Legislature(1993 - 1994)

04/05/1993 09:20 AM Senate STA

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
  SENATOR LEMAN introduced  SB 145 (POSITION OF  STATE MEDICAL                 
  EXAMINER) as the next order of business.                                     
  BETTY  HARGRAVE,  staff to  the  Senate Health,  Education &                 
  Social Services Committee, read into  the record a statement                 
  by the committee chair, Senator Steve Rieger.                                
  Currently,   a  coroner   determines  whether   post  mortem                 
  examinations  are  necessary,  physicians  conduct the  post                 
  mortem examinations under a fee for service arrangement, and                 
  the Department  of Health and  Social Services pays  for the                 
  exams and associated costs.                                                  
  SB 145 creates a  new position of state medical  examiner in                 
  the  Department of Health and  Social Services.  It provides                 
  that coroners may request the  state medical examiner, under                 
  regulations to be adopted by  the department, to conduct  an                 
  external and/or internal examination of the body and to take                 
  other appropriate actions  to determine  the cause of  death                 
  and to certify it.                                                           
  It is the  expectation of the  Senate HESS Committee that  a                 
  state  medical examiner  will be  able  to reduce  the total                 
  number  of  post  mortem  exams   performed  by  eliminating                 
  unnecessary exams.                                                           
  Number 225                                                                   
  SENATOR LEMAN asked  if there was any  existing procedure to                 
  restrict  the  number of  post mortem  exams.   MS. HARGRAVE                 
  answered  that at  this  time, the  court system  orders the                 
  autopsy and the Department of Health and Social Services has                 
  no choice as to whether or not they perform it.                              
  Number 245                                                                   
  DR. PETER  NAKAMURA, Director,  Division  of Public  Health,                 
  Department of Health and Social Services, explained that for                 
  any determination of death, perhaps related  to a crime or a                 
  public  health  medical  issue,  the  program   allows  that                 
  determination to be made.  Without this service, many crimes                 
  and  many  public  health issues  would  go  unaddressed and                 
  unidentified.  He said they have a good system in place  for                 
  making these  determinations.    However,  the  monies  made                 
  available to support  this program have been  inadequate for                 
  the  past  eight  years.    It  is  projected  that  without                 
  additional  resources they could  experience a  shortfall of                 
  $250,000 this year.                                                          
  The department's response to the absence of adequate funding                 
  to run the program is to  try to control these expenditures.                 
  They feel that by having a  medical examiner system in place                 
  they  would  have   the  opportunity  to  have   the  fiscal                 
  responsibility in  the same location  as the  responsibility                 
  for  determining  who  should and  who  should  not  have an                 
  autopsy performed.                                                           
  Dr.  Nakamura related  that  the State  of Alaska  ranks the                 
  highest in the percentage of death  autopsies.  Part of this                 
  is  explained  by the  higher  number of  deaths  that occur                 
  outside of hospitals.   However, even with  that adjustment,                 
  Alaska  is  still  third  in  the  nation in  terms  of  the                 
  frequency of examinations.                                                   
  Dr.  Nakamura  noted that  the  bill  calls for  a  licensed                 
  physician,  but  he  stressed  the  importance of  having  a                 
  licensed forensic pathologist.                                               
  Number 355                                                                   
  SENATOR TAYLOR asked if there was a definition to the phrase                 
  "cause of death."   AL ZANGRI,  Bureau of Vital  Statistics,                 
  Department  of Health and  Social Services,  responded there                 
  are two issues when a death occurs.  The first is the manner                 
  of death and  that is a  legal determination that  addresses                 
  the question and  the coroner is responsible  for answering.                 
  The second issue is the cause of death and that is a medical                 
  question.  The problem that the system has right now is that                 
  there is  nobody internal  to the  system that  is medically                 
  qualified  to  make cause  of  death determinations  and the                 
  department has to contract out for all cause of death.                       
  Number 460                                                                   
  SENATOR TAYLOR commented  that he  is in favor  of the  bill                 
  because he wants  a system that works more  efficiently than                 
  the current system, but he is concerned that there will only                 
  be one medical  examiner and that medical  examiner is going                 
  to have  to  rely heavily  upon  somebody at  another  site,                 
  otherwise  they  will have  to  continue shipping  bodies to                 
  other  locations  to  determine the  cause  of  death.   DR.                 
  NAKAMURA said they will still  have contractual arrangements                 
  with the medical  forensic pathologists  in the  state.   By                 
  having an individual  who is  responsible for this  program,                 
  their  hopes are that there will be enough communication and                 
  enough  control  of  the  program  so  that  those  forensic                 
  pathologists  under contract  will be  working very  closely                 
  with the state medical examiner system.                                      
  Number 485                                                                   
  ART SNOWDEN, Administrative  Director, Alaska Court  System,                 
  stated the court system's support for SB 145.                                
  Mr. Snowden said there are a  number of magistrates in rural                 
  Alaska  that  are  charged  under  present  law  with  being                 
  coroners and that there must be a cause of death stated.  So                 
  there is  someone who  is completely  untrained in  medicine                 
  trying  to  make  a determination  on  the  cause  of death.                 
  Because  magistrates  are  not  capable  of  giving  medical                 
  diagnosis  on  unattended  deaths,  the court  system  seeks                 
  autopsies which creates tremendous problems in rural Alaska.                 
  Mr. Snowden pointed  out that approximately 35  to 40 states                 
  have  medical examiner types  of organization.   He  said he                 
  believes that Alaska should go to a medical examiner  system                 
  because the judicial  branch of government is  not qualified                 
  to make those medical determinations.                                        
  Mr. Snowden said  the bill will help save money  and that it                 
  will still take  care of the public safety  requirements and                 
  the prosecution requirements.                                                
  Number 535                                                                   
  SENATOR LEMAN  questioned if there really would be a savings                 
  with  this  new system.   ART  SNOWDEN  answered that  it is                 
  projected that there will be over  a $100,000 savings a year                 
  and that the savings may increase as time goes on.                           
  DR. NAKAMURA added  that part of the medical examiner system                 
  will be  the responsibility to  train not only  those within                 
  the present coroner system but physicians in  rural areas to                 
  better be able to respond to these things in a way that they                 
  can short circuit some of these referrals for autopsies.  By                 
  having a  medical examiner in  the state system,  they would                 
  have the ability  to liaison and  coordinate with the  other                 
  practitioners and other health care systems in the state.                    
  Number 570                                                                   
  DR.  DON  ROGERS,  a  forensic  pathologist  testifying from                 
  Anchorage via  the teleconference  network, related  that he                 
  has been  practicing forensic pathology in the state for the                 
  past  26 years and that  he is one  of three board certified                 
  forensic pathologists in the State of Alaska.                                
  Dr. Rogers stated his opposition to SB 145, saying he thinks                 
  it sets up  another layer of  bureaucracy and will not  help                 
  anything.  He said the fastest  way to get a cause of  death                 
  now is to do it the way they are doing it now.                               
  TAPE 93-25, SIDE B                                                           
  Number 015                                                                   
  Dr. Rogers said he thinks that  Alaska's high ranking in the                 
  number of autopsies  that are performed  is good because  he                 
  thinks Alaska is doing a better job than any other state.                    
  Dr. Rogers commented that he thinks that reductions in costs                 
  can  be made in the present system,  and the only savings he                 
  can  see in  this  bill is  possibly  in the  transportation                 
  Number 080                                                                   
  SENATOR  LEMAN  asked   Dr.  Rogers   if  he  had   specific                 
  suggestions on ways to save money within  the present system                 
  and if there would be any benefit to having  the services of                 
  the  forensic  pathologists  to be  under  the  court system                 
  rather  than  under  the  Department  of Health  and  Social                 
  Services.  DR.  ROGERS answered that  a couple of years  ago                 
  the court  system  shifted  the  burden of  payment  to  the                 
  Department  of Health and Social Services, and he thinks the                 
  payment function should be sent back to the court system and                 
  then everything would be in the court system.  He added that                 
  it wouldn't save money, but it would  streamline the system.                 
  He suggested that perhaps a fee structure could be developed                 
  for some kind of a limited autopsy.  ART SNOWDEN said he can                 
  see no  savings under the  court system.  They  are going to                 
  order these autopsies anyway because the regulations  demand                 
  that those  regulations are  in the  executive branch  where                 
  also the expertise is.                                                       
  Number 175                                                                   
  KEN BISHOFF, Director of Administrative Services, Department                 
  of Public  Safety, voiced  the department's  support for  SB
  145,  saying  they would  support  anything that  could help                 
  control   the  costs  because  the  department  is  directly                 
  impacted by doing more than 60 percent of those autopsies in                 
  their facilities.                                                            
  Mr. Bishoff urged  support of  the Governor's amendment  for                 
  the crime lab related to the impact from this work which has                 
  never been funded.  Because the Department of Public  Safety                 
  happens to have a crime lab that is fairly well equipped for                 
  this  purpose it  has  become the  major  facility in  state                 
  government in recent years for this  service to be provided.                 
  He noted  the competition for  the crime  lab's services  is                 
  tremendous in that  they did 10  autopsies in 1988 and  this                 
  year they expect to do 600 autopsies.                                        
  Number 207                                                                   
  DR. ROGERS commented that  they used to do the  autopsies in                 
  the  funeral  homes,  but  when the  crime  lab  was  built,                 
  somebody decided that they needed  to justify its existence,                 
  so the  crime lab  set the  policy  at the  beginning.   KEN                 
  BISHOFF responded that  if they were doing a  criminal case,                 
  the funeral parlors were not exactly  the best place to keep                 
  control over the evidence so that it would withstand holding                 
  up in  court.   ART SNOWDEN added  that he  did support  the                 
  crime lab and during all  the testimony on the crime  lab it                 
  was envisioned that autopsies would be done at the lab.                      
  ELMER  LINDSTROM, Special  Assistant  to Commissioner  Mala,                 
  Department  of  Health  and   Social  Services,  stated  the                 
  department supports the concerns and  the fiscal note of the                 
  Department of Public Safety.                                                 
  Number 285                                                                   
  There being no  further witnesses wishing  to testify on  SB
  145, SENATOR LEMAN  stated it would  be held over until  the                 
  Wednesday  meeting.  He then  adjourned the meeting at 10:30                 

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