Legislature(2017 - 2018)HOUSE FINANCE 519
05/11/2017 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB159 | |
| HB6 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 74 | TELECONFERENCED | |
| += | SB 97 | TELECONFERENCED | |
| += | HB 6 | TELECONFERENCED | |
| *+ | HJR 23 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 159 | TELECONFERENCED | |
HOUSE FINANCE COMMITTEE
May 11, 2017
1:33 p.m.
1:33:54 PM
CALL TO ORDER
Co-Chair Foster called the House Finance Committee meeting
to order at 1:33 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Paul Seaton, Co-Chair
Representative Les Gara, Vice-Chair
Representative Jason Grenn
Representative David Guttenberg
Representative Scott Kawasaki
Representative Dan Ortiz
Representative Lance Pruitt
Representative Steve Thompson
Representative Cathy Tilton
Representative Tammie Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Dr. Jay Butler, Chief Medical Officer and Director of
Public Health, Department of Health and Social Services;
Stacie Kraly, Chief Assistant Attorney General, Department
of Law; Sara Chambers, Acting Director, Alcohol and
Marijuana Control Office, Department of Commerce, Community
and Economic Development; Kara Nelson, Director, Haven
House, Juneau; Taneeka Hansen, Staff, Representative Paul
Seaton; Linda Bruce, Attorney, Legislative Legal Services;
Valerie Davidson, Commissioner, Department of Health and
Social Services; Representative George Raucher, Sponsor;
Darrel Breeze, Staff, Representative George Raucher;
Representative Lora Reinbold; Representative Andy
Josephson.
PRESENT VIA TELECONFERENCE
Michael Karson, Chair, Matsu Opioid Task Force, Matsu;
Carol Carman, Self, Palmer; Ryan Brett, AK Mudslingers,
Anchorage; Patti Barber, Self, Mat-Su; Kenny Barber, Self,
Mat-Su; Clark Cox, Natural Resource Manager, Department of
Natural Resources.
SUMMARY
HB 6 JONESVILLE PUBLIC USE AREA
CSHB 6(RES) was REPORTED out of committee with a
"do pass" recommendation and with three
previously published zero fiscal notes, FN1
(DNR), FN 2 (DPS), FN3 (DPS); and one new zero
fiscal note from the Department of Natural
Resources.
HB 159 OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES
CSHB 159(FIN was REPORTED out of committee with a
"do pass" recommendation and with two previously
published fiscal notes, one zero note: FN2 (DHS);
and one fiscal impact note: FN3 (CED).
SB 97 PENSION OBLIGATION BONDS
SB 97 was SCHEDULED but not HEARD.
Co-Chair Foster reviewed the agenda for the day.
HOUSE BILL NO. 159
"An Act relating to the prescription of opioids;
establishing the Voluntary Nonopioid Directive Act;
relating to the controlled substance prescription
database; relating to the practice of dentistry;
relating to the practice of medicine; relating to the
practice of podiatry; relating to the practice of
osteopathy; relating to the practice of nursing;
relating to the practice of optometry; relating to the
practice of veterinary medicine; related to the duties
of the Board of Pharmacy; and providing for an
effective date."
1:35:18 PM
DR. JAY BUTLER, CHIEF MEDICAL OFFICER AND DIRECTOR OF
PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
provided a broad overview of the major provisions in the
bill. He relayed that HB 159 was an omnibus bill that
enhanced the department's current approach for treating the
opioid epidemic by primarily focusing on ways to support
people in recovery and reduce the number of newly addicted.
The bill included opportunities to avoid opioid
prescriptions through advanced directives documented on
patient's medical records and for partial refills. He
indicated that the bill offered civil liability protection
for providers and enforced some of the regulations
contained in the federal Comprehensive Addiction and
Recovery Act of 2016. The legislation set a standard of
care limit of a seven day supply for first time
prescriptions for an opioid. The policy was aligned with
the Center for Disease Control (CDC), other professional
agencies and organizations, and the Veteran's
Administration's Opioid Safety Initiative. He related that
the initiative made "remarkable progress" in reductions in
overdoses and addiction of opioids since 2013. The bill
included waivers for judicious use of increased opioid
dispensing at the discretion of a professional for
situations like palliative care, acute and chronic pain
syndromes, etc. Another provision in the bill dedicated a
certain portion of required professional continuing
education credits for pain management or addiction. He
qualified that the education was beneficial even for
healthcare providers who did not prescribe opioids due to
the "highly prevalent" instances of dealing with patients
struggling with addictions or in recovery. The bill
"enhanced" the prescription drug database and required
veterinarians to register. The bill allowed the Department
of Commerce, Community and Economic Development (DCCED) to
provide feedback to providers comparing prescribing habits
of other providers and required pharmacists to update the
database more frequently. He thought that the database
implemented with passage of SB 74 Medicaid (Reform;
Telemedicine; Drug Database) [Chapter 25 SLA 16 06/21/2016)
was a useful tool only with the continued input of quality
data.
1:40:21 PM
Representative Guttenberg thanked Dr. Butler and the
department for doing a "great job." He referred to the
update of the prescription drug database. He asked him to
address the issues that arose with the implementation of
the "Prescription Drug Managers" database established in SB
74 [Prescription Drug Monitoring Program (PDMP)] and
whether the database was being regularly updated. Dr.
Butler responded that the monitoring program updates were
in the process of being increased from monthly to weekly as
mandated in SB 74. He relayed that more than 25 states
required daily updates and the standard was considered a
best practice. However, the more frequent the updates the
more burdensome the requirement was for small independent
rural pharmacies. He acknowledged the Alaska Pharmacy
Association's help in developing a strategy to address the
issue by delaying the implementation of the daily updates
until mid-2018 to allow a year for pharmacies to adjust to
weekly updates before moving forward. The pharmacies with
highly automated systems easily complied with more frequent
updating requirements but wanted to enable all pharmacies
to comply. He thought Representative Guttenberg had raised
a good point of looking at how the epidemic grew in Alaska
and how the Pharmacy Benefit Manager (PBM) influenced
prescribing practices and reimbursement and pointed out
that the issue provoked much discussion among the medical
community. He drew attention to a book entitled "Drug
Dealer M. D." authored by Anna Lembke M. D.
Representative Ortiz understood that pharmacies had an
initial concern about HB 159. He asked whether the concerns
had been addressed. Dr. Butler deferred to the Department
of Law (DOL) for a response. He added that the issue also
related to provisions in SB 74 that defined who was
considered a provider. The intent was that the prescriber
checked the prescription drug database and the dispenser
"populated" the database to ensure quality data.
1:46:41 PM
STACIE KRALY, CHIEF ASSISTANT ATTORNEY GENERAL, DEPARTMENT
OF LAW, responded affirmatively. She explained that within
the statutory framework of the prescription drug database
was a definition section that referred to a definition
contained in Title 11 of the criminal code, which applied
the Title 11 definition unless otherwise specifically
stated in the SB 74 statute. The pharmacists were concerned
over the use of the word "practitioner." She clarified that
AS 17.30.200 specifically identified that the definition in
the criminal code only applied if not addressed in other
statutes. She emphasized that the statutes in SB 74 and the
amendments in HB 159 were clearly crafted. She believed the
definition of practitioner was very concise and delineated
between prescriber and pharmacist. She felt that the
pharmacists concern was adequately addressed.
Representative Ortiz asked Ms. Kraly to provide the page
numbers of the bill referring to the definitions. Ms. Kraly
clarified that the current bill did not amend the
definition section of the database. She delineated that
"under the current framework of the statutory scheme" the
concerns raised by pharmacists had been addressed.
1:49:41 PM
Vice-Chair Gara referred to his previous discussion
regarding the adequacy of a three day supply as opposed to
the seven day supply in the bill. He requested an answer
about the prevalence in the literature recommending a three
day supply as adequate for pain and why the seven day
supply was chosen. Dr. Butler responded that the seven day
period was based on recent studies pointing to the length
of time of a first time prescription and the likelihood of
chronic use for a year or more. He indicated that the
"flashpoint" of an increase in risk for abuse was roughly 5
to 7 days for first time use. He stated that 3 days was the
guideline from the CDC and that supplies of longer than
seven days was rarely necessary. Vice-Chair Gara
ascertained that the bill allowed for a doctor's override
from the 7 day restriction due to certain circumstances. He
wondered why the legislature should not pay attention to
CDC's recommendation and establish a three day limit and
allow a longer supply under the doctor's discretion.
1:53:01 PM
Dr. Butler indicated the department was not ignoring the 3
day CDC guidelines. He mentioned that one of the analysis
that pointed to a 5 to 7 day supply as an increased risk
for prolonged use came from CDC data. He believed that a
"magic date" did not exist. He offered that the issue fell
under the concept of "accountable justification" that
described the judicious use of other drugs where a stronger
evidence base existed for how to change prescribing
behavior to optimize patient safety. He communicated that
the concept was not proven with opioids. Vice-Chair Gara
provided an example of someone responding well to a three
day supply. He wondered why the bill did not impose the
limit under the number of days that carried an increased
risk of abuse since the doctor could prescribe beyond 3
days at her discretion and the science supported it. Dr.
Butler understood Vice-Chair Gara's point. The issue of 3
days versus 7 days had to do with analysis of the risk of
addiction and dependency and the dramatic increase in risk
that occurred in 5 to 7 days. The 3 day clinical
recommendation was "sound" but flexibility for professional
judgement was important.
Co-Chair Foster acknowledged Representative Pruitt had
joined the meeting.
Vice-Chair Gara wanted to protect the individuals that kept
taking the drug subsequent to pain relief after the third
day. Dr. Butler thought Vice-Chair Gara's question
addressed the issue of whether opioids were a "first line
drug." He remarked that the legislation did not
specifically address the issue but was the reason for the
continuing education provision dedicated to behavioral pain
management and treatment. Over the last ten years,
prescriptions for opioids and overdose deaths increased
three to four fold without a corresponding decline in
chronic pain.
Representative Ortiz asked whether Dr. Butler's
professional judgement was that the seven day language was
in the best interest of the state. Dr. Butler responded
that the appropriate number of days was a balancing act. He
believed that the risk versus benefit was reasonable. He
commented that some of the risk was the under management of
pain and a larger administrative burden but it limited the
risk for dependency. He reported that the state of New
Jersey had limited the number of days to 5 days and was
unaware of any state that adopted the three day limit.
1:59:18 PM
Representative Wilson felt that only a medical doctor could
make educated judgements about prescribing and she was not
a doctor. She wondered whether it was already a crime to
prescribe too much opioid medication. Dr. Butler agreed
that the public official's role was not to dictate
individual patient management but felt that advancing
patient safety through guidance of how medical care was
addressed was acceptable. He noted that prescribing
hundreds of opioid pills for "fairly minor surgical
procedures" was not a crime. Representative Wilson thought
that patient safety should be the number one priority for
physicians. She wondered whether addressing the issue of
over prescribing via criminal law was a better approach
than laws limiting prescriptions made by people without a
medical education. Dr. Butler thought that scrutinizing
every instance of large opioid prescriptions would be
micromanagement of the practice of medicine. He stated that
some people adequately managed pain through prolonged use
of opioids and he did not want to inhibit access for such
use. Conversely, the problem of over prescribing large
quantities of opioids was identified as a problem that
contributed to the epidemic. He referred to the testimony
of a young man that had ultimately become addicted to
opioids and heroine from experimenting with the remainder
of a previous opioid prescription. He voiced that the
criminal justice system controlled the illicit flow of
opioids into communities and additional "stop checks" on
the legal flow was needed as well.
2:03:18 PM
Representative Wilson could not understand why a physician
would over prescribe opioids. She believed that the
legislature was doing the job a doctor should do and
assumed the doctor was incapable of determining the proper
dosing amounts. She wanted to understand how her reasoning
was incorrect. Dr. Butler offered that the limit was
related to the risk analysis and recommendations from
professional groups like the CDC, United States Surgeon
General, the American College of Physicians, and Veteran's
Administration. He thought the provision was "providing
guardrails" based on quantifiable information.
Representative Wilson could not understand why physicians
were not limiting prescriptions "on their own" if it was
"not the right thing to do." Dr. Butler explained that the
way doctors prescribe medications and some of the drivers
of the system had evolved over 25 years. The reimbursement
mechanisms and medication marketing had also been drivers
of over prescribing. He exemplified that the cost of a pill
was lower than some of the other ways to manage chronic
pain and pain syndromes. Representative Wilson appreciated
what the bill was trying to do. She reiterated that
legislators were not doctors and were incapable of making a
determination about prescribing.
2:07:21 PM
SARA CHAMBERS, ACTING DIRECTOR, ALCOHOL AND MARIJUANA
CONTROL OFFICE, DEPARTMENT OF COMMERCE, COMMUNITY AND
ECONOMIC DEVELOPMENT, was impressed with the crafting of
the bill. She pointed out that although the bill contained
recommendations, doctors were given flexibility. She
described the 7 day limit as the "stop and think moment"
when a provider could prescribe over the limit but needed
to document the transaction. Many physicians were not
properly trained in prescribing opioids and unaware of the
recent advances in pain management. She liked Dr. Butler's
comparison to limiting the use of antibiotics; physicians
no longer just handed out antibiotics due to the resistance
issues. The bill offered providers an opportunity to
receive additional education. She expounded that the four
prescribing boards that were affected were also given the
authority, in SB 74 and HB 159, to govern, review and
discipline its members if continued over prescribing was an
issue. She reminded the committee that the boards were
comprised of medical professionals qualified to make
decisions affecting its profession.
2:10:37 PM
Representative Guttenberg thought the previous question
made the assumption that all doctors were equal. He
remarked that the issue was multi-faceted. He surmised that
nothing in the bill restricted a doctor from prescribing
over 7 days. He inquired whether the state overrode the
doctor patient relationship. Dr. Butler affirmed that the
state did not override the provider patient relationship.
Representative Guttenberg asked whether the legislature
could impose a strict limit on prescribing without an
exception or waiver. Ms. Chambers responded that most
states had set recommended guidelines. The legislature had
the opportunity to set restrictive legal guidelines for
overprescribing. She detailed that in HB 159 regulatory
authority was left up to the discretion of the professional
judgements of the boards based on acceptable standards of
care. Representative Guttenberg was not advocating for any
restrictive limits. He asked about the authority held by
pharmacists and their liability. Ms. Chambers responded
that currently the Board of Pharmacists set a threshold for
identifying "doctor shopping" through the use of the
prescription drug manager. The pharmacist entered the data
into the database and the practitioner could review prior
to prescribing. She elaborated that the reporting filtered
back to a two-fold reporting process. One route of data was
streamed to the prescribing board through the Board of
Pharmacy; the two boards worked together to see if further
investigation was needed. The other element offered the
prescriber a report card in comparison to their peers. The
reporting offered the provider the opportunity to become
self-aware through viewing the practice of their peers. She
described the Board of Pharmacy's role as the "delegated
governor" of the entire process.
2:16:20 PM
Representative Guttenberg ascertained that the physician
had the ability to "self-examine" her prescribing practices
through the report card. He wondered who else had the
ability to monitor the database to identify when something
was wrong. Ms. Chambers responded that AS 17.30.200 (d)
delineated who can access the database but was quite
restricted. She reported that the Prescription Drug
Monitoring Program (PDMP) manager reviewed the information
at a "higher level" to identify trends and worked with the
Control Substances Advisory Committee, the Task Force on
Opioids, Board of Pharmacy, DHSS experts, and other
professional groups to review "trending." The analyzed data
helped shape policy. In Alaska's case, the data was lacking
until the SB 74 provisions went "live" in July, 2017.
Vice-Chair Gara referred to a remark made by Dr. Butler
about the 5 day period of an initial opioid prescription
and asked for further clarification. Dr. Butler answered
that a CDC study from one of its weekly Morbidity and
Mortality Weekly Report (MMWR Weekly) included a graph that
depicted the length of time from an initial opioid
prescription an individual remained on opioids a year
later. He noted that the line was not flat and peaked at
the five to seven day period and again at the thirty day
periods. Vice-Chair Gara asked Dr. Butler to provide the
document. He clarified that the risk of addiction rose
steeply at the five to seven day period. Dr. Butler
answered in the affirmative and agreed to provide the full
report to Vice-Chair Gara.
2:20:32 PM
Representative Grenn asked what the goals of the proposed
changes in the database were. Ms. Chambers indicated that
with the passage of SB 74 the PDMP went from a voluntary
basis with low participation rates to a mandatory program
for all providers with prescribing authority. She related
that in the following months the data would be analyzed for
trends in prescribing by occupation, reports on what
substances were being prescribed and comparisons that
provided more information on further trends. The
expectation was that the knowledge gained from the data
would instruct further policy and procedural decisions for
the professionals as well as legislators. Mandatory
reporting to the legislature was a provision in the
legislation.
2:23:51 PM
Co-Chair Seaton appreciated the legislation. He mentioned
that private industry did a very good job of marketing
their products to prescribers. The state had an antiquated
education system regarding pain management that only
considered pain without looking at addiction. He remembered
that the state had changed the criteria for rating
hospitals and doctors that included adequately managing
pain. He explained that the criteria resulted in the
dispensing of many prescriptions for drugs to ensure the
criteria was met. He asked whether the state had removed or
reformed the pain management criteria. He wondered whether
the legislature needed to address anything further to
remove the incentive for a facility to receive a good
rating based on dispensing medications for pain. Dr. Butler
appreciated the comments. He offered that previously pain
was undertreated so the emphasis over the years, became
eliminating pain rather than managing it. He reported that
he along with ten other state health officials composed a
letter to the Joint Commission and the Center for Medicare
and Medicaid Services (CMS) pointing out the "unintentional
incentive" of opioid dispensing from the HCAHPS (Hospital
Consumer Assessment of Healthcare Providers and Systems)
survey. He explained that the HCAPS was a survey of
patients' perspectives of hospital care and physicians. He
added that CMS reimbursement was based on the HCAP score.
Initially, the two entities resisted the constructive
dialogue but through continued communications and with
assistance from the American College of Physicians the HCAP
score was changed. The changes recognized that addressing
pain was a subjective experience that encompassed emotional
and pathological states.
2:29:36 PM
Co-Chair Foster OPENED Public Testimony.
2:30:12 PM
KARA NELSON, DIRECTOR, HAVEN HOUSE, JUNEAU, supported of
the legislation. She particularly favored the "non-opioid
directive." She spoke of her own long-term recovery and of
her daughter entering treatment only 2 days prior. She
thought of herself as an expert in recovery. She relayed a
story of a woman who had built a strong recovery framework
that was undermined by a prescription from a tooth
extraction. The women experienced a temporary relapse and
turned to heroin. She felt that a lot of addiction had to
do with pain management and shared that was the
circumstance regarding her daughter. She advocated for the
necessary guidelines contained in the bill and commented
that society was moving in the right direction. She spoke
of fighting an uphill battle everyday through addiction
education and the tools contained in the bill to combat the
misconceptions and mishandling of the issue. She thought it
was imperative to work aggressively to fight the opioid
addiction.
2:35:17 PM
Representative Ortiz asked whether Ms. Nelson was familiar
with the committee discussion regarding the appropriate
number of days for a first time opioid prescription. He
asked Ms. Nelson for her perspective. Ms. Nelson reported
that based on her work experience and last year's Surgeon
General's report on the issue Haven House changed its
policy to a three day limit. She personally supported a 3
day policy. She advocated for the continuing education
requirements in the bill as a crucial tool in the "battle"
against addiction that she characterized as a "war."
Vice-Chair Gara asked whether she was aware of doctors who
prescribed "more than others." Ms. Nelson answered in the
affirmative. However, she noticed that the "tide was
changing." She relayed that her work as an advocate for
addicts often included attending a doctor's appointment
with the individual and noted some doctor's misperceptions
and lack of knowledge about addiction.
2:38:34 PM
MICHAEL KARSON, CHAIR, MATSU OPIOID TASK FORCE, MATSU (via
teleconference), spoke in strong support of the bill. He
reported a drastic increase in heroin overdoses and use and
cited statistics. He reported the number of overdose deaths
due to fentanyl [a powerful synthetic opioid analgesic] and
relayed that the drug was 25 percent to 50 percent stronger
than heroine. Eighty percent of heroin users began using
pain opioid medication and 75 percent of the group received
the drugs from friends, grandparents, and parents. He
believed that the 7 day limit was imperative and informed
the committee that a 10 day supply translated to a one in
ten chance of long-term addiction and a 50 percent chance
after 30 days. He related that the state of Washington's
PDMP reduced medical costs by $33 million and decreased
opioid related hospital visits by 24 percent. He remarked
on the deadly nature of addiction.
Vice-Chair Gara asked for Mr. Karson's appropriate
credentials for reference. Mr. Karson replied that he
worked in public schools for 35 years, as the Vice-
President and addiction specialist for My House, a drop in
homeless shelter, and chaired the task force. Vice-Chair
Gara thanked Mr. Karson for his work.
Representative Guttenberg remarked on the bill's goal of
plugging a leaking hole. He asked Mr. Karson to identify
another issue where a difference could be made. Mr. Karson
referred the committee to an Icelandic study. He stated
that Iceland "knew how to reduce teenage substance abuse,
but the rest of the world was not listening." He reported
that teen tobacco, marijuana, and alcohol use was in the
single digits and spoke to the country's work in "upstream"
prevention." He delineated that research led officials to
discover that youth under stress took two paths: one became
risk takers and other became stimulant users. The stimulant
users became sedative users. The solution employed was to
match the behaviors with activities. The risk takers
engaged in activities like rock climbing and snowboarding.
The sedative users engaged in music, poetry, and yoga. He
emphasized that prevention was imperative. He acknowledged
Dr. Butler for his work on pilot projects like "drug-take
backs." The bill "turned back the spigot on opioids" but
upstream prevention was necessary. He commented that the
Icelandic study revealed that no one was listening to drug
education.
2:46:03 PM
Representative Guttenberg noted that Spain or Portugal had
legalized all drugs and had successful results. He wondered
if Mr. Karson was familiar with any of the practices. Mr.
Karson was unaware of the situation but referred to the
method as "harm reduction." He used needle exchanges as an
example. The contact that the individual user had with
workers at the needle exchange was an important resource
for the user seeking treatment. He noted the belief that
"addiction was isolation whereas recovery was
relationships." He referred to other harm recovery methods
such as injection sites or public places where Narcan was
immediately available in case of an overdose. The locked
boxes of Narcan located on street corners were unlocked by
a call to 911 for immediate use. He thought that the
Iceland study was the best resource for Alaska due to
Iceland's Arctic location.
2:49:07 PM
Co-Chair Foster CLOSED Public Testimony.
2:49:17 PM
Co-Chair Foster MOVED to ADOPT Amendment 1 (copy on file):
Page 11, line 3:
Delete "for every 40 hours of education received"
Insert "in the two years preceding an application
for renewal of a license"
Representative Wilson OBJECTED for the purposes of
discussion.
Co-Chair Foster explained the amendment. The department
requested the amendment that corrected an inadvertent error
regarding continuing medical education. The original intent
of the bill was to require physicians to receive 2 hours of
education in pain management and opioid use and addiction
in a 2 year licensing period. The current language mandated
the 2 hours of education for every 40 hours of continuing
education credit. He pointed out that some doctors were
required by their professional boards to take up to 200
hours of continuing education that resulted in 10 hours of
pain management, opioid use and addiction continuing
education, which was not the intent of the department. The
amendment reinstated the continuing education mandate for 2
hours in a 2 year licensing cycle.
Representative Guttenberg asked whether two hours for the
training was enough. Dr. Butler thought the question was
challenging. He voiced that the amount balanced
administrative demands and benefits and avoided placing
"unintended barriers" to seeking continuing education
credits beyond the amount required by the Board of
Medicine. Representative Guttenberg wanted to ensure the
training was useful and academic. Dr. Butler responded that
the department offered suggestions of free online material
that DHSS had reviewed.
Representative Wilson WITHDREW her OBJECTION.
There being NO OBJECTION, it was so ordered.
Amendment 1 was ADOPTED.
Co-Chair Seaton MOVED to ADOPT Amendment 2 (copy on file):
Page I, following line 9:
Insert a new bill section to read:
"* Section 1. The uncodified law of the State of
Alaska is amended by adding a new section to read:
LEGISLATIVE INTENT. It is the intent of the
legislature that the seven-day supply limit for
an initial opioid prescription under secs. 5, 16,
and 22 of this Act may not be considered as a
minimum length of time appropriate for an initial
prescription. The United States Centers for
Disease Control and Prevention guidelines state
that a three-day initial prescription of an
opioid is sufficient for most cases of acute
pain. The United States Centers for Disease
Control and Prevention reported in its March 17,
2017, weekly report that the likelihood of a
person's chronic opioid use increases with each
additional day of medication supplied after the
second day. Practitioners should use their
professional judgement in each case and not
interpret the seven-day limit as a direction to
prescribe the full seven days."
Page 1, line 10:
Delete "Section 1"
Insert "Sec. 2"
Renumber the following bill sections accordingly.
Page 34, line 10:
Delete "secs. 31 and 42"
Insert "secs. 32 and 43"
Page 34, line 16:
Delete "sec. 34"
Insert "sec. 35"
Page 34, line 17:
Delete "sec. 39"
Insert "sec. 40" 9
Page 34, line 19:
Delete "secs. 34 and 39"
Insert "secs. 35 and 40"
Page 34, line 24:
Delete "secs. 1 and 2"
Insert "secs. 2 and 3"
Page 34, line 26:
Delete "secs. l and 2"
Insert "secs. 2 and 3"
Page 34, line 28:
Delete "secs. 6 - 13"
Insert "secs. 7 - 14"
Page 34, line 30:
Delete "secs. 6 - 13"
Insert "secs. 7 - 14"
Page 35, line l:
Delete "secs. 18 and 20"
Insert "secs. 19 and 21"
Page 35, line 3:
Delete "secs. 18 and 20"
Insert "secs. 19 and 21"
Page 35, line 5:
Delete "secs. 23 - 25"
Insert "secs. 24 - 26"
Page 35, line 7:
Delete "secs. 23 - 25"
Insert "secs. 24 - 26"
Page 35, line 8:
Delete "Section 27"
Insert "Section 28"
Page 35, line I 0:
Delete "Section 32"
Insert "Section 33"
Page 35, line 12:
Delete "Section 33"
Insert "Section 34"
Page 35, line 14:
Delete "Section 35"
Insert "Section 36"
Page 35, line 16:
Delete "Section 36"
Insert "Section 37"
Page 35, line 18:
Delete "Sections 37 and 38"
Insert "Sections 38 and 39"
Page 35, line 20:
Delete "Section 41"
Insert "Section 42"
Page 35, line 22:
Delete "Section 1, 2, 6 - 13, 18, 20, 23 - 25,
34, and 39"
Insert "Sections 2, 3, 7 - 14, 19, 21, 24 - 26,
35, and 40"
Page 35, line 24:
Delete "Sections 31 and 42"
Insert "Sections 32 and 43"
Page 35, line 25:
Delete "secs. 45 - 53"
Insert "secs. 46 - 54"
Representative Wilson OBJECTED for the purposes of
discussion.
Co-Chair Seaton spoke to his amendment. He explained that
the amendment inserted intent language clarifying that the
seven day limit for initial opioid prescription should be
considered a minimum. He cited CDC data that discovered
that a 3 day supply alleviated most cases of acute pain and
the likelihood of chronic opioid use increased with each
additional day. A sharp increase in risk occurred on the
5th day, with a second prescription or refill, 700
milligrams of morphine equivalents, or an initial 10 or 30
day supply. He wanted the intent language to clarify that
while the provider maintained the discretion to prescribe a
seven day prescription, the full amount was not appropriate
in every situation and definitely not a mandate.
Vice-Chair Gara supported the amendment and reminded the
committee that intent language was uncodified law and was
not included in statute. He advocated for a "presumptive
number" set in statute, which was currently 7 days in the
bill and questioned whether it was the proper number.
2:56:24 PM
Representative Ortiz asked Dr. Butler whether the amendment
"limited the overall intent of the bill." Dr. Butler
thought the amendment was very reasonable. He explained
that the number of days was not intended to define a length
of a prescription but to define when a greater quantity was
justified in the medical record. He thought Co-Chair
Seaton's amendment was rational and he supported it.
Representative Wilson WITHDREW her OBJECTION.
Vice-Chair Gara MOVED to AMEND Amendment 2. He offered
Conceptual Amendment 1 to delete the language in line 3
that read:
The uncodified law of the State of Alaska is amended
by adding a new section to read:
Vice-Chair Gara explained that he wanted the language to
remain in statute.
Co-Chair Seaton asked for a brief "at ease" in order to
consult with legal services.
Vice-Chair Gara WITHDREW his Conceptual Amendment 1 to
Amendment 2.
Vice-Chair Gara WITHDREW his OBJECTION.
There being NO OBJECTION, it was so ordered.
Amendment 2 was ADOPTED.
Co-Chair Seaton MOVED to ADOPT Amendment 3 (copy on file):
Page 8, line 27, following "Surgeons":
Insert "or by the National Board of Osteopathic
Medical Examiners"
Representative Wilson OBJECTED for the purposes of
discussion.
Co-Chair Seaton reviewed the amendment. He conveyed that
the amendment updated a portion of the licensing statute
related to Osteopathic Physicians by updating the name of
the national examination certification board. The bill
listed the board's name as the National Board of Examiners
of Osteopathic Physicians and Surgeons. However, the board
was currently known as the National Board of Osteopathic
Medical Examiners and would be inserted in the legislation
along with the existing name. He noted that some osteopaths
in the state might still have their license under the
previous name of the board.
Representative Wilson WITHDREW her OBJECTION.
There being NO OBJECTION, it was so ordered.
Amendment 3 was ADOPTED.
3:01:08 PM
Co-Chair Seaton MOVED to ADOPT Amendment 4 (copy on file):
Page 26, line 10, following "older":
Insert "or an emancipated minor, a parent
or legal guardian of a minor, or an
individual's guardian or other person appointed
by the individual or a court to manage the
individual's health care"
Page 26, line 12, following "individual":
Insert "or the minor"
Page 26, line 18, following "individual":
Insert "a parent or legal guardian of a minor, or
an individual's guardian or other person
appointed by the individual or a court to manage
the individual's health care"
Page 26, lines 24 - 30:
Delete all material and insert:
"(c) An individual who is 18 years of age or
older or an emancipated minor, a parent or
legal guardian of a minor, or an
individual's guardian or other person
appointed by the individual or a court to
manage the individual's health care may
revoke a voluntary nonopioid directive at
any time in writing or orally."
Page 26, line 31, following "individual":
Insert, "a parent or legal guardian of a minor,
or an individual's guardian or other person
appointed by the individual or a court to manage
the individual's health care"
Page 27, line 7:
Delete "who has executed"
Insert "or a minor who has"
Page 27, line 11:
Delete "a controlled substance"
Insert "an opioid"
Following "individual's":
Insert "or a minor's"
Page 27, following line 24:
Insert a new paragraph to read:
"(2) "emancipated minor" means a minor whose
disabilities have been removed for general
purposes under AS 09.55.590;"
Renumber the following paragraphs accordingly.
Page 27, following line 26:
Insert a new paragraph to read:
"(5)"minor" means an individual who is under
18 years of age and is unemancipated;"
Renumber the following paragraphs accordingly.
Representative Wilson OBJECTED.
Co-Chair Seaton presented the amendment. He purported that
the amendment was related to the opioid directive for
minors. The amendment allowed parents or guardians of
minors to issue an opioid directive on behalf of the child.
Currently, the directive only applied to individuals 18
years or older, but minors were also prescribed opioids or
had already experienced addiction. He explained that in
emergency situations a child may be treated without
parental consent and the directive would notify the
practitioner to avoid opioid use. He added that the
amendment clarified the role of legal guardians for non-
minors. Previously, legal guardians could revoke a
directive but not execute one. The department concurred
that a legal guardian should be able to execute a directive
therefore, the provision was included in the amendment.
Representative Wilson cited page 27, line 24 of the bill or
page 2 of the amendment and asked whether the definition of
emancipated minor was new.
3:03:45 PM
TANEEKA HANSEN, STAFF, REPRESENTATIVE PAUL SEATON, informed
the committee that staff from Legislative Legal Services
would be able to answer the question.
Representative Wilson stated that she supported the
amendment as long as the definition of emancipated minor
was not altered. She requested that the committee waited to
hear from legal services before voting on the amendment.
Ms. Kraly responded that the definition was not changed
from current statute. She detailed that the language on
page 2, lines 13 through 14 of the amendment referenced AS
09.55.590, which was the definition of emancipation.
Representative Wilson repeated her question regarding the
definition of emancipation of a minor.
LINDA BRUCE, ATTORNEY, LEGISLATIVE LEGAL SERVICES,
confirmed that the definition was not changing. She
indicated that the existing definition was cited in the
section.
Representative Wilson WITHDREW her OBJECTION.
There being NO OBJECTION, it was so ordered.
Amendment 4 was ADOPTED.
3:07:03 PM
Vice-Chair Gara MOVED to ADOPT New Conceptual Amendment 5
(copy on file):
On page 5, lines 23,25,30,31 and page 6, lines 6 and 9
replace "seven-day" with "five-day."
Make confirming language changes as needed.
Representative Wilson OBJECTED for the purposes of
discussion.
Vice-Chair Gara spoke to his amendment. He cited the CDC
study [Morbidity and Mortality Weekly Report, March 17,
2017 I Vol. 66, No. 10 US Department of Health and Human
Services/Centers for Disease Control and Prevention] of
which he distributed one page [267] (copy on file) that
reported the risk of opioid addiction rose sharply after 5
days of the initial prescription and that for most people a
3 day supply was effective. He noted the bill's waiver for
an initial prescription that was longer than 7 days. He
asserted that the bill should reflect the science that the
addiction risk grew sharply after 5 days and proposed the
change in the amendment. He emphasized that the change was
appropriate due to the waiver for longer periods of time in
the bill. He remarked that the intent of the amendment was
to include all healthcare prescribers that had prescription
authority.
Representative Thompson asked whether Amendment 5 altered
the intent language in Amendment 2. Vice-Chair Gara
answered that the amendment would mesh with Amendment 5 and
state that the intent was to prescribe for less than 5 days
unless otherwise necessary. He thought the amendment would
remain the same but mean fewer than 5 instead of fewer than
7 days.
3:10:44 PM
Representative Kawasaki asked whether the amendment
included all prescribers. Vice-Chair Gara responded in the
affirmative. Representative Kawasaki noted that the CDC had
recommendations for chronic pain and separate guidelines
for cancer or palliative care. He observed that the bill
referenced the limited supply for a person with chronic
pain and wondered whether how that affected a person with
cancer or palliative care. Vice-Chair Gara deferred the
question to Dr. Butler. He recounted that the doctor had
the authority to prescribe for longer than the limit
depending on the situation in either the bill or amendment.
Dr. Butler responded that the waiver provided the
protections as defined in the CDC guidelines. He commented
that the CDC guideline was "a guideline and not a specific
study." He expounded that a summary of the available data
in 2015 was used to develop the guideline published in
early 2016. The discussion regarding 5 or 7 days was not
available in 2015. He concurred with the CDC guideline that
pointed to the 3 day supply as being optimal and that a 7
day supply was rarely necessary. He referred to the CDC
line graph he referenced earlier and characterized the line
as a line of increasing risk containing "a couple bumps
that were steeper at 5 and 30 days" but did not represent a
"sudden quadrupling of the risk."
3:14:32 PM
Representative Ortiz asked whether Amendment 5 was drafted
without consultation with DHSS. Vice-Chair Gara answered in
the affirmative and commented that the amendment was based
on the department's testimony and the CDC information. He
noted that he spoke with the department. Representative
Ortiz asked Dr. Butler how he felt about Conceptual
Amendment 5. Dr. Butler understood that the administration
did not support the amendment. He felt that the amendment
containing the intent language [Amendment 2] struck the
balance between risks and benefits.
Co-Chair Seaton clarified that Dr. Butler was talking about
a line graph, which was not handed out and requested
distribution of the document. [MMWR dated March 17, 2017
Vol. 66, No. 10 CDC page 267] He conveyed that the CDC
guideline reference that Dr. Butler previously discussed
was from the Morbidity and Mortality Weekly Report, March
15, 2016, Vol. 65, - US Department of Health and Human
Services/Centers for Disease Control and Prevention (copy
on file). He read from the March 17, 2017 handout:
The probability of long-term opioid use increases most
sharply in the first days of therapy, particularly
after 5 days or 1 month of opioids have been
prescribed…
Co-Chair Seaton queried why the committee should not
embrace the most recent CDC data that demonstrated an
increased risk after 5 days of use and adjust the
legislation. Dr. Butler remarked that the graph was a
helpful visual aid but the department focused on the
textural interpretation of the report. He furthered that
the main structural advantage of retaining the 7 day supply
was the conceptual ease for the provider keeping track of
calendar days. He speculated that 5 days was a bit more
complicated.
3:19:21 PM
Vice-Chair Gara asked whether the concern over a doctor's
had the ability to perform simple math was on balance with
the CDC stated guideline that after 5 days addiction grew
sharply. Dr. Butler was not remarking on the ability of
providers to prescribe for 5 days versus 7 days. He
articulated that he wanted to make the guidelines as easy
as possible for busy providers.
Representative Kawasaki asked whether the consequence of
prescribing an opioid past the 7 day limit was that the
provider was required to document and justify the event in
the patient's chart. Dr. Butler responded in the
affirmative. Representative Kawasaki wondered whether the
prescriber would feel that she had to prescribe lesser
amounts to avoid reporting. Dr. Butler thought he raised a
good question and was not sure whether the reporting was
significant to a prescriber or not.
3:23:11 PM
Representative Ortiz understood Vice-Chair Gara's concern
but was not comfortable with further accessing the
relevance of the issue. He felt that the department
thoroughly vetted the issue before the decision was made.
Co-Chair Seaton referred to the 2 charts on the CDC handout
[MMWR, March 17, 2017 Vol. 66, No. 10 - CDC, page 267 (copy
on file)] he cited earlier and asked for an explanation of
the second chart the depicted the number of prescriptions
in the first episode of opioid use. Dr. Butler referred to
the first chart that depicted the days' supply of first
opioid prescription. He explained that the solid line
denoted the 1 year probability and the vertical line
denoted the probability of continuing use [1 to 100
percent] by the number of days' supply in the horizontal
axis. He noted the steeper upswing between 5 to 7 days and
a slight leveling off and did not feel the increase was
much more dramatic at 5 days than seven. Co-Chair Seaton
interpreted that the risk at five days was roughly 7
percent and 7 to 8 days was over 15 percent and asked
whether he concurred. Dr. Butler interpreted the data a 10
percent risk at 5 days and 13 to 14 percent at 7 days.
Vice-Chair Gara was "really confused" about the
department's balancing of risks and rewards. He interpreted
the data to read a sharp rise in the risk of addiction from
10 percent to 15 percent from 5 to 6 days. He cited the
text and read:
…increases most sharply in the first days of therapy
particularly after five days.
Vice-Chair Gara voiced that the graph concurred with the
narrative. He reiterated his skepticism that the burden of
choosing a limit based on prescribing around calendar days
was worth the increased risk of addiction. He felt that the
danger to the public was demonstrated to be much higher at
7 days and even higher at 10 days, roughly 20 percent. Dr.
Butler did not intend to imply that Vice-Chair Gara's
interpretation was "way off." Vice-Chair Gara asked whether
Dr. Butler thought the 5-day limit was bad policy. Dr.
Butler replied in the negative and would not object to the
amendment.
3:30:20 PM
VALERIE DAVIDSON, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES, attempted to provide more clarity. She
relayed that there was nothing in the bill that precluded
the provider from writing a prescription for less than 7
days. The bill required the provider to justify in the
medical record why the script was written for more than 7
days. She shared that the department had worked with
providers to find an amount of time that did not pose an
administrative burden and 7 days was agreed upon. She was
uncertain how providers would react to the amendment.
Representative Wilson thought the issue had been properly
vetted. She had not heard objections from providers
regarding the current 7 day limit. She did not support the
amendment.
Co-Chair Seaton asked whether a doctor could prescribe a
refill for an initial opioid prescription. Dr. Butler
answered in the affirmative and added that the refill was
possible due to the waiver.
Co-Chair Seaton clarified that he was asking about a refill
on an initial 3 day or 5 day prescription. He indicated
that the objective of HB 159 was to halt the opioid
epidemic that was partially caused by over prescribing. He
reiterated his inquiry regarding whether a refill on a 3 or
5 day prescription was allowed under the bill. He wanted to
place "downward pressure on initial prescriptions" and
strike a balance between need and the 5 and 7 day options.
He deduced that if a refill was allowable, without a
further prescription, the distinction between the 5 and 7
day was irrelevant.
3:36:18 PM
Commissioner Davidson responded that the way the bill was
written the 7 day limit applied to the initial
prescription. She added that the refill was considered a
second prescription and fell outside of the scope of the
seven day limit. The bill allowed a patient to request a
partial fill of a prescription. She indicated that the bill
attempted to "reset" the standard practice of automatically
prescribing much larger amounts i.e., 30 days. She restated
that the bill recognized instances where a longer dose was
necessary by providing the waiver and the required
justification.
Vice-Chair Gara understood that a doctor could already
prescribe less but the bill was necessary to create a
standard. Commissioner Davidson responded, "That is
correct." Vice-Chair Gara reasoned that the question was
what the standard should be. He noted that the CDC data was
released subsequent to the bill's introduction. He asked
whether she had spoken to the providers about the spike in
risk that occurred after 5 days.
Dr. Butler shared that he used the same graph in a slide
when he spoke to providers about the bill. None had spoken
out about the issue. Vice-Chair Gara cited statistics that
the state experienced 90 deaths due to opioid addiction and
two thirds were linked to prescription use. He reiterated
that the risk for abuse sharply increased after five days.
He stressed that even though providers did not weigh in on
the issue the legislature could make the "policy call." He
asserted that the bill needed to include a guideline and
that the guideline should be 5 days; the point before
prescription opioid abuse rose sharply.
3:41:06 PM
Representative Wilson MAINTAINED her OBJECTION.
A roll call vote was taken on the motion.
IN FAVOR: Gara, Grenn, Thompson, Seaton
OPPOSED: Wilson, Kawasaki, Ortiz, Pruitt, Tilton, Foster.
Representative Guttenberg was absent from the vote.
The MOTION to ADOPT Amendment 5 FAILED (4/6).
Amendment 5 FAILED to be ADOPTED.
Co-Chair Foster asked Vice-Chair Gara to discuss the fiscal
notes.
Vice-Chair Gara had a question regarding Amendment 2. He
reiterated that the amendment provided intent language
clarifying that the provider could prescribe an initial
opioid prescription for less than seven days. He asked if
the language, "The uncodified law of the State of Alaska is
amended by adding a new section to read:" was deleted on
lines 3 and 4 would the intent language remain in the
statue books.
LINDA BRUCE, ATTORNEY, LEGISLATIVE LEGAL SERVICES, asked
whether he meant that by removing the uncodified lead-in
the language would be codified law.
Vice-Chair Gara explained that he wanted the intent
language to remain in statute. Ms. Bruce did not believe
that as drafted the Amendment 2 language would appear in
the statute. Vice-Chair Gara restated his question
regarding removing the lead-in language and adding a new
section if Amendment 2 would remain in statute. Ms. Bruce
responded in the negative. She clarified that a section
number was necessary and substantive language needed to
replace the intent language.
3:45:42 PM
Vice-Chair Gara reviewed the Department of Commerce,
Community and Economic Development fiscal note FN 3 (CED)
appropriated to the Division of Corporations Businesses and
Professional Licensing in the amount of $27.5 thousand for
legal and printing costs for new regulations. The second
fiscal note DHSS FN 2 (DHS) was zero.
3:46:58 PM
AT EASE
3:47:11 PM
RECONVENED
Co-Chair Foster noted that Fiscal 1 was no longer relevant.
Co-Chair Seaton MOVED to report CSHB 159(FIN) out of
Committee with individual recommendations and the
accompanying fiscal notes.
Representative Wilson OBJECTED.
Representative Wilson felt that the legislature was
attempting to be doctors and the bill was "beyond the scope
of where we belong." She believed that overprescribing
should be a crime. The bill only contained suggested
guidelines and included ways to maintain the
overprescribing practices. She believed that the decisions
were better left up to the medical professionals and their
boards and allow them to deal with the problem.
3:49:59 PM
Representative Pruitt disagreed with his colleague from
North Pole. He thought that the medical community was slow
to respond to the crisis. He felt that the problem
"ballooned" rapidly. He believed that the epidemic
warranted government intervention for the public's
protection. He supported the legislation and thanked the
sponsor for introducing the bill.
Representative Kawasaki thanked the administration for
bringing the legislation forward. He commented that the
United States had 28 thousand deaths due to prescription
opioids last year; half were procured legally. The black
market for opioids was still a major part of the problem
but the legislation addressed part of the issue.
Representative Grenn appreciated the department's efforts
and felt that the bill sent a "strong message" of awareness
to all parts of the state. He approved of Dr. Butler's
three pronged approach: working with patients, physicians,
and prescribing.
Representative Guttenberg thought the issue crossed
multiple lines. He elucidated that the medical community
was self-regulating and was inattentive to "broad public
policy." The pharmacists were prescribing drugs and filling
prescriptions and the pharmaceutical companies were
manufacturing and marketing drugs under their own agendas.
He believed that the factors made addressing the problem
difficult.
3:55:49 PM
Co-Chair Seaton addressed the previous testifier, Michael
Karson's comments. He believed that the state was
"tinkering around the edges attempting to get something
under control." He thought the state had a problem to solve
when 85 percent of addiction was started with prescription
opioids and warned that the bill was only part of the
solution. He agreed with Mr. Karson's comments regarding
prevention and upstream solutions and felt they offered a
"better" solution. He advocated for a holistic approach to
the problem. He thanked all who worked on the bill.
Vice-Chair Gara agreed with all of Co-Chair Seaton's
comments and also thanked the department. He maintained
that physicians remaining silent during a power point
presentation containing the 5 or 7 day data was not enough
"evidence" to standby the 7 day period, especially when
prescribers opinions were not directly solicited. He
considered the issue unresolved. He urged the department to
revisit the issue with providers to determine whether it
was worth choosing the 5 day limit "to save extra lives."
Representative Wilson MAINTAINED her OBJECTION.
A roll call vote was taken on the motion.
IN FAVOR: Gara, Grenn, Guttenberg, Kawasaki, Ortiz, Pruitt,
Thompson, Foster, Seaton
OPPOSED: Tilton, Wilson
The MOTION PASSED (9/2).
CSHB 159(FIN) was REPORTED out of committee with a "do
pass" recommendation and with two previously published
fiscal notes, one zero note: FN2 (DHS); and one fiscal
impact note: FN3 (CED).
3:59:14 PM
Co-Chair Foster indicated that due to time constraints the
committee would not hear SB 28 today.
3:59:35 PM
AT EASE
4:17:27 PM
RECONVENED
HOUSE BILL NO. 6
"An Act establishing the Jonesville Public Use Area."
4:17:36 PM
REPRESENTATIVE GEORGE RAUCHER, SPONSOR, thanked the
committee for hearing the legislation. He provided
information about the legislation. The bill provided an
opportunity to make a public use area for the community of
Sutton in conjunction with the Matanuska/Susitna Borough,
Department of Natural Resources (DNR), Alaska Mental Health
Trust Authority (AMHTA), and all of the user groups. The
bill simply authorized a public use area that allowed the
community to design a management plan in the future.
Co-Chair Foster OPENED public testimony.
CAROL CARMAN, SELF, PALMER (via teleconference), testified
in support of the legislation. She relayed information
about a man who had been shot and killed in the Jonesville
mine area about one year earlier. She shared that the area
was popular with campers, four wheelers, and shooters. The
area lacked management and was littered with trash, unsafe
with frequent shooting incidences, experienced stray
gunfire, and out of control, which created safety issues
for residents living in the area. She shared another story
about an individual shooting into a crowd around a bonfire.
The area was heavily used. She discussed that the police
needed to have the ability to take preventative measures
instead of merely responding to negative events after they
took place in the area. She remarked that the legislature
passed bill's dealing with honoring indigenous people and
African American soldier's efforts to build the Alaska
Highway during World War 2 and opined that HB 6 was "passed
over." She urged the committee and legislature to pass the
legislation.
4:23:47 PM
RYAN BRETT, AK MUDSLINGERS, ANCHORAGE (via teleconference),
spoke in favor of the legislation. He provided information
about the organization and noted that the group conducted
an annual Jim Creek/Knik River area cleanup where over 1000
people participated. He reported a large decrease in trash.
He shared that the same issues in the Sutton area were
present in the Jim Creek/Knik River area prior to
management. He had personally seen bonfires and out of
control activities in the unmanaged area in Sutton. He
believed the bill would have a positive impact on the area
and all user groups. He spoke to protecting the community
of Sutton. He reported that his organization was conducting
a Jonesville area cleanup in June. The annual cleanups
provided more exposure to the issue. He asked the committee
to pass the bill.
Representative Tilton thanked Mr. Brett for coordinating
the cleanups and for the way he ran the organization.
4:26:45 PM
PATTI BARBER, SELF, MAT-SU (via teleconference), testified
in support of the legislation. She stated that the area was
popular and needed direction to contain the uncontrolled
use. She spoke to the burned out vehicles, trash, and
bullets in the area. She related that the community of
Butte had the same problems until the Knik River Public Use
Area was established. She believed that creating the
Jonesville Public Use area would educate the public about
using the area safety and advocated for funding in the
future.
4:27:56 PM
KENNY BARBER, SELF, MAT-SU (via teleconference), spoke in
support of the bill. He believed it was a positive effort
and hoped for financial support of the area in the future.
4:28:54 PM
Co-Chair Foster CLOSED public testimony.
Vice-Chair Gara addressed the four zero fiscal notes from
the Department of Natural Resources, Department of Public
Safety, and the Department of Fish and Game.
Representative Kawasaki asked for discussion regarding the
two fiscal notes from DPS.
4:31:20 PM
AT EASE
4:31:33 PM
RECONVENED
4:31:47 PM
CLARK COX, NATURAL RESOURCE MANAGER, DEPARTMENT OF NATURAL
RESOURCES (via teleconference), introduced himself and
asked Representative Kawasaki to repeat his question.
Representative Kawasaki noted that the DNR fiscal note from
the Division of Mining, Land and Water discussed that
troopers were unlikely to provide enforcement in the area.
Mr. Cox explained that the departments gauged HB 6 to the
Knik River Public Use area when creating the fiscal notes.
The Knik River area was very successful due to the funding
appropriated when the area was established. The
appropriation afforded one DNR staffer and funding for
troopers for enforcement. Representative Kawasaki indicated
that Mr. Cox's response clarified his question. He
remembered that previously a fiscal note attached to the
establishment of the Knik River Public Use Area was roughly
$400 thousand in 2007. The major portion of the funding was
for creation of the management plan. He asked how DNR would
prioritize the planning work for Jonesville with a zero
fiscal note. Mr. Cox answered that the Knik River planning
took several years with ample funding and the Jonesville
area would take much longer with a zero fiscal note.
Representative Kawasaki cautioned the Jonesville Public Use
Area's supporters that without funding the proposal and
management plan would take a long time to implement. He
noted that troopers and a half-time ranger was necessary
for the Knik River area.
4:36:22 PM
DARREL BREEZE, STAFF, REPRESENTATIVE GEORGE RAUCHER, noted
the letter in member's packet from the commissioner of DNR,
Andrew Mack (copy on file) and pointed to the second
paragraph that stated without additional funding the
process was expected to take 5 years. He related that the
sponsor acknowledged that the plan would take time. He
favored taking five years to work with the community,
borough, and users to develop a management plan that met
the needs of all of the users.
Representative Wilson asked whether the sponsor was
expecting the borough to play a large role in developing
the plan to present to DNR and participate in fundraising
efforts unlike the development of the Knik River area.
Representative Raucher answered in the affirmative. He
referred to Page 2, lines 10 through 11 of the bill:
…the commissioner may designate incompatible uses and
shall adopt and may revise a management plan for the
Jonesville Public Use Area….
Representative Raucher expounded that the bill did not
stipulate that DNR should write the management plan. The
Matsu Borough was committed to developing the public use
area and was willing to help write the management plan and
help facilitate the public process among user groups. There
was currently a 30 page plan developed from surveys and
previously meeting and working with user groups every other
week. The same process would be used to continue building
the comprehensive plan to present to DNR for their review
and approval.
Representative Wilson thanked the representative for
working with local government, the community, and user
groups. She thought that everyone would understand that the
project would not happen overnight.
4:41:40 PM
Co-Chair Seaton MOVED to report CSHB 6(RES) out of
Committee with individual recommendations and the
accompanying fiscal notes. There being NO OBJECTION, it was
so ordered.
CSHB 6(RES) was REPORTED out of committee with a "do pass"
recommendation and with three previously published zero
fiscal notes, FN1 (DNR), FN 2 (DPS), FN3 (DPS); and one new
zero fiscal note from the Department of Natural Resources.
Co-Chair Foster reviewed the agenda for the following
meeting.
ADJOURNMENT
4:43:41 PM
The meeting was adjourned at 4:43 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 74 JBER Response 2017-04-26-084348.pdf |
HFIN 5/11/2017 1:30:00 PM |
HB 74 |
| HB 159 - Amendments 5.11.17.pdf |
HFIN 5/11/2017 1:30:00 PM |
HB 159 |
| SB 97 - Amendment.pdf |
HFIN 5/11/2017 1:30:00 PM |
SB 97 |
| SB 97 Retirement System Data LFD.pdf |
HFIN 5/11/2017 1:30:00 PM |
SB 97 |
| HB 159 Conceptual Amendment New 5 Gara.pdf |
HFIN 5/11/2017 1:30:00 PM |
HB 159 |
| HB 159 Backup for Amendment 5.pdf |
HFIN 5/11/2017 1:30:00 PM |
HB 159 |
| HB 159 CDC Data Opiod RX-Use.pdf |
HFIN 5/11/2017 1:30:00 PM |
HB 159 |