Legislature(2005 - 2006)BUTROVICH 205

04/22/2005 08:30 AM JUDICIARY

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Heard & Held
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
            HB 85-PRESCRIBED MEDICATION FOR STUDENTS                                                                        
CHAIR RALPH SEEKINS announced HB 85 to be up for consideration.                                                                 
8:43:33 AM                                                                                                                    
REPRESENTATIVE KEVIN  MEYER introduced  HB 85, which  proposes to                                                               
allow children  to carry  their own  inhalers (commonly  known as                                                               
Epipen®).  Not having  their  medication  readily available  puts                                                               
children  at   risk.  Some  children  have   died  because  their                                                               
medication was in the school nurse's  office. HB 85 would allow a                                                               
parent or  guardian to sign  a release of liability  provided the                                                               
healthcare provider  submit a written consent  treatment plan and                                                               
certify that the child is capable  of using the medication. HB 85                                                               
would  qualify  Alaska for  federal  grants  under the  Asthmatic                                                               
Schoolchildren's Treatment Act of  2004. Thirty-seven states have                                                               
passed  similar   legislation.  It  protects  the   schools  from                                                               
liabilities and it would potentially reduce absences.                                                                           
8:46:17 AM                                                                                                                    
SENATOR GRETCHEN GUESS asked Representative  Meyer to explain why                                                               
pharmacist  is   listed  under   the  definition   of  healthcare                                                               
REPRESENTATIVE MEYER  explained the  reason is  pharmacists often                                                               
train children to use their inhalers.                                                                                           
8:49:03 AM                                                                                                                    
MR. MIKE  PAWLOWSKI, legislative aide,  reiterated Representative                                                               
Meyer's  assertion  that  pharmacists  are  the  ones  who  teach                                                               
children how  to use their  medication. The Department  of Public                                                               
Health (DPH) supports adding pharmacists.                                                                                       
SENATOR  GUESS  asserted HB  85  allows  pharmacists to  write  a                                                               
treatment plan.                                                                                                                 
CHAIR  SEEKINS said  he  would feel  more  comfortable if  backup                                                               
medicine was available in the school nurse's office.                                                                            
REPRESENTATIVE  MEYER advised  under HB  85 children  could still                                                               
leave backup medication with the nurse.                                                                                         
8:52:42 AM                                                                                                                    
REPRESENTATIVE  MEYER continued  families couldn't  always afford                                                               
two inhalers so he would be hesitant to require a backup.                                                                       
8:54:38 AM                                                                                                                    
Senator Gene Therriault joined the committee.                                                                                   
SENATOR CHARLIE  HUGGINS expressed concern over  children passing                                                               
their inhalers around.                                                                                                          
REPRESENTATIVE MEYER stated the school would not be liable.                                                                     
SENATOR HUGGINS  said he was  worried about children  causing the                                                               
death of other children by sharing inhalers.                                                                                    
REPRESENTATIVE  MEYER countered  inhalers wouldn't  kill a  child                                                               
although they might make someone hyperactive.                                                                                   
8:56:21 AM                                                                                                                    
SENATOR   HUGGINS  asked   the  definition   of  advanced   nurse                                                               
SENATOR  HOLLIS  FRENCH  advised   all  nurse  practitioners  are                                                               
advanced nurse practitioners.                                                                                                   
CHAIR  SEEKINS   agreed  and  stated  licensed   nurse  would  be                                                               
included. The difference  is a licensed nurse who is  not a nurse                                                               
practitioner would not be able to prescribe medications.                                                                        
SENATOR FRENCH asked Mr. Pawlowski to explain Epipen®.                                                                          
MR.  PAWLOWSKI  advised it  is  short  for epinephrine  injector,                                                               
which is a self-administered injection.                                                                                         
SENATOR  FRENCH asked  whether the  use  of epinephrine  inhalers                                                               
among schoolchildren was common.                                                                                                
8:58:47 AM                                                                                                                    
CHAIR SEEKINS replied yes. He  explained epinephrine is a form of                                                               
8:59:36 AM                                                                                                                    
SENATOR THERRIAULT  asked the recourse  if a child lets  a friend                                                               
take a dose of the medication.                                                                                                  
MR.  PAWLOWSKI replied  discipline according  to the  school code                                                               
would govern that situation.                                                                                                    
9:01:36 AM                                                                                                                    
SENATOR  THERRIAULT   asked  the  recourse  when   children  pass                                                               
inhalers around to get each other high.                                                                                         
MR. PAWLOWSKI responded  the debate occurred in the  House and it                                                               
was  decided  disciplinary  action   by  the  schools  should  be                                                               
CHAIR SEEKINS mentioned  a person can buy some  types of inhalers                                                               
over  the counter  and  there  is no  present  issue of  children                                                               
buying inhalers.  He asserted it  is serious when someone  has an                                                               
asthma attack.                                                                                                                  
9:03:35 AM                                                                                                                    
CHAIR SEEKINS  said his  only concern  was if  a student  were to                                                               
forget to bring their medication. He  prefers to have a backup in                                                               
place. He  read a  statement from  the Alaska  Nurses Association                                                               
that asked to  require a student to have an  extra inhaler stored                                                               
in the school nurse's office.                                                                                                   
MR.  PAWLOWSKI  commented  that  was included  in  Section  5.  A                                                               
healthcare  provider  could  include   that  stipulation  in  the                                                               
written treatment plan.                                                                                                         
SENATOR  FRENCH said  it  could  be included  in  the list  under                                                               
"doses of medications needed."                                                                                                  
9:05:27 AM                                                                                                                    
SENATOR GUESS advised  it would be beneficial to  keep the option                                                               
so as not  to mandate families to always have  two inhalers. Some                                                               
families may not be able to afford two inhalers.                                                                                
9:07:40 AM                                                                                                                    
CHAIR SEEKINS said it is not  his intent to put someone who can't                                                               
afford the  medication in risk  of violating the law.  However, a                                                               
serious case of asthma needs to be considered.                                                                                  
9:08:55 AM                                                                                                                    
MS. PATRICIA SENNER, nurse practitioner,  testified in support of                                                               
HB  85. She  maintained  school nurses  are  having trouble  with                                                               
managing inhalers. Children often forget  them or they run out of                                                               
medication.  She  suggested  to  stipulate under  Section  5  the                                                               
healthcare provider state what back up is needed.                                                                               
9:10:29 AM                                                                                                                    
MS.  SENNER advised  the committee  albuterol inhalers  run about                                                               
twenty dollars  while steroid inhalers  run close to  one hundred                                                               
dollars. She  expressed concern with children  carrying Epipens®,                                                               
however  school nurses  report  they have  not  had trouble  with                                                               
abuse, although there are instances  of sharing. The side effects                                                               
of albuterol are  minimal unless the person suffers  from a heart                                                               
condition.  The  Anchorage  school   districts  do  have  Epipen®                                                               
9:12:08 AM                                                                                                                    
MS. SENNER admitted  the Alaska Nurses Association  has a problem                                                               
with  the definition  of healthcare  provider.  The problem  with                                                               
adding pharmacists is they do  not have personal knowledge of the                                                               
child. She  suggested restricting  the description  of healthcare                                                               
provider  to  those people  who  legally  have the  authority  to                                                               
diagnose and treat.                                                                                                             
9:13:54 AM                                                                                                                    
MS. SENNER suggested leaving out licensed nurse and pharmacists.                                                                
SENATOR FRENCH  asked whether all  inhalers have the  same active                                                               
MS. SENNER  replied the  most common  are rescue  inhalers, which                                                               
contain albuterol. There are a variety of others.                                                                               
SENATOR  FRENCH  asked which  kind  would  work in  an  emergency                                                               
MS. SENNER stated albuterol.                                                                                                    
SENATOR  FRENCH  asked  the reason  children  bring  inhalers  to                                                               
MS. SENNER informed  albuterol is often taken four  times per day                                                               
and most other inhalers are twice a day medications.                                                                            
9:15:59 AM                                                                                                                    
SENATOR  FRENCH asked  what kind  of emergency  inhaler a  school                                                               
would select.                                                                                                                   
MS. SENNER affirmed it would be albuterol.                                                                                      
SENATOR  FRENCH  asked  the  danger  from  using  someone  else's                                                               
MS.  SENNER said  the main  thing would  be a  contagious disease                                                               
through the transfer of germs.                                                                                                  
SENATOR FRENCH  asked whether any  children have died  because of                                                               
asthma attacks.                                                                                                                 
MS. SENNER replied she is not aware of any.                                                                                     
9:17:33 AM                                                                                                                    
MS. STEPHANIE  BIRCH, chief  of the  women and  children's health                                                               
section, Division of Public Health  (DPH), offered support for HB
85 and also offered to answer questions.                                                                                        
MS. MARGE  LARSEN, American Lung Association  of Alaska testified                                                               
in  support.  She reminded  the  committee  not every  school  in                                                               
Alaska has  a school  nurse. The  intent of HB  85 is  for school                                                               
children have  access to  their medication.  Most people  who die                                                               
from asthma are  mild asthmatics who do not  manage their asthma.                                                               
Rescue  medication is  a necessary  and critical  part of  asthma                                                               
9:20:12 AM                                                                                                                    
SENATOR GUESS  asked the  procedure when a  school has  no school                                                               
MS.  LARSON  advised  the  medications   are  locked  up  in  the                                                               
principal's office.                                                                                                             
The  LIO connection  was lost  and so  Chair Seekins  announced a                                                               
brief recess at 9:22:08 AM.                                                                                                   
Chair Seekins reconvened the meeting at 9:42:27 AM.                                                                           
CHAIR SEEKINS proposed Amendment 1.                                                                                             
     Page 2, line 19 after the word "permitted to" insert                                                                       
     "personally" and following the word "nurse" insert "or                                                                     
     other school official".                                                                                                    
Hearing no objections the motion carried.                                                                                       
9:44:15 AM                                                                                                                    
CHAIR SEEKINS proposed Amendment 2.                                                                                             
     Page 2, line 25 state "in this section, healthcare provider                                                                
     means a person with prescriptive authority in this state."                                                                 
SENATOR GUESS objected  for the purpose of  discussion. She asked                                                               
whether a village health aide would fall under that definition.                                                                 
MS. BIRCH said  a village health aide  has delegated prescriptive                                                               
authority.  She suggested  adding  wording on  line  26 to  state                                                               
"within their  state regulations." This  would allow for  them to                                                               
practice within their occupational licensing regulations.                                                                       
CHAIR SEEKINS said a pharmacist  might be the person best capable                                                               
of showing the child how to use the inhaler device.                                                                             
9:49:48 AM                                                                                                                    
MR.  PAWLOWSKI  suggested  a  pharmacist   might  attempt  to  do                                                               
something outside their authority, such as write a prescription.                                                                
SENATOR  GUESS expressed  concern  the  definition of  healthcare                                                               
provider is being used as a catchall.                                                                                           
9:51:36 AM                                                                                                                    
CHAIR  SEEKINS withdrew  Amendment  2 and  proposed Amendment  3,                                                               
which  defines healthcare  provider.  Hearing  no objection,  the                                                               
motion carried.                                                                                                                 
9:52:32 AM                                                                                                                    
SENATOR  HUGGINS moved  Amendment 4,  which inserts  a permissive                                                               
requirement  that  medication  must  be kept  with  a  designated                                                               
school official. Hearing no objections, the motion carried.                                                                     
9:54:41 AM                                                                                                                    
SENATOR  GUESS inferred  the committee  should clarify  HB 85  in                                                               
regards to public versus private school.                                                                                        
MR. PAWLOWSKI  referred to  a legal memo  included in  the packet                                                               
dated April  6, 2005 from  legislative legal. There is  a concern                                                               
that the  word school is  not specific enough. It  is problematic                                                               
for the state  to require a private school to  do anything. It is                                                               
limited under  AS 14.45.100. The sponsor  suggested inserting the                                                               
word "public" to clarify.                                                                                                       
CHAIR SEEKINS moved Amendment 5, insert the word "public."                                                                      
SENATOR THERRIAULT objected for the purpose of discussion.                                                                      
9:57:47 AM                                                                                                                    
SENATOR GUESS  noted the drafter might  have had a reason  not to                                                               
specify public school.                                                                                                          
MR. PAWLOWSKI  admitted that was  true. The drafter  described it                                                               
as not expressly necessary.                                                                                                     
10:02:30 AM                                                                                                                   
SENATOR  THERRIAULT  suggested asking  the  drafters  for a  memo                                                               
clarifying the  intent that  HB 85  addresses public  schools and                                                               
not private schools.                                                                                                            
10:05:11 AM                                                                                                                   
CHAIR SEEKINS  announced he wanted  to be  on record that  it was                                                               
not his intent to force private schools to adhere to HB 85.                                                                     
10:06:38 AM                                                                                                                   
Amendment 5 was adopted.                                                                                                        
CHAIR  SEEKINS announced  the committee  would wait  for a  clean                                                               
version of the amended bill before going further.                                                                               

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