Legislature(2005 - 2006)BELTZ 211

02/24/2005 03:30 PM STATE AFFAIRS

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Heard & Held
Bills Previously Heard/Scheduled
Moved CSSB 104(STA) Out of Committee
Moved SB 95 Out of Committee
           SB  75-PUBLIC HEALTH DISASTERS/EMERGENCIES                                                                       
3:55:51 PM                                                                                                                    
CHAIR GENE THERRIAULT announced SB  75 to be up for consideration                                                               
and recognized Dr. Mandsager.                                                                                                   
3:55:56 PM                                                                                                                    
RICHARD  MANDSAGER,  M.D.,  director Division  of  Public  Health                                                               
stated he would  explain why SB 75 is  important, review problems                                                               
with current statutes, and briefly  review the bill. He noted the                                                               
PowerPoint handout in  the packets and said he would  use that to                                                               
introduce the bill.                                                                                                             
3:57:28 PM                                                                                                                    
Slide 2: A  quote from the Institute of  Medicine. "Public Health                                                               
is  what  we,  as  a  society,  do  collectively  to  assure  the                                                               
conditions in which people can be healthy."                                                                                     
SB 75 is  about the governmental side of public  health, he said.                                                               
One hundred  years ago, public  sewer and water systems  were the                                                               
most important  aspect of public  health and following WW  II the                                                               
concern  was  vaccinations   to  protection  against  preventable                                                               
diseases. In  the last 25 years  the focus has been  clean indoor                                                               
air  policies,  removing  lead   from  gasoline  and  paint,  and                                                               
removing DDT from pesticides.                                                                                                   
3:58:22 PM                                                                                                                    
Slide  3: Public  Health  is not  health care;  it's  a focus  on                                                               
populations  rather than  individuals  and  on prevention  rather                                                               
than  treatment.  Government  has  a   very  real  role  in  that                                                               
4:00:02 PM                                                                                                                    
Slide  4:  Division  of  Public  Health  core  services  include:                                                               
infectious  disease  control;  chronic  disease  control;  injury                                                               
prevention; response  to disasters;  access to quality  care; and                                                               
protection against environmental health hazards.                                                                                
4:00:24 PM                                                                                                                    
Slide  5:  Emergency preparedness  does  play  a larger  role  in                                                               
public  health  since   911,  but  the  more   ordinary  part  is                                                               
infectious disease.                                                                                                             
4:03:03 PM                                                                                                                    
Slide 6: Preparation weakness is  the reasoning for SB 75 because                                                               
legal authority is inadequate to  deal with public health threats                                                               
such as  Sudden Acute  Respiratory Syndrome  (SARS) or  Bird Flu.                                                               
Two thirds  of public health  funds are federal and  problems are                                                               
increasing as the federal government shifts its priorities.                                                                     
4:03:25 PM                                                                                                                    
Slides  7  and  8:  Old Public  Health  Enemies  and  Traditional                                                               
Disease Control. In the past  the public trusted government to do                                                               
the right thing but societal  expectations have changed over time                                                               
and   the  public   is   somewhat   suspicious  of   governmental                                                               
authorities and individual due process has become more an issue.                                                                
4:04:16 PM                                                                                                                    
Slide 9: The Next  SARS. The tools need to be  in place for quick                                                               
action to protect public health.                                                                                                
4:04:39 PM                                                                                                                    
Slide 10:  Alaska Public Health  Law Reform Proposal.  Except for                                                               
tuberculosis control  in 1995 and  SARS control in 2003,  most of                                                               
the current public health statutes date from Territorial days.                                                                  
4:05:33 PM                                                                                                                    
Slide 11:  The Proposed Solution  - updated laws that  provide: a                                                               
statutory  framework that  supports  the  public health  mission,                                                               
services and role;  clear authority for control  of conditions of                                                               
public health  importance; and modern due  process provisions for                                                               
the protection of individual rights.                                                                                            
4:06:20 PM                                                                                                                    
Slide 12: SB 75 is the result  of years of work and includes: the                                                               
definition of  essential public  health services;  description of                                                               
the state's  role in health protection  and promotion; provisions                                                               
for  clear authority  for disease  control through  surveillance;                                                               
epidemiologic  investigation  and medical  treatment;  quarantine                                                               
and  isolation; requires  protection  of  individual due  process                                                               
rights;  and  strengthens  requirements for  confidentiality  and                                                               
data security.                                                                                                                  
4:07:16 PM                                                                                                                    
Slide 13: Discusses the amendments to SB 75.                                                                                    
4:07:41 PM                                                                                                                    
Slide 14: Speaks to separate sections of SB 75                                                                                  
4:08:20 PM                                                                                                                    
Slide 15:  Tools are  needed to protect  public health,  but that                                                               
must be balanced with due process.                                                                                              
4:09:04 PM                                                                                                                    
Slide 16: The constitutional constraints  on public health powers                                                               
must  satisfy four  tests:  public  health necessity;  reasonable                                                               
means; proportionality; and harm avoidance.                                                                                     
4:10:01 PM                                                                                                                    
Slide 17:  Summarizes the limitations  SB 75 has  on governmental                                                               
powers. In  particular, "An  individual has  the right  to refuse                                                               
treatment  and  may not  be  required  to submit  to  involuntary                                                               
treatment (AS 18.15.380).                                                                                                       
4:10:44 PM                                                                                                                    
SENATOR WAGONER joined the hearing.                                                                                             
4:11:11 PM                                                                                                                    
Slide  18:  Lists  additional  governmental  limitations  in  the                                                               
balance  between individual  rights  and common  good. Point  two                                                               
says, "The  department shall isolate  or quarantine by  the least                                                               
restrictive means necessary to prevent  the spread of disease (AS                                                               
4:12:08 PM                                                                                                                    
Slide 19: Due process provisions  are listed. The government must                                                               
be able to  move quickly in cases of contagious  disease, but the                                                               
individual needs  a clear  set of rights  available if  they feel                                                               
they are treated unfairly.                                                                                                      
4:13:54 PM                                                                                                                    
Pursuant   to  conversations   regarding  further   limiting  the                                                               
government's  role,  two  amendments   are  proposed.  The  first                                                               
deletes a provision  to remove party status of  parents of minors                                                               
from  court  proceedings  when  quarantine/isolation  orders  are                                                               
contested   and  the   second  addresses   indirect  court   rule                                                               
4:14:31 PM                                                                                                                    
SENATOR HUGGINS asked for clarification.                                                                                        
4:14:38 PM                                                                                                                    
DR. MANDSAGER  suggested Mr.  Branch from  the Department  of Law                                                               
4:14:44 PM                                                                                                                    
Slide 20:  Evaluation by Trust  for America places Alaska  as the                                                               
only state in  the U.S. that doesn't have  statutory authority to                                                               
quarantine  and respond  to a  hypothetical bio-terrorism  attack                                                               
4:15:14 PM                                                                                                                    
CHAIR  THERRIAULT  referenced the  repealers  in  Section 12  and                                                               
asked for clarification.                                                                                                        
DR. MANDSAGER said  the repealers deal with  the tuberculosis and                                                               
SARS  statutes  for the  most  part  and  SB 75  generalizes  the                                                               
particular authorities and removes disease specific reference.                                                                  
CHAIR  THERRIAULT  referenced  the  findings  in  Section  1  and                                                               
remarked he routinely drops findings.  He noted there was nothing                                                               
compelling  in (a)  and little  more  in (b)  and questioned  the                                                               
necessity of including that section.                                                                                            
4:17:17 PM                                                                                                                    
DR. MANDSAGER responded  since it makes no difference  in the law                                                               
and because it  is a statement of intent, it  doesn't matter from                                                               
a legislative point.  However, what these people  do is important                                                               
and it does matter, he emphasized.                                                                                              
4:17:42 PM                                                                                                                    
CHAIR THERRIAULT  suggested reading a  letter of intent  into the                                                               
record and that he  would be happy to do so in  the debate on the                                                               
Senate floor.                                                                                                                   
4:18:05 PM                                                                                                                    
CHAIR  THERRIAULT asked  Senator  Elton whether  he had  separate                                                               
legislation to address proposed amendment 1.                                                                                    
SENATOR KIM ELTON replied he would  like to return to the comment                                                               
made  regarding page  2, line  8-10 to  ask whether  it might  be                                                               
appropriate to keep that subsection.                                                                                            
CHAIR THERRIAULT admitted the justification was a bit stronger.                                                                 
SENATOR ELTON remarked it is different than the other language.                                                                 
CHAIR  THERRIAULT agreed  there might  be a  compelling need  for                                                               
that section.                                                                                                                   
CHAIR  THERRIAULT asked  about Representative  Wilson's amendment                                                               
related to embalming.                                                                                                           
4:19:05 PM                                                                                                                    
DR. MANDSAGER  responded the embalming  language was  inserted in                                                               
the Senate Health Education and Social Services (HES) Committee.                                                                
4:19:14 PM                                                                                                                    
SENATOR ELTON added it's on page 6, lines 17-20.                                                                                
CHAIR THERRIAULT  noted the second amendment  relates to indirect                                                               
court rules  and explained  that it takes  a two-thirds  vote for                                                               
the Legislature to make court rule changes.                                                                                     
4:19:58 PM                                                                                                                    
SENATOR  CHARLIE HUGGINS  questioned  why it  is called  indirect                                                               
court rule.                                                                                                                     
4:20:28 PM                                                                                                                    
DAN  BRANCH Department  of Law,  explained  that the  Legislature                                                               
sometimes  passes legislation  that  indirectly  changes a  court                                                               
rule and  Legislative Legal attorneys  felt the provisions  of SB
75 would do just that.                                                                                                          
4:21:23 PM                                                                                                                    
DR.  MANDSAGER mentioned  the suggested  amendment to  change the                                                               
party  status for  minors on  the bottom  of the  page containing                                                               
Senator Elton's  proposed amendment. He acknowledged  it had been                                                               
an oversight to exclude parents from court proceedings.                                                                         
4:21:53 PM                                                                                                                    
CHAIR  THERRIAULT questioned  whether  that was  included in  the                                                               
version under consideration.                                                                                                    
DR. MANDSAGER replied  "that was put in the  House version that's                                                               
not in the Senate version yet."                                                                                                 
CHAIR THERRIAULT  asked whether  the Senate Health  Education and                                                               
Social Services (HES) Committee took that up.                                                                                   
DR. MANDSAGER  replied the  issue came up  after Senate  HES took                                                               
action on the bill.                                                                                                             
4:22:15 PM                                                                                                                    
CHAIR THERRIAULT asked Dr. Mandsager to explain the issue.                                                                      
DR. MANDSAGER explained it doesn't  make sense that parents can't                                                               
be   present  during   court  proceedings   in  situations   when                                                               
quarantine/isolation orders are contested.                                                                                      
4:22:55 PM                                                                                                                    
SENATOR ELTON asked whether \G was the working document.                                                                        
4:23:08 PM                                                                                                                    
CHAIR THERRIAULT replied the \G  version came to the committee so                                                               
it is the working document.                                                                                                     
4:23:15 PM                                                                                                                    
SENATOR  ELTON asked  if  he would  like a  motion  to adopt  the                                                               
CHAIR THERRIAULT indicated agreement.                                                                                           
SENATOR ELTON  motioned to place  a period after "minor"  on page                                                               
15, line 13  and to strike the rest of  the sentence. There being                                                               
no objection, Amendment 1 passed.                                                                                             
4:23:48 PM                                                                                                                    
CHAIR THERRIAULT  noted there were  no further questions  for Dr.                                                               
Mandsager and he called Ms. Rarick.                                                                                             
4:24:16 PM-4:28:12 PM                                                                                                       
ALICE  RARICK, Alaska  Public  Health  Association board  member,                                                               
read a letter of support for SB 75 into the record.                                                                             
CHAIR THERRIAULT called on Patricia Senner.                                                                                     
4:28:30 PM - 4:32:19 PM                                                                                                     
PATRICIA SENNER, Alaska  Nurses Association (ANA) representative,                                                               
testified  in support  of SB  75 but  suggested some  changes and                                                               
questioned how some sections interact with existing laws.                                                                       
Because Section  18.15.387 refers to disease  outbreaks only when                                                               
referring    to    quarantines     and    thereafter    discusses                                                               
decontamination, the AMA suggests expanding  the section to refer                                                               
to situations in which people are exposed to toxic substances.                                                                  
AS  18.15.360 authorizes  the department  to request  information                                                               
from individuals  and inspect health  care records  maintained by                                                               
health  care  providers  that  identify  individuals  with  other                                                               
conditions  of public  health importance.  The AMA  suggests that                                                               
authority is too broad.                                                                                                         
AS 18.15.380 states that an  individual may refuse treatment, but                                                               
the  AMA  suggests the  individual  should  also accept  personal                                                               
responsibility to  the extent of  taking measures to  ensure that                                                               
others aren't infected.                                                                                                         
4:32:30 PM                                                                                                                    
SENATOR ELTON referenced  the right to refuse  treatment and said                                                               
others  addressed that  point  as well.  He  asked whether  model                                                               
language  suggested   by  the  Christian  Science   Committee  on                                                               
Publication for Alaska would address  that concern. That language                                                               
states:  "The provisions  of  this  section do  not  apply to  an                                                               
individual who  objects to the testing,  examination or screening                                                               
because  of the  individual's religious  beliefs; provided,  such                                                               
individual may  be subject to  isolation or quarantine  under the                                                               
provisions of this Act."                                                                                                        
4:33:22 PM                                                                                                                    
MS. SENNER  agreed that a  qualifier should be inserted  and made                                                               
the point that  measures short of isolation  and quarantine might                                                               
be taken to prevent the spread of illness.                                                                                      
4:34:14 PM                                                                                                                    
CHAIR THERRIAULT asked  Dr. Mandsager if he wanted  to comment on                                                               
the suggestions.                                                                                                                
4:34:32 PM                                                                                                                    
DR.  MANDSAGER said  the suggested  language  Senator Elton  read                                                               
came  as a  result of  religious concerns  and he  would like  to                                                               
consider combining  that with  Ms. Senner's  suggestion regarding                                                               
individual responsibility.                                                                                                      
SENATOR  WAGONER  said  he doesn't  object  to  someone  refusing                                                               
treatment  for religious  reasons, but  he certainly  thinks that                                                               
personal  financial responsibility  should  be  written into  the                                                               
4:36:00 PM                                                                                                                    
DR. MANDSAGER  said people should  have the choice, but  it ought                                                               
to be clear  that the financial cost associated  with that choice                                                               
would not be borne by the state.                                                                                                
CHAIR THERRIAULT asked about the other suggested modifications.                                                                 
DR. MANDSAGER  mentioned the  highly toxic  substances suggestion                                                               
and said he needed to think about that.                                                                                         
4:36:55 PM                                                                                                                    
CHAIR  THERRIAULT  asked about  the  broad  authority related  to                                                               
reportable  disease   or  other   conditions  of   public  health                                                               
DR.  MANDSAGER   responded  the  ACLU  suggested   narrowing  the                                                               
conditions  of public  health importance,  but  most issues  that                                                               
become a  great concern  aren't clear in  the beginning.  At this                                                               
point it would be worrisome  to narrow the definition. That being                                                               
said, DHSS is  currently working on proposed  amendments to raise                                                               
the bar for quarantine and isolation.                                                                                           
4:38:08 PM                                                                                                                    
CHAIR THERRIAULT referenced obesity.                                                                                            
DR. MANDSAGER  agreed that narrowing  for that type  of condition                                                               
makes  sense. "We  shouldn't  be going  into  health records  for                                                               
those purposes. It  ought to be ... a standard  that is more than                                                               
just of interest."                                                                                                              
CHAIR  THERRIAULT agreed  it  should  be tied  to  the spread  of                                                               
infectious disease or something similar.                                                                                        
DR. MANDSAGER said they would work with that suggestion as well.                                                                
CHAIR THERRIAULT asked Mr. McCleod-Ball to testify.                                                                             
4:38:49 PM - 4:42:20 PM                                                                                                     
WES MCCLEOD-BALL,  ACLU representative, announced he  wouldn't go                                                               
over the  testimony he gave  in previous hearings on  this topic,                                                               
but he  would say they agree  that the bill is  needed to clarify                                                               
the state's  authority in this  area. They  also agree it  is the                                                               
Legislature's  task to  find the  balance  between protecting  an                                                               
individual's right to privacy and protecting the public health.                                                                 
The ACLU  has four  areas of  concern. The  first is  the state's                                                               
scope of  authority authorized  in the  bill. He  suggested there                                                               
should be  a higher standard for  the exercise of the  powers for                                                               
quarantine or  isolation, forced  testing, and  government access                                                               
to  individual  medical records.  They  also  have concern  about                                                               
privacy as it relates to  protecting private medical records. The                                                               
ACLU would like  assurance that there are no  negative impacts in                                                               
civil  or   criminal  proceedings  for  individuals   subject  to                                                               
quarantine or isolation orders.  Finally, they have concern about                                                               
procedural  measures such  as ex  parte proceedings  because they                                                               
see  no reason  why the  subject  should be  excluded from  those                                                               
CHAIR THERRIAULT  noted the ACLU  document was well  organized in                                                               
its  explanation of  the  four  areas of  concern  and asked  Dr.                                                               
Mandsager if he was working from the same document.                                                                             
DR.  MANDSAGER responded  they are  using two  documents. One  is                                                               
testimony submitted to Representative  Wilson in the House Health                                                               
Education and Social Services Committee  and a follow up document                                                               
suggesting line-by-line changes to the bill.                                                                                    
CHAIR THERRIAULT called on Mr. Johnson.                                                                                         
4:42:52 PM - 4:44:40 PM                                                                                                     
NATHAN  JOHNSON, Anchorage  Municipal Health  and Human  Services                                                               
division  manager, testified  in support  of SB  75 and  read his                                                               
testimony into the record.                                                                                                      
"The bill is  important to the Municipality  of Anchorage because                                                               
it clarifies  the extent  and scope of  public health  powers and                                                               
provides specific due process to protect individual rights."                                                                    
CHAIR THERRIAULT asked Ms. Smith to come forward.                                                                               
4:45:04 PM                                                                                                                    
BEVERLY SMITH,  Christian Science  Committee on  Publications for                                                               
Alaska,  said  she  watches  for  legislation  that  could  erode                                                               
Alaskan's  rights to  pursue spiritual  means for  the prevention                                                               
and  cure  or disease  according  to  the individual's  religious                                                               
After reviewing  the bill thoroughly  they request  the following                                                               
amendments: Add  a new subsection  (f) to Section  18.15.375 that                                                               
would read,  "The provisions of this  section do not apply  to an                                                               
individual who  objects to the testing,  examination or screening                                                               
because  of the  individual's religious  beliefs; provided,  such                                                               
individual may  be subject to  isolation or quarantine  under the                                                               
provisions  of  this  Act."  She  justified  the  explanation  by                                                               
reading the following into the record:                                                                                          
     The purpose  of the amendment  is to provide  for those                                                                    
     instances  in which  a person  is unwilling  to undergo                                                                    
     medical testing,  examination or screening  because the                                                                    
     person is relying on a  religious non-medical method of                                                                    
     treatment for his or her health and well-being.                                                                            
     Christian Science  is one of the  religious non-medical                                                                    
     forms  of  treatment  that relies  on  spiritual  means                                                                    
     through  prayer to  heal  illness,  injuries and  other                                                                    
     conditions. Christian  Science has  been systematically                                                                    
     practiced,  quietly and  successfully,  in many  Alaska                                                                    
     families   for  a   century,  sometimes   through  many                                                                    
     generations.  The application  of  this religious  non-                                                                    
     medical method of healing does  not involve any type of                                                                    
     medical  examination or  screening.  The experience  of                                                                    
     those  practicing   Christian  Science  is   that  this                                                                    
     healing  method  has  both  preventative  and  curative                                                                    
     The  amendment  recognizes  an  individual's  right  of                                                                    
     self-determination,  including  the   right  to  refuse                                                                    
     medical testing, examination  or screening; however, it                                                                    
     also  recognizes legitimate  public health  concerns by                                                                    
     providing that  a person  who refuses  medical testing,                                                                    
     examination or  screening because of  religious beliefs                                                                    
     may be subject to isolation or quarantine.                                                                                 
     The  amendment language  is based  on similarly  worded                                                                    
     provisions in Section 602 of  The Model State Emergency                                                                    
     Health  Powers  Act  (revised December  21,  2001;  the                                                                    
     "Model Act"). The Model Act  was prepared by The Center                                                                    
     for  Law  and the  Public's  Health  at Georgetown  and                                                                    
     Johns Hopkins Universities for  the Centers for Disease                                                                    
     Control   (CDC)   to   assist   Governors   and   State                                                                    
     Legislatures  and   others  in   formulating  emergency                                                                    
     health powers plans.                                                                                                       
MS. SMITH noted she attached copies of the Model State Emergency                                                                
Health Powers Act and copies of statutes from other states that                                                                 
contain the language suggested for the amendment.                                                                               
4:48:33 PM                                                                                                                    
CHAIR THERRIAULT asked whether she had any comment on the issue                                                                 
of who should bear the cost.                                                                                                    
MS. SMITH  responded she didn't  have any prepared  comments, but                                                               
the personal responsibility request is reasonable.                                                                              
CHAIR THERRIAULT announced  he would hold SB 75  in committee for                                                               
further work.                                                                                                                   
4:49:50 PM                                                                                                                    
SENATOR  ELTON said  this has  been a  refreshing process  and he                                                               
appreciates Dr. Mandsager's efforts and approach.                                                                               
4:50:17 PM                                                                                                                    
SENATOR HUGGINS  said he  doesn't like  government to  intrude on                                                               
people's lives,  but neither does he  want to find there  is need                                                               
to revisit the issue after an epidemic or a terrorist attack.                                                                   
CHAIR THERRIAULT  acknowledged they  would both  have to  work to                                                               
convince their  constituents that  they are  working to  strike a                                                               
4:51:45 PM                                                                                                                    
CHAIR THERRIAULT announced  he would set SB 75  aside for further                                                               

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