Legislature(1995 - 1996)
01/26/1995 03:02 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
January 26, 1995
3:02 p.m.
MEMBERS PRESENT
Representative Cynthia Toohey, Co-Chair
Representative Con Bunde, Co-Chair
Representative Al Vezey
Representative Gary Davis
Representative Norman Rokeberg
Representative Caren Robinson
Representative Tom Brice
MEMBERS ABSENT
None
COMMITTEE CALENDAR
* HB 39:"An Act relating to the authority of mobile intensive
care paramedics, physician assistants, and emergency
medical technicians to pronounce death under certain
circumstances."
PASSED OUT OF COMMITTEE
(* First public hearing)
WITNESS REGISTER
REPRESENTATIVE GENE THERRIAULT
Alaska State Legislature
State Capitol, Room 421
Juneau, AK 99801
Telephone: (907) 465-4797
POSITION STATEMENT: Provided sponsor statement for HB 39.
MATT ANDERSON, Training Coordinator
State Emergency Medical Services
P.O. Box 110616
Juneau, AK 99811-0616
Telephone: (907) 465-3141
POSITION STATEMENT: Testified in support of HB 39.
ELLEN WOFFORD, Trainer
Delta Rescue
P.O. Box 1357
Delta Junction, AK 99737
Telephone: (907) 895-4746
POSITION STATEMENT: Testified in support of HB 39.
GARY JUDD, Emergency Medical Technician
North Slope Borough
P.O. Box 69
Barrow, AK 99723
Telephone: (907) 852-0265
POSITION STATEMENT: Testified in support of HB 39.
CRAIG LEWIS
Alaska Emergency Medical Services Association,
Interior Region Emergency Medical Services, Inc.
1881 Marika Street
Fairbanks, AK 99709
Telephone: (907) 456-3978
POSITION STATEMENT: Testified in support of HB 39.
GREG BARCLAY
Central Emergency Services
231 S. Binkley Street
Soldotna, AK 99669
Telephone: (907) 262-4792
POSITION STATEMENT: Testified in support of HB 39.
DR. WILLIAM COOPER
Central Emergency Services
231 S. Binkley Street
Soldotna, AK 99669
Telephone: (907) 262-4792
POSITION STATEMENT: Testified in support of HB 39.
ROCKY ANSELL, Emergency Medical Technician
P.O. Box 217
Copper Center, AK 99573
Telephone: (907) 822-5361
POSITION STATEMENT: Testified in support of HB 39.
JACK HEESCH, Lobbyist
Alaska Academy of Physician Assistants
P.O. Box 201608
Anchorage, AK 99520
Telephone: (907) 463-3381
POSITION STATEMENT: Presented client testimony in support
of HB 39.
PREVIOUS ACTION
BILL: HB 39
SHORT TITLE: AUTHORITY TO PRONOUNCE DEATH
SPONSOR(S): REPRESENTATIVE(S) THERRIAULT,B.Davis,Bunde,G.Davis
JRN-DATE JRN-PG ACTION
01/06/95 30 (H) PREFILE RELEASED
01/16/95 30 (H) READ THE FIRST TIME - REFERRAL(S)
01/16/95 31 (H) HES, JUD
01/19/95 90 (H) COSPONSOR(S): BUNDE
01/26/95 (H) HES AT 03:00 PM CAPITOL 106
ACTION NARRATIVE
TAPE 95-2, SIDE A
Number 000
The House Health, Education and Social Services Committee was
called to order by Co-Chair Cynthia Toohey at 3:02 p.m. Members
present at the call to order were Representatives Bunde, Vezey and
Robinson.
CO-CHAIR TOOHEY stated that a quorum was present. She announced
the meeting is on teleconference with Barrow, Delta Junction,
Fairbanks, Glennallen, Soldotna and Tok.
Number 073
CO-CHAIR TOOHEY introduced Representative Gene Therriault to the
committee.
HHES - 1/26/95
Number 090
HB 39 - AUTHORITY TO PRONOUNCE DEATH
REPRESENTATIVE GENE THERRIAULT, sponsor of HB 39, explained that
the bill proposes to allow mobile intensive care paramedics,
physician assistants and emergency medical technicians (EMTs) to
determine and pronounce death under certain circumstances.
Registered physician assistants, registered paramedics and
certified emergency medical service may make a determination and
pronouncement of death upon determining that a person has suffered
irreversible cessation of circulatory and respiratory function
while a physician is not immediately available for consultation by
radio or telephone.
REPRESENTATIVE THERRIAULT continued that currently, when a member
of an emergency medical service begins CPR they are required to
continue resuscitation until: The person recovers; the EMT,
physician assistant, or paramedic is relieved by either a medical
facility or physician; the responding parties become physically
exhausted and no longer are able to continue; their physical safety
is seriously threatened; or a physician pronounces the person dead.
REPRESENTATIVE THERRIAULT stated that many times, particularly in
rural Alaska, physicians and medical facilities are not immediately
available, and emergency medical response members are required to
continue unproductive resuscitation for several hours.
REPRESENTATIVE THERRIAULT explained that HB 39 would allow an EMT,
physician assistant or paramedic to declare death in situations
where a physician is not available. This will help emergency
response teams to better attend to the emergency medical needs of
Alaska.
Number 214
REPRESENTATIVE THERRIAULT added the bill is currently the same bill
the HESS committee considered and passed out of the committee last
year. Also, last year testimony was heard from a number of
teleconference sites around the state which recounted efforts where
individuals were required to perform resuscitation efforts on a
person who was obviously dead, due to the presence of perhaps a
fleeting heartbeat. Once the efforts were begun, they could not be
discontinued until someone with authority pronounced the person
dead, or the rescuer became physically exhausted or felt his or her
life was threatened.
Number 266
REPRESENTATIVE THERRIAULT said the passage of this bill would set
Alaska ahead of other states. According to legislative research,
a number of other states are considering similar legislation,
basically for the same reasons. But in the state of Alaska there
are many remote areas where authorized personnel are unavailable to
pronounce death.
Number 297
REPRESENTATIVE THERRIAULT directed the committee to read a letter
from Craig Lewis, head of the Interior Region Emergency Medical
Services Council, and a newspaper article from the Juneau Empire
concerning the proposed legislation. The article recounts a
specific story in which this legislation would have proved
beneficial to all involved.
REPRESENTATIVE THERRIAULT stated the bill tries to be fairly
specific about when death can or cannot be pronounced, and how long
cardiopulmonary resuscitation (CPR) must be attempted, taking into
consideration hypothermia.
Number 380
REPRESENTATIVE THERRIAULT said that some changes to the bill have
been suggested; therefore, he introduced a Sponsor Substitute to HB
39.
CO-CHAIR TOOHEY noted for the record that Representative Rokeberg
arrived at 3:03 p.m., Representative Gary Davis arrived at 3:05
p.m., and Representative Brice arrived at 3:06 p.m.
REPRESENTATIVE THERRIAULT explained that changes occur on lines 19
and 20 on page 2 of HB 39, where the words collaborative physician
have been added. This is due to the fact that a mobile intensive
care paramedic or emergency medical technician works with a
consulting physician, but a physician's assistant works with a
collaborative physician.
Number 513
REPRESENTATIVE THERRIAULT discussed another change found on page 3,
line 13 of HB 39, where the words "properly performed by an
emergency medical technician" have been dropped. This was so the
statute would apply to anyone performing rescue efforts.
Number 568
REPRESENTATIVE THERRIAULT recalled that a member of the House HESS
committee asked him a question earlier in the day about page 2,
lines 10 and 11 of HB 39. The individual asked: If the authority
to pronounce death was granted if a physician was not available for
consultation by radio or telephone, did that authority to pronounce
death under HB 39 continue if a doctor was available by phone or
radio, or would resuscitation efforts have to continue fruitlessly?
REPRESENTATIVE THERRIAULT clarified that the doctor relieved the
rescuer from duty, meaning the doctor could tell the rescuer to
stop CPR, bring the person to where the physician was and the
doctor would pronounce the victim dead. The doctor is not able to
declare the person dead over the telephone or radio; he or she is
only relieving the rescuer of continued resuscitation efforts.
Number 666
CO-CHAIR TOOHEY asked if the extent of the injuries which made the
patient/victim incompatible with life would have to be relayed to
the doctor, therefore giving the doctor the ability to authorize
the end of resuscitation efforts.
REPRESENTATIVE THERRIAULT responded that under the terms of the
bill, if the rescuer is not in contact with a doctor, the power to
declare death would be extended to the rescuer. If contact is
achieved with the consulting official, the rescuer would explain
the circumstances and the doctor could then authorize the rescuer
to discontinue resuscitation.
Number 708
CO-CHAIR CON BUNDE moved that the committee use the Sponsor
Substitute for HB 39 as the working document. Representative Gary
Davis seconded the motion and it was passed without objection by
Co-Chair Toohey.
Number 742
REPRESENTATIVE NORMAN ROKEBERG said he questioned whether or not
there actually were remote places where a doctor could not be
reached for consultation by radio or phone.
Number 774
REPRESENTATIVE THERRIAULT responded that there are many places in
his district where accidents could occur and contact could not be
established. He continued that if CPR begins immediately, there is
no time to travel down the road in an attempt to establish contact
with an authorized physician. He reiterated that the power of the
rescuer to declare death is erased upon contact with an authorized
physician; however, the physician has the ability to relieve the
rescuer of his or her resuscitation efforts.
Number 833
REPRESENTATIVE ROKEBERG felt that the bill would be unnecessary if
contact could be established in all cases. But he now understood
the bill would be necessary if contact could not be established.
Number 861
CO-CHAIR BUNDE asked for testimony via teleconference and from
present witnesses.
Number 880
REPRESENTATIVE AL VEZEY asked Representative Therriault about the
fate of the bill after it was passed out of the House HESS
committee last year.
REPRESENTATIVE THERRIAULT responded that the bill made it to the
Senate Rules committee. He had to prioritize the four bills he had
in that committee. He felt that HB 39 was so noncontroversial it
would be passed out of that committee without incident. He
"miscalculated."
Number 917
CO-CHAIR TOOHEY called for testimony from Matt Anderson.
Number 932
MATT ANDERSON, Training Coordinator for the Emergency Medical
Services section within the Department of Health and Social
Services, spoke briefly in support of HB 39. He felt the bill will
do a great deal to help EMTs and paramedics, particularly in
outlying areas and small communities where establishing contact is
difficult. He added that those people preparing to testify from
the Mat-Su borough and Fairbanks will agree with him.
Number 966
CO-CHAIR TOOHEY recalled discussing state training guidelines last
year which would assist rescuers in establishing death.
MR. ANDERSON said he wasn't involved in that testimony but it was
clear some training would have to take place. An entirely new EMT
curriculum is being introduced throughout the state, and HB 39
would fit nicely into that new training curriculum. He felt that
a great deal of education could be accomplished throughout the
state in a very short time.
CO-CHAIR TOOHEY wanted assurance that the additional training would
not put further economic strain on the state. Mr. Anderson said it
would not.
Number 1016
MR. ANDERSON added that the bill has a zero fiscal note, and
communication would not be a problem as quick communication can
take place through a newsletter to about 4,000 people.
Number 1025
REPRESENTATIVE GARY DAVIS solicited comments on the deletion of the
words "the presence of post mortem lividity" on page 3, line 3 of
HB 39, as requested in a letter by Donald R. Lehmann, M.D.,
president of the Alaska State Medical Association.
MR. ANDERSON responded that he had not seen the letter before the
start of the committee meeting, and declaring a position on the
deletion was not within his scope of expertise. He did note that
the words in question had been an issue for some time. He
solicited comments from individuals at the teleconference sites.
Number 1070
REPRESENTATIVE DAVIS replied he was sure the sponsor of the bill
would provide an opinion on the matter and proceedings would
continue from there.
Number 1083
REPRESENTATIVE VEZEY recalled that he had concerns the last time
the bill was heard in the HESS Committee. He stated he had
difficulties finding people to train as EMTs. The training was
becoming increasingly technical and contained increasing legal and
health liabilities.
MR. ANDERSON responded that his training classes were always
completely full.
REPRESENTATIVE VEZEY asked if many people dropped out of training.
MR. ANDERSON replied that about 50 percent had dropped out by the
end of the first two years. After that level, the attrition
decreases sharply. Surveys to discover the cause of the attrition
revealed that most is caused by relocation or lack of time.
Indeed, some students were afraid of communicable diseases, but not
many. Mr. Anderson added that the legislature has been very good
to the Emergency Medical Service in terms of statutes such as AS
18.08.086, which provides immunity from liability for EMTs.
Number 1151
REPRESENTATIVE VEZEY wondered whether or not it was futile for the
legislature to describe the qualities of a dead person to an
emergency medical services provider. He questioned whether it was
beyond common sense to legally require that extra life saving
efforts be performed.
MR. ANDERSON said legally they were required to perform extra life
saving efforts. The duty of an emergency medical services provider
is to provide life saving practices until the rescuer is physically
exhausted, a physician declares the person dead or the patient and
rescuer arrive at a medical facility. Mr. Anderson felt this bill
would definitely benefit the majority of people. He also felt the
wording of the bill does a good job of taking the guess work out of
the declaration of death.
Number 1234
CO-CHAIR TOOHEY recounted that she had performed CPR on a dead
person and she was not legally allowed to stop until a physician
came on the scene. It was very difficult.
REPRESENTATIVE VEZEY questioned whether they were writing more
statutes to solve a problem that was created by a combination of
statutes and court decisions. He wondered if they should simply
look at eliminating the problem which was created.
Number 1270
MR. ANDERSON felt the current duty guidelines for resuscitation
efforts were standard, and he could not think of another way, other
than HB 39, to spare people from performing resuscitation efforts
in a futile situation.
REPRESENTATIVE VEZEY surmised that something could be added to the
statute as outrageous as "If the EMT thinks a person is dead...."
MR. ANDERSON felt that would result in many people expressing
concern over the consequences. It would put EMTs and others at
much more risk for litigation.
REPRESENTATIVE VEZEY asked if that problem would be solved if
something was added about absolution from liabilities.
MR. ANDERSON responded that standards by which decisions about
death were made would have to be present, and such standards exist
currently in HB 39. Medical directors would not want people
arbitrarily making decisions on life and death based simply on
judgment. Specific criteria would be necessary.
Number 1350
ELLEN WOFFORD, Trainer, Delta Junction Rescue, spoke via
teleconference on behalf of the Delta Rescue Squad in support of HB
39.
Number 1371
GARY JUDD, an emergency medical technician in Barrow, Alaska,
testified via teleconference and expressed support for HB 39 on
behalf of the emergency services workers of the North Slope
Borough. He felt the bill would alleviate many problems for
emergency workers in very rural areas. He asserted that in many
rural areas it is very seldom that radio or telephone contact can
be established with physicians. The toll extended resuscitation
efforts takes on providers is great. He felt the bill constituted
good judgment and applauded the committee's support of this bill.
Number 1438
CRAIG LEWIS, of the Alaska Emergency Medical Services Association
and the Interior Region Emergency Medical Services Inc., testified
on behalf of those groups via teleconference from Fairbanks. He
felt the bill was sound and competent. He reiterated previous
testimony that establishing contact with physicians is very
difficult in outlying and rural areas. In such a situation, the
relatives of the deceased are traumatized, the competence of the
EMT is questioned and the EMT often questions his or her ability to
save lives. A dead person, according to the criteria in the bill,
should be treated as if they are dead, not alive. He hoped the
bill would again pass out of committee.
Number 1518
CO-CHAIR BUNDE asked those testifying via teleconference to comment
on the letter written by Dr. Lehmann and the deletions he
recommended. The letter says the members of the Alaska State
Medical Association oppose any dilution of the clear guidelines
listed in Section 2 of this bill. Some members also have expressed
concern and request that line 3 of page 3, item C, the presence of
post mortem lividity, be deleted. They feel that pathologists feel
this criteria can be problematic and should not be used by EMTs in
the field as a signifier of death.
Number 1597
MS. WOFFORD responded via teleconference that post mortem lividity
is a clear indicator of death, and the criteria should be left in
the bill.
Number 1619
MR. JUDD also felt the bill should be left as is. Post mortem
lividity is identifiable and would probably not be as large an
issue as the letter implies.
MR. LEWIS testified that he remembered this discussion from last
year. Many scientists feel the need to criticize semantics and
language and science, and practicality should be separated in this
case. Post mortem lividity may not stand alone as the singular
indicator of death, it may be in a list of indicators. However,
some living individuals may exhibit this state and in that case, he
would encourage training for emergency medical service providers on
post mortem lividity.
Number 1698
GREG BARCLAY, Central Emergency Services, Soldotna, was called upon
by Co-Chair Toohey to comment via teleconference on the section
concerning post mortem lividity. He was very supportive of the
bill, but wished to let a present physician testify concerning post
mortem lividity.
Number 1730
DR. WILLIAM COOPER, Medical Director of Central Emergency Services
and emergency physician, testified via teleconference that he has
been in Alaska for 12 years dealing with paramedics and emergency
services. He felt the bill was long overdue for all the reasons
stated by those testifying before him. He reiterated there were
many remote areas in the Kenai Peninsula and many areas were
unreachable by radio and telephone. He felt it was pragmatically
impossible to get patients from these places to areas where
consultation could be achieved.
DR. COOPER continued that those conditions place a large burden on
EMTs. The resuscitation times stipulated in the bill for cold
water drowning were very reasonable, and Dr. Cooper applauded the
bill. Concerning post mortem lividity, he said the determination
of death involves many criteria including pupil response,
respiration, and monitored responses to resuscitation. He would
not place much emphasis on that one line. He felt that whether
that line was included in the bill or not was not as important as
the whole bill being passed.
Number 1822
CO-CHAIR TOOHEY asked for a definition of post mortem lividity from
the doctor.
DR. COOPER explained that post mortem lividity occurs when
circulation ceases and gravity settles the blood into the
appendages of the body. It looks like a bluish area. Most EMTs
recognize this as an indicator that a person has been dead for any
length of time. When this state appears is variable according to
temperature and conditions. He reiterated his confidence that all
emergency medical service providers he has dealt with could deal
with post mortem lividity effectively.
REPRESENTATIVE ROKEBERG asked Dr. Cooper to repeat his comfort with
the times established in the bill for resuscitation efforts.
DR. COOPER responded that he realized there is some controversy
about those times, especially in the areas of hypothermia and cold
water near-drowning. However 60 minutes, along with the
temperature level of the individual, is what he uses to base his
resuscitation times upon. By and large, the training of Alaskan
EMTs is such that they are well aware of these situations.
REPRESENTATIVE ROKEBERG also questioned if 30 minutes was
reasonable concerning pulmonary resuscitation as it relates to
cardiac arrest.
DR. COOPER felt that actually, if a person who had a normal body
temperature did not respond in 10 or 15 minutes, he or she was not
going to respond. Thirty minutes provided plenty of response time.
REPRESENTATIVE ROKEBERG asked about cases in which a person had
been submerged in cold water, and what was a reasonable length of
time to attempt resuscitation.
DR. COOPER answered in such a case, resuscitation will be attempted
for 60 minutes. He assured the committee that training teaches
rescuers that circumstances may extend that time period. Sixty
minutes is simply a guideline. The EMTs he is associated with
would not stop resuscitation efforts at an exact set time if they
felt there was a chance to save a life.
Number 2008
ROCKY ANSELL, EMT, Copper River Medical Services, testified via
teleconference from Glennallen. Testifying as an EMT in rural
Alaska where response times may be quite extensive, he supported HB
39. He also had been involved in futile resuscitation efforts and
had he been able to pronounce death legally, it would have been a
blessing; not only to him but to the family members and the entire
medical team. The family members knew their loved one was
deceased, and if death could have been pronounced, the grieving
process could have begun. As it was, the entire family was further
traumatized by the actions of the medical responders who were doing
their job as prescribed by the current law.
MR. ANSELL continued that such a situation is unacceptable in
Glennallen. He added that the section on post mortem lividity
should be left in the bill, as it is just one of the many signs of
death. He assured the committee that if a medical responder has
any doubt about whether death has occurred, he or she attempts
resuscitation.
Number 2080
JACK HEESCH, President of the J.R. Heesch Company, and lobbyist for
the Alaska Academy of Physician Assistants testified in person. He
read into the record a letter which stated: "The Alaska Academy of
Physician Assistants is in support of HB 39. This bill will give
the authority to physician's assistants to pronounce death. While
in urban areas, where physicians, coroners and law enforcement
personnel are available, pronouncement of death is not generally a
problem. But since our state is mainly rural and these personnel
are often not available in the bush, it has become an issue. A
number of villages and remote industrial sites have physician
assistants available to perform the duty of pronouncement of death.
Please give your support for the bill. Thank you."
CO-CHAIR TOOHEY asked for any further testimony from the audience.
Number 2117
REPRESENTATIVE TOM BRICE asked for clarification from
Representative Therriault on the sectional analysis. He asked if
it corresponds to the committee substitute bill or to the original
HB 39.
REPRESENTATIVE THERRIAULT responded that the sectional analysis was
to the original bill. He felt it should still apply.
CO-CHAIR TOOHEY closed the bill to public testimony and asked for
the pleasure of the committee.
Number 2140
CO-CHAIR BUNDE moved that CSHB 39 be passed from the HESS committee
with the accompanying zero fiscal note onto the next committee of
referral. Hearing no discussion, Co-Chair Toohey announced that
the bill had been passed out of the committee.
ADJOURNMENT
CO-CHAIR TOOHEY adjourned the meeting at 3:46 p.m.
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