                                                                                                
     Sec. 10: Amends AS  13.52.100(c) Capacity by adding "an                                                                  
     advanced  practice  registered  nurse, or  a  physician                                                                    
     assistant" to  language regarding protocols and  how do                                                                    
     not  resuscitate  orders   govern  decisions  regarding                                                                    
     cardiopulmonary    resuscitation   and    other   life-                                                                    
     sustaining procedures.                                                                                                     
                                                                                                                                
     Sec. 11:  Amends AS 13.52.300  Optional Form  by adding                                                                  
     "an  advanced practice  registered nurse,  or physician                                                                    
     assistant" to the Advanced Health Care Directive Form.                                                                     
                                                                                                                              
     Sec. 12: Amends AS  13.52.390(12) Definitions by adding                                                                  
     "an  advanced practice  registered nurse,  or physician                                                                    
     assistant"  to language  defining  "do not  resuscitate                                                                    
     order."                                                                                                                    
                                                                                                                                
     Sec. 13: Amends AS  13.52.390(23) Definitions by adding                                                                  
     "an  advanced practice  registered nurse,  or physician                                                                    
     assistant"   to   language  defining   "life-sustaining                                                                    
     procedures."                                                                                                               
                                                                                                                              
     Sec.  14:  Adds a  new  paragraph  to AS  13.52.390(38)                                                                  
     defining  an "advanced  practice registered  nurse" and                                                                    
     "physician  assistant" by  referring to  the definition                                                                    
     in  AS 08.68  Nursing  and AS  08.64.107 Regulation  of                                                                    
     Physician  Assistants  and   Intensive  Care  Paramedic                                                                    
     respectively.                                                                                                              
                                                                                                                              
     Sec.  15: Amends  AS 18.15.230(c)  by adding  "advanced                                                                  
     practice registered nurse,  or the physician assistant"                                                                    
     to   the   instructions    for   completing   a   death                                                                    
     certificate.                                                                                                               
                                                                                                                                
1:43:31 PM                                                                                                                    
CHAIR WILSON turned to invited testimony.                                                                                       
                                                                                                                                
1:44:04 PM                                                                                                                    
CHRISTINE KRAMER,  DNP and APRN, Anchorage,  Alaska, testified by                                                               
invitation on  HB 392.  She stated that  she has  been practicing                                                               
for  23   years,  primarily  in   hospitals.  She   reviewed  her                                                               
credentials and specific work history  and advised that she would                                                               
talk  from perspective  of an  APRN about  how this  bill impacts                                                               
practice. She recounted that when  a patient is admitted from the                                                               
emergency  department,  their  code  status  must  be  determined                                                               
through discussion  with the  patient and  their family.  This is                                                               
documented  in the  admission  notes and  orders  are written  to                                                               
reflect  those  wishes.  The  NP  is  an  integral  part  of  the                                                               
treatment team  throughout the patient's hospitalization.  If the                                                               
patient passes, that  is documented in the death  summary. The NP                                                               
provides  all  this  documentation  but  cannot  sign  the  death                                                               
certificate. Under the current process  a physician must sign the                                                               
death certificate even  though they may not be  familiar with the                                                               
patient care  and case, and  this may  delay the signing.  HB 392                                                               
changes this  practice and would allow  the NP to sign  the death                                                               
certificate.  She  offered  her professional  opinion  that  this                                                               
legislation would  improve care  for patients who  are critically                                                               
ill and facing end-of-life issues.                                                                                              
                                                                                                                                
1:46:59 PM                                                                                                                    
SENATOR   COSTELLO  referenced   Section   5   and  offered   her                                                               
understanding that an Alaskan can sign  a DNR form and have it on                                                               
file in anticipation of needing  it someday. She asked Dr. Kramer                                                               
to comment.                                                                                                                     
                                                                                                                                
DR. KRAMER  said that's correct,  but what frequently  happens is                                                               
that  family members  are aware  of the  document but  don't know                                                               
where  it is  filed. If  the document  is on  file at  Providence                                                               
Hospital  she can  look it  up, but  frequently that  is not  the                                                               
case.                                                                                                                           
                                                                                                                                
CHAIR WILSON  said he didn't  believe she tailored her  answer to                                                               
Section 5.                                                                                                                      
                                                                                                                                
1:48:58 PM                                                                                                                    
SENATOR COSTELLO said  her reading is that the DNR  may have been                                                               
written and  signed in  advance or  the parent  or guardian  of a                                                               
minor can  make the decision when  the need arises. It  also says                                                               
the nurse or  physician shall document the grounds  for the order                                                               
in the patient's medical file.                                                                                                  
                                                                                                                                
DR. KRAMER  asked if  she was talking  about the  amendment [that                                                               
passed on the House floor].                                                                                                     
                                                                                                                                
SENATOR COSTELLO  said yes.  She added that  she knows  DNR forms                                                               
can be filled  out in advance, she just wanted  it on the record.                                                               
She called it prior consent.                                                                                                    
                                                                                                                                
DR. KRAMER  offered her perspective  that requiring a  patient to                                                               
sign their consent  to their DNR status when  they're just coming                                                               
from the  emergency department could  be difficult  to impossible                                                               
depending on the patient's condition.                                                                                           
                                                                                                                                
1:52:08 PM                                                                                                                    
CHAIR  WILSON asked  if she  understood that  the discussion  was                                                               
about an amendment that passed on the House floor.                                                                              
                                                                                                                                
DR. KRAMER answered yes.                                                                                                        
                                                                                                                                
REPRESENTATIVE SNYDER said a concern  that she has with the floor                                                               
amendment is that a  spouse may not be able to  decide on what to                                                               
do with a  DNR if the patient doesn't have  paperwork on file and                                                               
is suddenly  incapacitated. The  other concern is  what to  do in                                                               
situations where  it is  not possible  to obtain  written consent                                                               
from the patient.                                                                                                               
                                                                                                                                
1:54:23 PM                                                                                                                    
DR.  KRAMER said  she didn't  believe the  floor amendment  would                                                               
prevent  a spouse  from signing  a DNR  on the  patient's behalf.                                                               
Alaska  statutes make  the  spouse the  decision  maker in  those                                                               
situations, but they would have to  be present at the hospital to                                                               
sign the paperwork.                                                                                                             
                                                                                                                                
SENATOR HUGHES  asked if she  agreed that  the part of  Section 5                                                               
that requires  written consent  was a  bit redundant  because the                                                               
forms are by either the patient or the family.                                                                                  
                                                                                                                                
1:56:54 PM                                                                                                                    
DR. KRAMER agreed it was  redundant. She also emphasized that the                                                               
utmost  attention  is given  to  the  patient's wishes  when  DNR                                                               
orders are made and no decision  is made without consent from the                                                               
patient or the family.                                                                                                          
                                                                                                                                
SENATOR  HUGHES asked  if it's  been  a problem  that DNR  orders                                                               
aren't  defined  in  AS  13.52.065.  She  said  she'd  also  like                                                               
clarification on  the record regarding  what the  sponsor brought                                                               
up  about a  person's ability  to make  a DNR  decision if  their                                                               
spouse is unable to do so.                                                                                                      
                                                                                                                                
1:59:19 PM                                                                                                                    
REPRESENTATIVE SNYDER  asked Senator Hughes  if she had  seen the                                                               
definition  for "do  not resuscitate  order" in  Section 12  that                                                               
starts on page 18. She noted  that there had been some discussion                                                               
about adding  the word "surrogate"  to the language in  Section 5                                                               
about those who  have the ability to make a  decision about a DNR                                                               
order when the patient is unable to do so.                                                                                      
                                                                                                                                
SENATOR  HUGHES offered  her perspective  that the  definition in                                                               
Section  12 makes  it sound  as though  the health  care provider                                                               
could issue a  DNR order without advanced  consent. She suggested                                                               
that should  be clarified  and she would  speak with  the sponsor                                                               
offline  about whether  that was  a discussion  to have  with the                                                               
drafter.                                                                                                                        
                                                                                                                                
REPRESENTAIVE  SNYDER  said  there  are  good  reasons  that  the                                                               
language in  statute isn't  as specific  as the  requirements and                                                               
policies  at  the  health provider  level  where  signatures  are                                                               
required.  She  added  that  Ms. Salanguit  would  reach  out  to                                                               
Senator Hughes  about whether  it was  appropriate to  speak with                                                               
the drafter about this.                                                                                                         
                                                                                                                                
2:03:23 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
2:04:10 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
SENATOR  HUGHES  asked  if  there   was  any  situation  where  a                                                               
physician,  and potentially  PAs and  nurse practitioners,  would                                                               
issue a DNR order without patient or family consent.                                                                            
                                                                                                                                
2:04:46 PM                                                                                                                    
DR.  KRAMER answered  yes, but  it  is highly  unusual. It  might                                                               
happen  when an  individual is  gravely  ill and  all efforts  to                                                               
locate the  family have been unsuccessful.  In that circumstance,                                                               
two  physicians look  at the  situation, perhaps  in consultation                                                               
with the Ethics Committee, consider  the care options, and make a                                                               
DNR  judgement call.  She then  reiterated her  concern with  the                                                               
change  in  Section   5  that  resulted  from   the  House  floor                                                               
amendment.                                                                                                                      
                                                                                                                                
2:06:55 PM                                                                                                                    
CHAIR  WILSON  clarified that  Dr.  Kramer  was talking  about  a                                                               
change made  to Section 5  when the bill  was in the  other body.                                                               
This committee was not considering an amendment.                                                                                
                                                                                                                                
2:07:14 PM                                                                                                                    
CHRISTOPHER  DITTERICH, PA,  Past  President,  Alaska Academy  of                                                               
Physician  Assistants,  Palmer,  Alaska,  stated that  he  was  a                                                               
practicing  PA  with  Orion  Behavioral   Health  Network  and  a                                                               
behavioral  health and  primary care  services provider  with the                                                               
Department  of  Corrections.  He  stated that  NPs  and  PAs  are                                                               
integrative  leaders in  patient care  teams  who are  in a  good                                                               
position  and well  able to  provide end  of life  care decisions                                                               
with patients  and their families.  He continued to say  that PAs                                                               
in  particular  are  medical   providers  who  diagnose  illness,                                                               
develop and  manage treatment  plans, prescribe  medications, and                                                               
often  serve as  the  patient's principal  health care  provider.                                                               
They   are  also   specifically   prepared   to  complete   death                                                               
certificates,  provide  life-sustaining treatment,  and  complete                                                               
the DNR orders with patients.                                                                                                   
                                                                                                                                
2:09:07 PM                                                                                                                    
CHAIR WILSON opened public testimony  on HB 392; finding none, he                                                               
closed public testimony.                                                                                                        
                                                                                                                                
2:09:29 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
2:11:54 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
2:11:59 PM                                                                                                                    
SENATOR BEGICH directed attention to  AS 13.52.065 related to the                                                               
do not resuscitate protocol and  AS 13.52.100 related to capacity                                                               
[to  make health  care decisions].  He said  it appears  that the                                                               
lingering issue  about responsible party could  be addressed with                                                               
a minor amendment to the capacity statute.                                                                                      
                                                                                                                                
2:12:33 PM                                                                                                                    
SENATOR HUGHES pointed out that  PAs fall under the State Medical                                                               
Board but APRNs  do not. According to the  current statute, APRNs                                                               
have to  comply with  the protocol  the department  developed and                                                               
the  State Medical  Board approved,  so  that would  be the  rule                                                               
regarding DNR  that APRNs would  have to follow in  the situation                                                               
where an individual either has no family or none can be located.                                                                
                                                                                                                                
SENATOR BEGICH relayed  that Senator Hughes was  describing AS 13                                                               
52 065(d).                                                                                                                      
                                                                                                                                
2:13:43 PM                                                                                                                    
CHAIR WILSON, finding  no further questions or  comments, held HB
392 in committee.                                                                                                               
                                                                                                                                
2:14:08 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
            SB 191-REPEAL COVID 19 DISASTER EMERGENCY                                                                       
                                                                                                                                
2:15:52 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  announced   the                                                               
consideration of SENATE BILL NO.  191 "An Act repealing emergency                                                               
powers  of the  commissioner of  health and  social services  and                                                               
certain  provisions   related  to  the  response   to  the  novel                                                               
coronavirus disease; and providing for an effective date."                                                                      
                                                                                                                                
2:16:11 PM                                                                                                                    
SENATOR  LORA  REINBOLD,  speaking  as the  sponsor  of  SB  191,                                                               
introduced  the  legislation  by reading  the  following  sponsor                                                               
statement:                                                                                                                      
                                                                                                                                
     The  purpose  of SB  191  is  to repeal  the  emergency                                                                    
     powers of the commissioner  of the Department of Health                                                                    
     and  Social Services  related to  the  response to  the                                                                    
     novel  coronavirus. The  responsibility  lies with  the                                                                    
     Governor,  nowhere  in  the   state  or  United  States                                                                    
     Constitution does it allow for  this transfer of power.                                                                    
     Separation  of Powers  is vital  to the  fabric of  our                                                                    
     country and  state, repealing  the emergency  powers of                                                                    
     the commissioner restores the delicate balance.                                                                            
                                                                                                                                
SENATOR  REINBOLD directed  attention to  the sectional  analysis                                                               
for SB 191 and then discussed the  reasons she feels SB 191 is so                                                               
important. The sectional analysis read as follows:                                                                              
                                                                                                                                
     Section  One: Sections  4,9,10,13-16, 20,  and 21  (b)-                                                                  
     (e), Ch. 2, SLA 2021, are repealed.                                                                                        
     Section Two:  This Act  takes effect  immediately under                                                                  
     AS 01.10.070 (c)                                                                                                           
                                                                                                                                
SENATOR  REINBOLD  relayed  her  belief  that  it  was  extremely                                                               
important for either the Department  of Law or the administration                                                               
to tell Alaskans what the  difference is between an emergency and                                                               
a  disaster  declaration.  She  highlighted  that  the  emergency                                                               
Governor Dunleavy  declared in  March 2020  that was  supposed to                                                               
last just 30  days was still in effect, and  that power regarding                                                               
this emergency  had been ceded  to Commissioner Crum.  She called                                                               
this a  massive abuse of  power. She  referenced SB 144  that she                                                               
introduced  to   embolden  the  Legislative  Branch   to  address                                                               
emergencies  and mentioned  the  vaccination bill  of rights  put                                                               
forward in SB 156 that was related to SB 191.                                                                                   
                                                                                                                                
2:21:55 PM                                                                                                                    
SENATOR REINBOLD  stated that  on December 20,  2021 she  wrote a                                                               
letter  under   the  Freedom  of   Information  Act   asking  the                                                               
administration to provide  answers to issues, and  she would like                                                               
those  to be  part of  the record  to explain  why SB  191 is  so                                                               
important. She described the issues as follows:                                                                                 
                                                                                                                                
   1. Provide all  clinical  evidence of  the  isolated  COVID-19                                                               
     virus and know  variants and where they  had been identified                                                               
     and  isolated. This  is to  justify the  emergency. Question                                                               
     number 11, in particular, is a really good one.                                                                            
   2. Provide all   clinical  evidence   that  masks   have  been                                                               
     successful in  preventing the spread of  COVID-19, and which                                                               
     ones worked the best.                                                                                                      
   3. Provide  all  available   clinical  evidence   that  social                                                               
     distancing  has been  effective  at stopping  the spread  of                                                               
     COVID-19.                                                                                                                  
   4. Provide all clinical evidence that COVID-19 vaccines are in                                                               
     fact  true  traditional  vaccines   and  that  they  provide                                                               
     immunity, not just mRNA therapy technology.                                                                                
   5. Provide all clinical  evidence that  COVID-19 vaccines  are                                                               
     effective at  preventing COVID-19  infection and  which have                                                               
     been proven to be the most effective.                                                                                      
   6. Provide all clinical  evidence that  COVID-19 vaccines  are                                                               
     effective in  preventing the spread and  which vaccines have                                                               
     been  proven  to  be  the   most  effective,  including  the                                                               
     clinical data.                                                                                                             
   7. Provide all clinical evidence  that COVID-19  vaccines have                                                               
     proven to  be safe for  human use, backed by  clinical data.                                                               
     Please  show the  adverse events/deaths  that have  followed                                                               
     with the  use of  these vaccines and  which have  been least                                                               
     safe according to all available clinical evidence.                                                                         
   8. Provide a list of the ingredients in the COVID-19 vaccines,                                                               
     broken out be manufacturer.                                                                                                
 9. Provide  information   regarding   known   adverse   events                                                                 
     regarding the COVID-19 vaccine.                                                                                            
 10. Provide all evidence that pertains to COVID-19 vaccines in                                                                 
    the US that each is fully FDA approved for broad use.                                                                       
 11. Provide all clinical evidence that an emergency exists to                                                                  
    justify the emergency use of the products.                                                                                  
 12. Provide the clinical information on the batches or lots of                                                                 
    vaccine may carry the mRNA technology - either the RNA or                                                                   
    the DNA, and any basic thing that could happen to that.                                                                     
    13. Provide all clinical documentation for the long-term                                                                    
    effects, including the side effects of the mRNA vaccinations                                                                
    in COVID-19.                                                                                                                
                                                                                                                                
SENATOR  REINBOLD  stated  that  the  response  to  the  forgoing                                                               
questions  could  be described  as  non-answers.  She found  this                                                               
unacceptable  because  Alaskans  have   the  right  to  know  the                                                               
answers. In conclusion  she noted the zero fiscal  note and urged                                                               
the governor  to answer the  questions and lift  this unnecessary                                                               
emergency order.                                                                                                                
                                                                                                                                
SENATOR  COSTELLO said  she shares  the concern  that power  that                                                               
should reside  with the governor  has been ceded to  an unelected                                                               
official.  She asked  when Commissioner  Crum's emergency  powers                                                               
would end if SB 191 did not pass.                                                                                               
                                                                                                                                
2:31:06 PM                                                                                                                    
SENATOR  REINBOLD  answered  that   the  bill  has  an  immediate                                                               
effective date,  but Commissioner Crum  has the power to  end the                                                               
emergency right  now. She has  requested an end to  the emergency                                                               
declaration repeatedly but to no  avail. She understands that one                                                               
reason is  related to  the enhanced SNAP  benefits and  she views                                                               
that as an  abuse of power. Her belief is  that more people would                                                               
return to work if benefits such as these were not available.                                                                    
                                                                                                                                
2:32:45 PM                                                                                                                    
SENATOR  HUGHES  referenced a  bill  that  passed that  says  the                                                               
commissioner's authority  would expire either when  the executive                                                               
branch  says the  emergency  is  ending or  when  the Center  for                                                               
Disease Control  (CDC) says  the emergency  is over.  The federal                                                               
emergency currently is under a  90-day extension that will end in                                                               
mid-July.  She acknowledged  that the  bill did  designate narrow                                                               
authority  to the  commissioner.  The  department could:  provide                                                               
public  health  services  to  mitigate  the  emergency,  maintain                                                               
federal benefits for SNAP and  congregate sheltering, and procure                                                               
and allocate medications related to the public health emergency.                                                                
                                                                                                                                
2:35:14 PM                                                                                                                    
SENATOR BEGICH asked, since this  is in uncodified law, would the                                                               
question be moot as of June  30 when the Department of Health and                                                               
Social Services  ceases to  exist. He also  asked the  sponsor to                                                               
post the letter to DR. Zink on  BASIS so it would be available to                                                               
the public.                                                                                                                     
                                                                                                                                
SENATOR  BEGICH said  his concern  with SB  191 is  that it  goes                                                               
beyond  the  commissioner's   power.  He  specifically  described                                                               
Sections 9, and 10, ch. 2, SLA 2021 that would be repealed:                                                                     
                                                                                                                                
   • Section 9 relates to legislation from Senator Costello                                                                     
     currently under consideration in the House relating to                                                                     
     charitable online gaming. He said he'd be reluctant to take                                                                
     away the ability for that to continue.                                                                                     
                                                                                                                                
   • Section 10 relating to school operating funds was removed                                                                  
     from  SB 111  to  ensure  a repeal  date  of  June 30,  2025                                                               
     because of  the federal funding  to the state for  COVID and                                                               
     the American Rescue  Plan Act (ARPA). The  intention was for                                                               
     schools to have the ability to absorb that money.                                                                          
                                                                                                                                
SENATOR BEGICH and  asked the sponsor why Sections 9  and 10 were                                                               
included in  SB 191. Both are  issues of public policy  that have                                                               
not been  settled, which  could cause  great hardship  for school                                                               
districts and charitable businesses that are operating online.                                                                  
                                                                                                                                
2:39:23 PM                                                                                                                    
SENATOR REINBOLD said she would like  both her letter to Dr. Zink                                                               
and  the  administration's response  to  be  part of  the  public                                                               
record.                                                                                                                         
                                                                                                                                
SENATOR BEGICH  clarified that he  requested the letter  from Dr.                                                               
Zink,   the  sponsor's   letter,  and   the  response   from  the                                                               
administration to be posted on BASIS.                                                                                           
                                                                                                                                
SENATOR REINBOLD read the February  8, 2022 memorandum from Megan                                                               
A. Wallace, Legal Services director:                                                                                            
                                                                                                                                
     Attached is  the draft bill you  requested, relating to                                                                    
     the  repeal of  ch. 2,  SLA 2021  (HB 76).  Please note                                                                    
     that  some sections  were  not  repealed, because  they                                                                    
     have  already been  repealed. More  specifically, under                                                                    
     sec. 21,  ch. 2, SLA  2021, secs. 1    3, 5, 7,  8, 11,                                                                    
     and  17  were repealed  on  April  30, 2021,  when  the                                                                    
     governor  declared  that  the  public  health  disaster                                                                    
     emergency  no longer  existed. I  also  did not  repeal                                                                    
     sec. 6,  because the  final report  was due  under that                                                                    
     section  no  later than  January  31,  2022, which  has                                                                    
     already  passed.  Please  note  that  considering  your                                                                    
     request  to  repeal  the  Act   in  its  "entirety,"  I                                                                    
     repealed  sec. 12,  which is  a section  preventing the                                                                    
     governor  from using  the  revised program  legislative                                                                    
     (RPL)  process to  increase an  appropriation item  for                                                                    
     the  fiscal  years  ending  June  30,  2021,  based  on                                                                    
     certain  additional federal  receipts. If  you did  not                                                                    
     intend to repeal that restriction,  please let me know.                                                                    
     Finally,  secs. 18  and 19  were not  repealed, because                                                                    
     they created  new repeal  dates for  ch. 10,  SLA 2020,                                                                    
     which have already passed.                                                                                                 
                                                                                                                                
2:41:30 PM                                                                                                                    
SENATOR BEGICH said  he was asking specifically  about Sections 9                                                               
and 10, which the memo did not mention.                                                                                         
                                                                                                                                
SENATOR REINBOLD provided the following response:                                                                               
                                                                                                                                
     If we have  another piece of legislation  in play right                                                                    
     now, it  would probably  be wise to  just go  ahead and                                                                    
     move forward  and not  keep the  whole state  under, in                                                                    
     some people's  opinion, oppression. If we  just need to                                                                    
     just deal with  gaming, let's deal with  gaming. But we                                                                    
     don't  need  to  keep everybody  in  this  unnecessary,                                                                    
     constant over two year state  of emergency. Also we can                                                                    
     do gaming. To me that doesn't make sense.                                                                                  
                                                                                                                                
2:43:57 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 191.                                                                                 
                                                                                                                                
2:44:19 PM                                                                                                                    
CINDY FULLER, representing self,  Juneau, Alaska, said the COVID-                                                               
19  mitigations that  are  being  done to  people  need to  stop.                                                               
There  have been  hundreds of  kids  that haven't  been in  class                                                               
because they weren't  masked. She asked the committee  to pass SB
191 so  people can  get on  with their lives  and money  could be                                                               
spent on more important things.                                                                                                 
                                                                                                                                
2:46:02 PM                                                                                                                    
RICH  ANDERSON,  representing  self,  Juneau,  Alaska,  described                                                               
traveling throughout the US last  year and finding the conditions                                                               
close to normal,  but not in Juneau. He opined  that the pandemic                                                               
will  be over  when people  decide it's  over. As  an issue  it's                                                               
becoming less  relevant. He said it's  time for people to  get on                                                               
with  their lives  because the  fallout could  be worse  than the                                                               
pandemic.  People have  anxiety  disorders that  "weren't on  the                                                               
map"  pre COVID.  He  urged  the committee  to  help people  move                                                               
forward.  He  also  voiced  concern   that  power  was  given  to                                                               
nonelected people because the public  didn't have a say and can't                                                               
vote them from office.                                                                                                          
                                                                                                                                
2:49:46 PM                                                                                                                    
ELIZE GAVITT, representing self,  Juneau, Alaska, stated that she                                                               
supports  SB 191  because the  mandates are  ruining society  and                                                               
traumatizing children. People should trust their immune system.                                                                 
                                                                                                                                
2:50:20 PM                                                                                                                    
LISA WARD, representing self, Juneau,  Alaska, stated support for                                                               
SB 191. She  asked when in history an emergency  lasted two years                                                               
and emphasized that it was time to move forward.                                                                                
                                                                                                                                
2:51:06 PM                                                                                                                    
CHAIR WILSON closed public testimony on SB 191.                                                                                 
                                                                                                                                
SENATOR COSTELLO referenced an earlier  question about what would                                                               
happen  to the  more than  800  charities that  are permitted  to                                                               
conduct online  gaming to  support things  like youth  sports and                                                               
other  activities. She  explained that  the online  portion would                                                               
end June 30 unless SB 201 were to pass.                                                                                         
                                                                                                                                
SENATOR BEGICH clarified  that Section 10 does  not have anything                                                               
to do with  spending money for masks for students.  It's about an                                                               
issue that's been debated for  years about whether to give school                                                               
districts flexibility on their fund  balances. That provision was                                                               
removed from  SB 111,  and if  SB 191 were  to pass  as currently                                                               
drafted, it  would not be  possible to address that  fund balance                                                               
issue. That is the reason for his concern about SB 191.                                                                         
                                                                                                                                
2:52:47 PM                                                                                                                    
SENATOR REINBOLD  said she  would be happy  to work  with Senator                                                               
Begich  and Senator  Costello to  resolve the  issues related  to                                                               
school operating funds and online gaming.                                                                                       
                                                                                                                                
SENATOR HUGHES  said she too  was concerned that SB  191 included                                                               
Section  10, ch.  2,  SLA 2021.  She continued  to  say that  she                                                               
appreciates the  sponsor's efforts, but wonders  if Mayor Bronson                                                               
was relying on  the federal COVID funding to develop  a long term                                                               
strategy  to address  shelter  for the  homeless.  She asked  the                                                               
sponsor if she had been in conversations with Mayor Bronson.                                                                    
                                                                                                                                
SENATOR REINBOLD answered  that she had spoken  to Mayor Bronson,                                                               
but on a  different topic. She said the  disaster declaration has                                                               
created a  disaster that  the state may  never recover  from, and                                                               
the entire state should not have to be in a state of emergency                                                                  
to deal with the homeless issue, as important as it is.                                                                         
                                                                                                                                
2:56:43 PM                                                                                                                    
CHAIR WILSON reviewed the questions the committee posed that                                                                    
require follow up.                                                                                                              
                                                                                                                                
2:57:40 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
2:57:54 PM                                                                                                                    
CHAIR WILSON reconvened the meeting and reviewed the committee                                                                  
schedule.                                                                                                                       
                                                                                                                                
CHAIR WILSON held SB 191 in committee.                                                                                          
                                                                                                                                
2:58:35 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Standing Committee meeting at 2:58 p.m.                                                                                         

Document Name Date/Time Subjects
SB 191 FN Various 4.29.22.pdf SHSS 5/3/2022 1:30:00 PM
SB 191
SB 191 Sectional 2.28.22.pdf SHSS 5/3/2022 1:30:00 PM
SB 191
SB 191 Sponsor Statement 2.21.22.pdf SHSS 5/3/2022 1:30:00 PM
SB 191
SB 191 Repeal Comm Powers.PDF SHSS 5/3/2022 1:30:00 PM
SB 191
7. HB 392 Research - POLST Signature Requirement by state 3.28.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
8. HB 392 Research - APRN Practice Maps 3.28.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
9. HB 392 LOS since 4.10.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
10. HB 392 Supporting Docs - Adding Physician Assistant 3.28.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
11. HB 392 FN 1 - DOH.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
13. HB 392 version A.PDF SHSS 5/3/2022 1:30:00 PM
HB 392
HB 392 Explanation of Changes ver. C 5.2.2022.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
HB 392 FN 2 - DCCED.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
HB 392 Sectional Analysis ver. C 5.2.2022.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
HB 392 Sponsor Statement ver. C 5.2.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
1. HB 392 version B.PDF SHSS 5/3/2022 1:30:00 PM
HB 392
HB 392 vers. C.PDF SHSS 5/3/2022 1:30:00 PM
HB 392
2. HB 392 Sponsor Statement ver. B 4.19.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
3. HB 392 Sectional Analysis version B 4.19.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
4. HB 392 Summary of Changes ver. A to ver. B.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
5. HB 392 Research - One Pager, 3.28.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
6. HB 392 Research - POLST FAQ 3.28.22.pdf SHSS 5/3/2022 1:30:00 PM
HB 392
SB 191 Dr. Zink Letter Dec. 2021.pdf SHSS 5/3/2022 1:30:00 PM
SB 191
SB 191 Leg Legal opinion Feb 8, 2022 Emergency Powers Repeal.pdf SHSS 5/3/2022 1:30:00 PM
SB 191
SB 191 Senator Reinbold COVID letter response (2-1-21).pdf SHSS 5/3/2022 1:30:00 PM
SB 191