Legislature(1995 - 1996)
04/09/1996 03:10 PM House HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE April 9, 1996 3:10 p.m. MEMBERS PRESENT Representative Cynthia Toohey, Co-Chair Representative Con Bunde, Co-Chair Representative Gary Davis Representative Norman Rokeberg Representative Caren Robinson Representative Tom Brice Representative Al Vezey MEMBERS ABSENT None COMMITTEE CALENDAR CS FOR SENATE BILL NO. 165(L&C) "An Act relating to psychologists and psychological associates." - SUBCOMMITTEE APPOINTED CS FOR SENATE BILL NO. 91(HES) "An Act creating the crime of criminal transmission of human immunodeficiency virus (HIV)." - HEARD AND HELD CS FOR SENATE BILL NO. 158(L&C) am "An Act relating to pharmacists and pharmacies." - SCHEDULED BUT NOT HEARD CS FOR SENATE BILL NO. 259(FIN) "An Act extending the termination date of the Alaska Commission on Aging; and providing for an effective date." - SCHEDULED BUT NOT HEARD PREVIOUS ACTION BILL: SB 165 SHORT TITLE: PSYCHOLOGISTS & PSYCHOLOGICAL ASSOCIATES SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES BY REQUEST JRN-DATE JRN-PG ACTION 04/25/95 1230 (S) READ THE FIRST TIME - REFERRAL(S) 04/25/95 1230 (S) HES, L&C 01/17/96 (S) HES AT 9:00 AM BUTROVICH ROOM 205 01/17/96 (S) MINUTE(HES) 01/18/96 2166 (S) HES RPT CS 4DP SAME TITLE 01/18/96 2166 (S) ZERO FISCAL NOTE TO SB & CS (DCED) 01/30/96 (S) L&C AT 1:30 PM FAHRENKAMP RM 203 01/30/96 (S) MINUTE(L&C) 01/31/96 2262 (S) L&C RPT CS 2DP 2NR SAME TITLE 01/31/96 2262 (S) PREVIOUS ZERO FISCAL NOTE (DCED) 02/02/96 (S) RLS AT 10:15 AM FAHRENKAMP RM 203 02/02/96 (S) MINUTE(RLS) 02/07/96 2324 (S) RULES TO CALENDAR 2/9/96 02/09/96 2359 (S) READ THE SECOND TIME 02/09/96 2359 (S) L&C CS ADOPTED UNAN CONSENT 02/09/96 2359 (S) ADVANCED TO THIRD READING UNAN CONSENT 02/09/96 2359 (S) READ THE THIRD TIME CSSB 165(L&C) 02/09/96 2360 (S) PASSED Y19 N0 E1 02/09/96 2363 (S) TRANSMITTED TO (H) 02/12/96 2718 (H) READ THE FIRST TIME - REFERRAL(S) 02/12/96 2718 (H) HEALTH,EDUCATION AND SOCIAL SERVICES 04/02/96 (H) HES AT 3:00 PM CAPITOL 106 04/02/96 (H) MINUTE(HES) 04/04/96 (H) HES AT 3:00 PM CAPITOL 106 04/04/96 (H) MINUTES(HES) 04/09/96 (H) HES AT 3:00 PM CAPITOL 106 BILL: SB 91 SHORT TITLE: CRIMINAL TRANSMISSION OF HIV SPONSOR(S): SENATOR(S) TAYLOR,Halford JRN-DATE JRN-PG ACTION 02/20/95 331 (S) READ THE FIRST TIME - REFERRAL(S) 02/20/95 331 (S) HES, JUD 03/08/95 (S) HES AT 9:00 AM BUTROVICH RM 205 03/08/95 (S) MINUTE(HES) 03/10/95 (S) MINUTE(HES) 03/10/95 577 (S) HES RPT CS 3DP SAME TITLE 03/10/95 577 (S) ZERO FISCAL NOTES (ADM, LAW) 03/20/95 (S) JUD AT 1:30 PM BELTZ ROOM 211 03/20/95 (S) MINUTE(JUD) 03/21/95 720 (S) JUD RPT 3DP 1DNP (HES)CS 03/21/95 720 (S) PREVIOUS ZERO FNS (ADM, LAW) 03/22/95 (S) RLS AT 12:30 PM FAHRENKAMP RM 203 03/22/95 (S) MINUTE(RLS) 03/24/95 790 (S) RLS RPT 3CAL 2DNCAL CALENDAR 3/27 03/27/95 790 (S) READ THE SECOND TIME 03/27/95 790 (S) HES CS ADOPTED UNAN CONSENT 03/27/95 791 (S) ADVANCE TO 3RD RDG FLD Y11 N7 E2 03/27/95 791 (S) THIRD READING 3/28 CALENDAR 03/28/95 824 (S) READ THE THIRD TIME CSSB 91(HES) 03/28/95 824 (S) PASSED Y13 N7 03/28/95 824 (S) ZHAROFF NOTICE OF RECONSIDERATION 03/30/95 850 (S) RECONSIDERATION NOT TAKEN UP 03/30/95 851 (S) TRANSMITTED TO (H) 04/05/95 1015 (H) READ THE FIRST TIME - REFERRAL(S) 04/05/95 1015 (H) HES, JUDICIARY 04/09/96 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER DR. ROBB STOKES P.O. Box 20949 Juneau, Alaska 99802 Telephone: (907) 586-3580 POSITION STATEMENT: Testified on CSSB 165(L&C) SUSAN BAXTER 1007 West 3rd Street, Suite 301 Anchorage, Alaska 99501 Telephone: (907) 272-0155 POSITION STATEMENT: Testified in support of CSSB 165(L&C) SHEILA CLARSON P.O. Box 671634 Chugiak, Alaska 99567 Telephone: (907) 688-6404 POSITION STATEMENT: Testified in support of CSSB 165(L&C) KATHRYN CARSSOW 1335 O Street Anchorage, Alaska 99501 Telephone: (907) 274-7909 POSITION STATEMENT: Testified in support of CSSB 165(L&C) ALLEN MOMA P.O. Box 231453 Anchorage, Alaska 99523 Telephone: (907) 562-1846 POSITION STATEMENT: Testified on CSSB 165(L&C) KAREN FORREST 408 Gold Street Juneau, Alaska 99801 Telephone: (907) 463-1536 POSITION STATEMENT: Testified on CSSB 165(L&C) KAREN GIBSON P.O. Box 110623 Anchorage, Alaska 99511 Telephone: (907) 346-1986 POSITION STATEMENT: Testified in support of CSSB 165(L&C) CATHERINE REARDON, Director Division of Occupational Licensing Department of Commerce & Economic Development P.O. Box 110806 Juneau, Alaska 99811-0806 Telephone: (907) 465-2534 POSITION STATEMENT: Testified on CSSB 165(L&C) JERRY REINWAND, Lobbyist Blue Cross of Washington & Alaska 2 Marine Way, Number 219 Juneau, Alaska 99801 Telephone: (907) 586-8966 POSITION STATEMENT: Testified on CSSB 165(L&C) SHARON MACKLIN, Lobbyist Alaska Psychological Association 315 5th Street, Number 8 Juneau, Alaska 99801 Telephone: (907) 586-9518 POSITION STATEMENT: Testified on CSSB 165(L&C) BARBARA GABIER, Program Coordinator Division of Occupational Licensing Department of Commerce & Economic Development P.O. Box 110806 Juneau, Alaska 99811-0806 Telephone: (907) 465-2572 POSITION STATEMENT: Answered questions on CSSB 165(L&C) JENNIFER JONES 2453 West 27th Avenue Anchorage, Alaska 99517 Telephone: (907) 243-2868 POSITION STATEMENT: Testified on CSSB 165(L&C) SENATOR ROBIN TAYLOR Alaska State Legislature Capitol Building, Room 30 Juneau, Alaska 99801-1182 Telephone: (907) 465-4906 POSITION STATEMENT: Prime sponsor of SB 91 BARBARA BRINK, Attorney Alaska Public Defender Agency 900 West 5th Avenue, Number 200 Anchorage, Alaska 99501 Telephone: (907) 264-4400 POSITION STATEMENT: Testified on CSSB 91(HES) AMY EILERTSEN, Director Stop AIDS Project 520 East 4th Avenue Anchorage, Alaska 99501 Telephone: (907) 278-5019 POSITION STATEMENT: Testified on CSSB 91(HES) JOHN MIDDAUGH, MD., Chief Epidemiology Section Division of Public Health Department of Health & Social Services P.O. Box 240249 Anchorage, Alaska 99524-0249 Telephone: (907) 561-4406 POSITION STATEMENT: Testified in opposition to CSSB 91(HES) JAYNE ANDREEN, Executive Director Council on Domestic Violence & Sexual Assault Department of Public Safety P.O. Box 111200 Juneau, Alaska 99811-1200 Telephone: (907) 465-4356 POSITION STATEMENT: Testified in opposition to CSSB 91(HES) LYNN STIMLER, Executive Director American Civil Liberties Union of Alaska P.O. Box 201844 Anchorage, Alaska 99520 Telephone: (907) 258-0044 POSITION STATEMENT: Testified in opposition to CSSB 91(HES) RACHEL KING, Board Member Alaskan AIDS Assistance Association West Fireweed Lane Anchorage, Alaska 99501 Telephone: (907) 276-3989 POSITION STATEMENT: Testified on CSSB 91(HES) ANNE CARPENETI, Assistant Attorney General Criminal Division Department of Law P.O. Box 110300 Juneau, Alaska 99811-0300 Telephone: (907) 465-3428 POSITION STATEMENT: Testified in opposition to CSSB 91(HES) ACTION NARRATIVE TAPE 96-37, SIDE A Number 001 The House Health, Education and Social Services Standing Committee was called to order by Co-Chair Con Bunde at 3:10 p.m. Members present at the call to order were Representatives Bunde, Toohey, Rokeberg, Robinson and Vezey. Members absent were Representatives G. Davis and Representative Brice. A quorum was present to conduct business. CO-CHAIR BUNDE announced the calendar for the meeting was CSSB 165(L&C), "An Act relating to psychologists and psychological associates"; CSSB 91(HES), "An Act creating the crime of criminal transmission of human immunodeficiency virus (HIV)"; SB 158, "An Act relating to pharmacists and pharmacies;" and SB 259, "An Act extending the termination date of the Alaska Commission on Aging; and providing for an effective date." CSSB 165(L&C) - PSYCHOLOGISTS & PSYCHOLOGICAL ASSOCIATES CO-CHAIR BUNDE said this was the second hearing on CSSB 165(L&C) and asked Dr. Stokes to come forward to testify. Number 088 DR. ROBB STOKES said the committee had requested he obtain the recommendations of other board members with respect to the length of supervision required. The licensing examiner, Wanda Fleming, was able to get three responses which constitutes a quorum of the board. One board member recommends two years of licensed practice which means three years pre-license, licensure, two years and then petition the board. He noted that current statute requires a person to petition the board, even with the five years. The Chair of the board recommends one year; three years pre-license, supervision for one year post license and then the person would be independent. CO-CHAIR BUNDE asked if that would be independent without petitioning the board? DR. STOKES said the individual has to petition the board in all cases. He stated his recommendation was to leave it at three years pre-license and allow a person to petition the board when they become licensed. It ranges from two, one to zero post license. CO-CHAIR TOOHEY questioned if he is the only board member who agrees with that, what chance does a person have petitioning the board? DR. STOKES replied in his opinion, a very good chance because the board is very flexible. He added that 99 percent of psychological associates who apply, including psychologists, are rejected because they don't have adequate course work as delineated in statute. Plans are set up for these individuals and they complete those plans. If an individual lacks certain courses but can demonstrate they have met the criteria for the course work by presenting a syllabus or a letter from their instructor, the board will accept it. He added that 99 percent of the psychological associates that are rejected because they don't have the course work, do just that. REPRESENTATIVE TOM BRICE arrived at 3:12 p.m. CO-CHAIR BUNDE inquired if 99 percent of the people who petition the board are rejected. DR. STOKES said no, the board does everything they can and 99 percent of those rejected will do whatever needs to be done to get their license. He commented that the committee had not heard testimony from those individuals, but has heard testimony from the other 1 percent. CO-CHAIR BUNDE asked of the people who petition, how many are rejected? DR. STOKES said 50 percent, including psychologists. He added there was no difference in psychologists or psychological associates in terms of rejecting applications and it's almost always because the person doesn't have the course work required by statute. CO-CHAIR BUNDE clarified that of the 50 percent that get rejected, the majority of those individuals are given a remedial course of action, are able to meet the criteria and are then accepted. DR. STOKES responded that was correct and the board is very lenient in setting up plans for them and those people do get licensed. CO-CHAIR BUNDE asked if it was correct that of the people who apply for licenses, 90 percent are licensed? DR. STOKES reiterated if those individuals choose to go back and meet the requirements. CO-CHAIR TOOHEY asked why a student would go to a school that wasn't following the criteria of the Board of Psychological Associates? Also, why would Postsecondary Education allow a student to get a student loan and go to a school that does not meet the academic standards for licensure? DR. STOKES said that was an excellent question and one that has been raised in the past. He explained there is no connection between the university and the board. One of the big problems is that students do not read the statutes and the requirements before they apply. Dr. Kappes, Chair of the Board, has been able to get two courses approved and they will now be taught at the University of Alaska, so psychological associates can meet those requirements. The one course that has been in people's way is called Human Development which Dr. Stokes took as an undergraduate, as do most people. He said he has tried to get that course out because it has stood in the way of almost every psychological associate who has applied, but he has been voted down. However, if students are able to show they have met what the board considers adequate understanding in human development in their course work, the board will grant it. CO-CHAIR TOOHEY said this was appalling to her. She is a nurse who went to school in Alaska, applied for a nursing degree, took the required courses at school, got her degree, took the state board exams and became a practicing nurse. She asked why there is such a breakdown in the psychological field? DR. STOKES commented that the board gets applications from schools all over the country, but he didn't know why there was a breakdown. He added the board is held to the statutes that were in place before they became members of the board. CO-CHAIR BUNDE suggested that perhaps some of the students in Alaska's program would be testifying and the committee could find out if they have the same problems. He said it is kind of illogical to think that an Alaskan school would not meet the Alaska requirements. Number 607 DR. STOKES gave the committee some history to point out his advocacy because it was being alleged that since he had the intelligence and the motivation to get a Ph.D. and do the eight years somehow that was negative. When he applied for licensure the requirement was one year, then licensed, and supervised for the rest of your life. During that time period, it was changed to three years. He petitioned the board to allow him to do the one year, but he was turned down. He and another psychological associate found that untenable and through Senator Fahrenkamp were able to get legislation passed for the five years in order to get independence. He commented that he has worked towards getting psychological associates more independent, not the other way around. CO-CHAIR BUNDE confirmed Dr. Stokes' testimony was that the current bill says three years before licensure, two years after licensure. DR. STOKES interjected the bill before the committee states two years before licensure, take the exams, and then the person is independent. CO-CHAIR BUNDE asked if Dr. Stokes was recommending three years, take the exam and then become independent. DR. STOKES confirmed that and added another board member is recommending take the exam, one year and then become independent; another board member recommends three years, take the exam and then two years. That brings it to an average of one year post getting the degree. He reiterated his recommendation of three years and to get rid of the five years totally. CO-CHAIR TOOHEY asked if three years post was correct? DR. STOKES replied no, it was three years pre-licensure. CO-CHAIR TOOHEY remarked it was three years pre- and one year post, for a total of four years. DR. STOKES stated that was correct. CO-CHAIR BUNDE explained that was only one board member's contention. DR. STOKES pointed out his contention was to get rid of the five years, petition the board and then independence. CO-CHAIR TOOHEY commented that she had lost faith in the board's ability to go back to what she thinks is reasonable. It is her belief that eight years supervision for anyone with a master's degree was ludicrous. Her recommendation was that the board come up with regulations outlining what course work was required and either the schools follow that criteria or they don't get the students. DR. STOKES reiterated that the board is held to the existing statutes and in the four years he has served on the board, to his knowledge the board has never rejected a petition. He added that at the last board meeting there were two petitions by people who had completed the five years and the board granted them independence. CO-CHAIR TOOHEY said she believed there had been testimony at the last meeting that there were 400 people who had graduated and were waiting for their license. DR. STOKES recalled the testimony indicated there were 400 people who had graduated, but only a small amount had applied for licensure. CO-CHAIR BUNDE commented there were people on teleconference waiting to testify. SUSAN BAXTER testified via teleconference from Anchorage that she was licensed in December 1995 after a fairly long process. When she applied to the board the first time for the examination, she was refused. In the process she sought specific guidance from the board in terms of what she might be able to do to meet the requirements. Specifically, the requirement that she lacked was course work at the graduate level in human development. There were no classes available in the state of Alaska at that time in human development; however, the university had taken some steps to infuse that (indisc.) in other courses, so the university felt at that time they were meeting that requirement; however, the board did not recognize that course work. She went through a rather significant process to inform the board of her own qualifications and the course work she had received. Because she had worked in the field of early childhood during her three years supervision, the board found her qualified. She did, however, express concern that the board had requirements which were not possible by their own interpretations. She shares the concerns about the interaction between the university program and the board's interpretation of what (indisc.). There are a number of students caught in the same situation that she was; a change in interpretation of the statute from the previous board to the present board. MS. BAXTER said in terms of supervision, she is now licensed but she had an extra year of supervision which gave her a total of four years supervision. The one year does not count however because the period of time that counts begins at the time the license is issued, so even though she has four years of supervision now, she still has to do an additional five years. Number 1057 CO-CHAIR BUNDE asked if it would be fair to characterize Ms. Baxter's position as supporting the bill in its current form? MS. BAXTER replied yes. Number 1072 SHEILA CLARSON testified via teleconference from Anchorage that she is a licensed psychologist at the Ph.D. level, currently in private practice in Anchorage and secretary of the Alaska Psychological Association. She testified in support of CSHB 165(L&C) and she wished to testify from the perspective of the impact on the rural mental health programs. From 1988-1994, she was employed as the chief psychologist for the Alaska Area Native Health Service and her job was to provide support, technical assistance and training in the development of mental health programs around the state. A major issue had to do with the problems created by the fact that mental health programs in the Bush could not hire master's level psychologists as easily as they could hire social workers or nurse practitioners because it was so much more difficult for the people with a masters in psychology to be licensed as psychological associates. People who wish to work in the rural region and have a masters in psychology from a program, for example at the University of Alaska Anchorage, are at a disadvantage if they do wish to be employed in the Bush because social workers and psychiatric nurse practitioners can be licensed after two years. From the perspective of the mental health programs, in many cases the individual who was thought to be the best person for the job was not licensed and needed to work under supervision because they were a master's level psychologist (indisc.) so a social worker or a nurse practitioner would be hired instead. Her reason for supporting this bill is that she believes it brings master's level practitioners in line with other mental health practitioners like social workers and psychiatric nurse practitioners. She believes that's fair and it provides additional resources to rural mental health programs that want to hire those people. CO-CHAIR BUNDE asked if Ms. Clarson felt the bill as currently written is adequate with two years of supervised practice? MS. CLARSON responded yes, she did. CO-CHAIR BUNDE asked if there were any questions of the witness. Hearing none, he invited Kathryn Carssow to testify. Number 1291 KATHRYN CARSSOW testified via teleconference from Anchorage that she has a master's level degree in clinical psychology and wanted to address a couple of points raised by Dr. Stokes. First, the course work issue regarding psychological associates and the board is a very hot issue presently and is of deep concern to her. However, she didn't feel that was what this bill was about. She believes the board will be taken care of. The Governor's Office has listened to the tapes from the last two board meetings and inasmuch as the board is up for reappointment she is not concerned about that issue because she thinks a reasonable board will take care of it in a fair and just way. This bill has been in front of individual board members as well as the full group for over six months and she feels the inconsistent input on how to change the years of supervision is a little late and poorly done. She said it is representative of this board of not being flexible and felt the board is impulsive, arbitrary and hostile towards the master's level psychological associates. She expressed her disappointment with the board in the way it is reacting. She concluded that she supports CSHB 165. CO-CHAIR BUNDE asked if it was Ms. Carssow's position that the board of which a member teaches the psychological associate program at UAA is hostile to their own students? MS. CARSSOW responded in the affirmative. She added it was her personal feeling that over the years there has been a difference on the faculty, but when she entered the program she had a written statement that said this University of Alaska clinical psychology program, of all the programs provided in the state, was the only one that had a curriculum which provided that students be eligible to sit for licensing. She believed the board was aware of that curriculum and was supportive of it. The university was acting in good faith with a program that in terms of cultural diversity and human development those requirements were infused very purposefully and very thoughtfully in the curriculum. She has a letter from the Dean's Office supporting that approach. Suddenly, a year ago last fall, the board re-interpreted its regulations and started requesting that students go back and get these courses, one of which, human development, was not even provided. The Chair of the board sits on the graduate study committee. She sat in his classes as a graduate student. He also was part of her graduate student orientation and never once did he indicate to her that she may not be eligible for licensure. Instead, she had a written statement that she would be eligible for licensure. She added that it had been insinuated that she had asked to sit for licensing, but in fact she cannot ask to sit for the examination until she has three years of supervision. CO-CHAIR TOOHEY asked if the University of Alaska Anchorage program was accredited by the American Psychological Association? MS. CARSSOW said she would let Mr. Moma answer that question. Number 1463 ALLEN MOMA, Alaska Psychological Association and Co-Chair of the committee that originated this bill, testified the American Psychological Association (APA) does not endorse or certify master's level programs; they only certify doctoral level programs. Currently, the master's level program at UAA is in the process of gaining certification from the North American Association of Master's Level Programs, which he surmised would be in place in the next year or two. He added the UAA does have certification at the university and their product is such that it has been certified by the Collegiate Certification Board (indisc.). CO-CHAIR BUNDE said he understood that, and asked if that qualifies them to teach psychology. MR. MOMA responded that was correct. CO-CHAIR BUNDE asked Karen Forrest to come forward to testify. Number 1540 KAREN FORREST testified that she has a masters degree in clinical and counseling psychology, is working toward licensure as a psychological associate under Dr. Stokes and has two years supervision in at the present time. CO-CHAIR BUNDE asked where she had gone to school? MS. FORREST replied Western Washington University in Bellingham. She said it appeared the biggest controversy focused on the number of years for licensing. She noted a comparison had been made to teachers and how much supervision they might need and urged the committee to look at more similar fields such as clinical social work and marriage and family therapists. She distributed information she had received from the Division of Occupational Licensing on the requirements and the scope of practice for psychological associates, social workers and marriage and family therapists. It seemed like the main defense against the bill was that the scope of practice for a psychological associate was much more extensive. She noted that it is different and asked the committee to review the different scopes of practice and make their own decision in terms of depth of practice. She encouraged the committee in making the decision to think about the purpose of the license; if it is to protect the public, she wasn't sure that more supervision after the two years is going to protect the public. She said she knew of a tremendous number of people who were not seeking licensure at all, and don't fall under the regulations, because of the overwhelming procedure. CO-CHAIR BUNDE asked why it is that people don't realize before they pursue their degree what a seemingly onerous challenge it is to become licensed as a psychological associate. MS. FORREST thought that people begin graduate studies for different purposes. In her particular case, she did not begin graduate studies for the purpose of being a full time therapist in this field, but rather for her own personal reasons, interests and intellectual stimulation. She realized after going through the program, this is what she would like to do. She added there is a lack of consistency between programs throughout the country and licensing requirements in different states. She could have become licensed much more easily in the state of Washington than in Alaska. CO-CHAIR BUNDE asked if Washington has reciprocity with other states? MS. FORREST said she could have stayed and sought licensure there and there would have been reciprocity, but she was born and raised in Juneau and didn't want to give up her Alaska residency. CO-CHAIR BUNDE asked if it was fair to say that people who seek the degree and then choose not to work in the field or not to seek licensure are not necessarily seeking licensure because of the onerous requirements, but because they have chosen to study in that field and will apply it somewhere else or for self-fulfillment. MS. FORREST imagined there were other people like that; she started taking the program for those reasons, but she was aware of a tremendous number of people who had gone through master's level programs and may qualify in another state, but are not seeking licensure in Alaska because of the tremendous procedures involved. Number 1759 REPRESENTATIVE ROBINSON asked Ms. Forrest if she knew what the rules were in Washington State? MS. FORREST stated when she went through the program, it was her understanding there was a grandfather clause that would have allowed her to take the exam when she graduated, but it was being changed to two years of supervision, take the exam and then be independent. Number 1799 KAREN GIBSON testified in support of the legislation as it is written. She noted this bill has received the support of the professional psychology organization. Their subcommittee drafted the bill so the body that represents all the psychologists in the state, whether licensed or not, support it and both universities in Anchorage support it. CO-CHAIR BUNDE asked if it was the psychologists or psychological associates who supported the bill? MS. GIBSON responded that both can be members of the Alaska Psychological Association. She continued that the major thrust of this bill is to seek parity and noted the information before the committee shows the education and supervisory experience required before licensure; however, what it doesn't show is that the educational requirements are different. For example, at UAA a person has to have at least 1,000 hours of supervised clinical experience before graduation even though it's not in statute. The practicum at the university is videotaped for the student and everyone else to critique. To become a licensed social worker, their statutes state that a person only needs a masters degree, but to become a psychological associate a person needs a masters degrees, but it specifies a minimum of 48 semester hours and certain areas must be covered. A person only needs 33 hours to be a licensed marital and family therapist. Even though the bill is seeking some parity in the amount of time after graduation, people who have a masters degree in psychology have received far more training than the other disciplines which are the only comparable disciplines for licensure. That was the point she wanted to stress. Number 1889 REPRESENTATIVE AL VEZEY said he would characterize 33 hours as one academic year. MS. GIBSON responded it would be a tough academic year, but it could be done. REPRESENTATIVE VEZEY commented that he would characterize 48 hours as one and one-half year. MS. GIBSON said it's a two and one-half year program. A person has to do 20 hours a week for a year in a site and there has to be a certain amount of course work before beginning clinical work. The 48-hour program at UAA, which the degree is a 50-hour minimum, takes at least two and one-half years because of the timing of the courses. CO-CHAIR BUNDE asked Mike Tibbles to apprise the committee of the insurance issues that were raised at the last hearing. Catherine Reardon joined Mr. Tibbles at the witness table to discuss the insurance questions. Number 1946 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Commerce & Economic Development, testified she had requested that a person from the Division of Insurance be available to provide some backup information; however, that person was not prepared to testify. CO-CHAIR BUNDE asked what the resolution was to the question that had been raised at the last hearing on the bill. MS. REARDON said having not been present at the last hearing, her understanding was the question related to insurance reimbursements for psychological associates versus psychologists; specifically can the psychological associate bill at the same rate even though a psychologist may have more training than the psychological associate. She stated that both psychologists and psychological associates already appear in the nondiscrimination section of the insurance statutes which indicates that providers can't be discriminated among. She noted that was the same section of statute that was of concern with the physician assistants legislation. It is her understanding that generally insurance companies reimburse for a specific procedure; in this case for mental health care it could be for counseling, and that insurance companies tend to set a standard and customary rate for that procedure or treatment and not to distinguish between which licensed health care professional provides it. When she asked the question if insurance companies could choose to reimburse different amounts depending on which type of licensee provided the service, the answer as she understands it is that it has never been tested in court and perhaps the theory that the treatment is not identical if it is provided by someone with a different background education could be used as an argument for different standard and customary rates. CO-CHAIR TOOHEY believed the committee was given a totally different answer at the last hearing. She felt it was dishonest to be treated by a psychological associate and billed at the rate for a psychologist. She believed it was important that the issue be addressed, particularly at a time when attempts are being made to lower the cost of medical care. The other issue is why should a person become a psychologist when you can get the same fee for being a psychological associate. REPRESENTATIVE GARY DAVIS arrived at 3:50 p.m. Number 2117 REPRESENTATIVE VEZEY said this all points to Title 21 dealing with the insurance discrimination statutes. He noted that two years ago the statute was changed so direct entry mid-wives couldn't be discriminated against and four years ago psychologists, psychological associates and licensed clinical workers were added to that statute. It appeared to him the problem some people were having with the bill was not whether these people could be licensed in two, four or five years, but rather what kind of financial burden would it be compelling the group insurance providers to pay for this service by granting them this license privilege in connection with an anti-discrimination statute. MS. REARDON said she didn't believe this bill would change the situation concerning billing. She explained the state doesn't set the rates health care providers can charge and she assumed the legislature didn't want to get into how much different professionals could charge for their services. In terms of the reimbursement, a professional can charge whatever he/she wants and then the amount that would be reimbursed is up to the insurance policy. Even if the psychologists and psychological associates were removed from the non-discrimination statute, all that would happen is their patients would have to pay for the service out of their pockets. She wasn't sure it would necessarily result in the type of distinguishing between the different professionals in terms of their billings that was being discussed. CO-CHAIR BUNDE commented that an individual had called him earlier and expressed some serious concerns that the insurance companies were really practicing medicine because they were deciding, in essence de facto, by what service they would cover and how much they would pay. The individual offered that perhaps if the non- discrimination clause was deleted, the insurance companies may quit practicing medicine. Number 2234 CO-CHAIR TOOHEY asked what the point was of having the non- discrimination list if the insurance companies were not taking advantage of it? If the insurance companies are paying a fee for a particular service, regardless of who provides the service, she questioned whose responsibility it was to cut the cost of medicine? She maintained it is each persons's responsibility to oversee it and when a particular service is being provided, a person should demand that it be provided by a nurse or physician assistant for example, because it will be cheaper. She believed the Division of Insurance should be looking at those things. Number 2275 JERRY REINWAND, Lobbyist for Blue Cross of Washington & Alaska, said he really hadn't intended to create a problem by raising the question at the last hearing, but he did think there was an underlying issue that gets to the unfair discrimination issue and that's why he had asked the question, "Can, for example, if we get a bill for the same scope of service from somebody who charges $500 an hour or the same person arguably is providing the same scope of service for $50 an hour and under the unfair discrimination statute, which -- can we say we don't pay the $50 and we can pay the $500 one?" In all fairness to the Division of Insurance, he said it was a huge gray area and the division is looking at this very question. His specific question last week was, "Does this bill in any way open the flood gate a little bit more so that because of the unfair discrimination statute that psychologists, psychological associates and clinical social workers are now on the books for, does that somehow increase costs to either the state and/or insurance companies and ultimately policy holders?" He does believe there is a link there. He didn't really want to cause a problem with this bill particularly, but he thinks there is a bigger policy question involved. He added this probably isn't the vehicle to attack the issue, however. CO-CHAIR TOOHEY asked if it would be in the best interest of the insurance company to handle the issue of setting different degrees of pay for different degrees of education, not service. MR. REINWAND replied he really hadn't thought about it in that context. TAPE 96-37, SIDE B Number 001 MR. REINWAND continued he would like to leave the unfair discrimination statute for the committee to consider as he felt it could have some interesting interpretations. He added there have been conflicting interpretations from the division and he would probably be asking the committee to revisit this issue at some point. CO-CHAIR TOOHEY asked if there were three levels of mental health providers - psychological associates, psychologist or a psychiatrist - which one would Mr Reinwand want to pay? MR. REINWAND said probably from the insurance company's point of view and hopefully from the patient's as well, a person would want to go to the health care provider that provided the best service for the least cost; that's ultimately what everyone is after. Whether this bill does that and whether the unfair discrimination statute ultimately results in that is another question. Number 051 REPRESENTATIVE ROKEBERG asked if Blue Cross makes a differentiation between a temporary licensed psychological associate and a licensed psychological associate in terms of paying a fee? MR. REINWAND said he didn't know. He added that he has asked his client, Blue Cross, a series of questions and he hasn't yet gotten any answers back, but he would check on it. REPRESENTATIVE ROKEBERG said he felt that was really the question. There certainly is a differential between the experience level and as far as he could tell, this bill as well as the existing statute does not draw a differentiation between those people that are temporarily licensed and those who are not. CO-CHAIR BUNDE asked if there was any further testimony on CSSB 165(L&C). Number 094 SHARON MACKLIN, Lobbyist for the Alaska Psychological Association said she would try to answer a couple of questions that had been raised. Regarding the scope of practice, she referred to page 3, Section 5, and said that could be coordinated with the last page of the document that had been distributed to the committee on the scope of practice for a psychological associate. She said that is the only section that includes the scope of practice and this bill does not expand the scope of practice that psychological associates would be providing. Another question that was raised had to do with whether insurance companies pay different rates for the cost of services by psychological associates, psychologists, masters of social workers and marriage and family therapists. She said when the issue of unfair discrimination was raised several years at the time when psychologists, psychological associates and masters of social workers were added, part of the testimony brought forward was that these people provided services at a lesser rate and they are more available in rural Alaska and in less urban areas. She added that psychiatrists who are Mds probably charge the most, but are not located all over the state so not everyone has access to mental health services through a psychiatrist. Therefore, more services can be provided by adding other levels of mental health providers and their rates are different. She noted that SB 165 was introduced last year but didn't have any hearings. It's had two hearings in the Senate this year and passed the Senate by a big majority vote. Some of the other insurance companies have had a chance to review this and no questions were raised until now. She invited questions from committee members. CO-CHAIR TOOHEY asked if continuing education was required for psychological associates and psychologists? DR. STOKES responded 20 hours annually was required for both. REPRESENTATIVE ROKEBERG asked Ms. Macklin if she was saying this bill didn't expand the scope of service of a psychological associate? He said, "Correct me if I'm wrong, Ms. Macklin, but it seems it deletes specificity and the specified areas on the license which could be provided or work done by an associate, and expands it to almost anything. I'm not sure that's the intention, but that certainly looks like an expansion of services to me." MS. REARDON responded that under current law the division does license psychological associates as counseling or clinical and that is printed on the license. However, it was her understanding there have not been any distinctions made in terms of what is legal for someone who has clinical written on their license and what is legal for someone else who has counseling written on their license to do. She understood that both types are able to do the whole range of psychological services as long as the person stays within their area of knowledge and competence. It was her impression that although the division is printing a certain thing on the license, it does not come in any way with a list of things that a person should or shouldn't do under that license that really distinguishes one from the other. She said that perhaps Dr. Stokes had a different understanding and deferred the question to him. DR. STOKES said the only difference is under Title 47 which involved civil commitment. Only a psychological associate with a specialty in clinical psychology is considered a mental health professional. Whereas, a psychological associate with a counseling specialty is not considered a mental health professional (indisc.). Number 342 MS. FORREST mentioned that she would like to address Representative Rokeberg's question. She referred to page 3, line 7 of CSSB 165(L&C) which states "A psychological associate shall be licensed to provide psychological services..." and said the statute defines psychological services. Thus, it is spelled out (indisc.-paper shuffling). REPRESENTATIVE ROKEBERG asked Ms. Reardon if the word "temporary" appears on the license? MS. REARDON replied yes. REPRESENTATIVE ROKEBERG asked for verification that it would read "Temporary psychological associate." MS. REARDON clarified that she had been referring to the temporary psychologists license; there are no temporary psychological associate licenses at this time. REPRESENTATIVE ROKEBERG asked if a person under the three year supervision plan is licensed as a psychological associate or is the person not granted a license for those three years? MS. REARDON deferred the question to her Program Coordinator, Barbara Gabier. Number 417 BARBARA GABIER, Program Coordinator, Division of Occupational Licensing, Department of Commerce & Economic Development, said currently there is no temporary license or licensure required while an associate level graduate is getting the three years of experience. CO-CHAIR BUNDE asked if that was because they work under the direct supervision of a psychologist? MS. GABIER confirmed that. CO-CHAIR TOOHEY asked if the person would receive a temporary license for five years after graduation? MS. GABIER replied no. She explained that currently when a person graduates, he/she has to get the three years of supervised experience before applying for the exam. Then after licensure, the person would have to practice for five years before applying for independent practice. CO-CHAIR BUNDE announced there were two additional people in Anchorage who would like to testify. Number 454 MR. MOMA testified that he was with the Alaska Psychological Association. He said with regard to the issue of scope of practice, the underlying theme is based on the American Psychologist Association's ethics guidelines which specify that a person cannot perform a procedure in which they have no training and expertise in performing. He referenced the examples of biofeedback and hypnosis that were given at the last hearing and said he had checked with a variety of people, both master's level individuals and Ph.D. level individuals to try to find out if biofeedback or hypnosis was part of a typical Ph.D. program; both of the areas are not part of a typical Ph.D. program. Both a master's level person or a Ph.D. level person would be required to get additional training in order to perform those types of services. The point is that (indisc.) tried to tie to the national standard for acceptability of practice as opposed to specifying a laundry list of things that a person can or can't do. He said the issue had been raised about why psychological associates or individuals receiving a masters degree were suddenly interested in having a license. He explained that over the last few years, managed care has come into play as insurance companies have become more cost conscious and are starting to require a license of individuals before they will reimburse. That is not just for individuals in private practice, but also for individuals working for agencies. What is happening is that agencies will not hire a psychological associate because they can't get reimbursement from the insurance companies. The (indisc.) is starting to dry up which has made the need for a license more critical now than it has been in the past. MR. MOMA said that insurance companies usually reimburse based on a standard they set internally and usually reimburse at the usual and customary charge for a given service as it is provided. There are mechanisms in place for insurance companies to determine what an acceptable fee is to be charged. Another point that comes into play relating to insurance companies is typically individuals, particularly children in smaller communities in Alaska, are being transported into Anchorage to spend time at North Star, Charter North or some type of facility when that child might be able to receive services in their home community if there were individuals available with the training and the ability to provide services. Presently, a number of smaller communities don't have anyone to provide those services because there is no reimbursement mechanism in place. MR. MOMA conveyed a story relating to the board where an individual in Anchorage had completed her three years of training, had sat for her exam, passed her exam and was at the end of her five year period of supervision. The board at its last meeting decided she didn't have the human development and multi-cultural (indisc.) classes that are part of the board's determination, so the board denied her the ability to practice independently based on not having those two classes. Part of the reason they have implemented the temporary license idea has to do with being able to meet with the board and have a contractual relationship to agree on a proposal for an acceptable standard and an acceptable course of training so at the end of that training a person could get a license. What's happening now, especially with this board, is that the rules have been changed and individuals who have been on a time line for eight years are not being notified and accommodations are not being made for the individual to get the course. In conclusion, he believes this bill provides psychological associates and mental health services in rural communities. Also it improves the oversight of the board on mental health providers who are practicing in the community currently. Number 735 JENNIFER JONES from Anchorage said she had nothing more to add to the discussion on CSSB 165(L&C). Number 745 DR. STOKES said the board is being painted as negative. He pointed out the board did not write the statutes and the individuals who are upset with the statutes should be angry at whoever wrote the statutes. The board is held by law to follow the statutes. His recommendation for the additional year is because of psychological testing. Several years ago, the primary reason for complaints and litigation against psychologists and psychological associates was sexual activity between the therapist and the patient. In the last year that has changed. The primary reason for litigation and complaints filed with the Division of Occupational Licensing has to do with child custody evaluations involving psychological testing. It is his opinion that without the additional year of supervision specific to psychological testing, psychological associates under this bill are setting themselves up for malpractice suits and litigation. His concern is to protect psychological associates by ensuring they are prepared and to protect the public at the same time. Number 804 CO-CHAIR BUNDE closed public testimony on CSSB 165(L&C). REPRESENTATIVE ROKEBERG expressed concern about the definition of psychological services and how it fits into the statute. Also, he was concerned about the length of time, the lack of differential between a temporary license and another license, and also the questions regarding the insurance issue. He felt that additional work was needed and he wasn't prepared to vote on the bill at this time. CO-CHAIR BUNDE announced he would place CSSB 165(L&C) in a subcommittee to be chaired by Representative Rokeberg and Representatives Vezey and Robinson as members. CO-CHAIR BUNDE turned the gavel over to Co-Chair Toohey. CSSB 91(HES) - CRIMINAL TRANSMISSION OF HIV Number 881 CO-CHAIR TOOHEY said the committee would be taking testimony only and would not be moving CSSB 91(HES) out of committee at this meeting. Number 929 SENATOR ROBIN TAYLOR, Sponsor, said Senate Bill 91 was introduced because of an article, which he had provided committee members with a copy, relating to one of the more winning race car drivers on the Nascar circuit named Richmond. He earned $2.3 million and won 13 Winston Cup races. He also was infected with AIDS, never bothered to notify his sexual partners and it is estimated he's probably going to kill 30 women. He already died. The picture in the article is that of a beautiful woman who has graced the covers of Glamour, Seventeen and Cosmopolitan magazines. Her doctor is quoted as saying, "She suffers today from temporal wasting"; in other words her skull is caving in as a complication of the AIDS. He referred to another article about a heterosexual woman infected with AIDS who said, "I feel if I have to die of a horrible disease, I won't be going alone." This woman lives in the Dallas area where she frequents bars and attempts to infect as many man as she can. He added that Dallas is rated number 12 nationally for AIDS; they have over 3,200 recorded cases in their community. Another reason he introduced this legislation is because of an individual named Governor Jim Edgar, current Governor of Illinois, who wanted to be kind and considerate. He explained that a woman had been convicted and sentenced to three years in prison because after being diagnosed with AIDS, she intentionally attempted to infect other people with the disease by having unprotected sex. Governor Edgar, who wanted to be a nice person, commuted her sentence. Three weeks after her sentence was commuted, "Tracy Eichman, 34, was arrested by Rockford police on Tuesday after offering to perform sexual acts for a police officer for $20, authorities said. She was being held in the Winnebago County Jail on $25,000 bond. She faces one to three years in prison if convicted on the new charges. In February 1991, Eichman was sentenced to 3 years in prison after being convicted." Governor Edgar commuted her sentence so she could get back out on the street and infect more people. Senator Taylor referred to an article about a heterosexual male, William Barker, who had tested positive for the AIDS virus and threatened to take all the women with him that he could before he dies. He quoted from the article, "Barker was arrested April 9 after a parole officer received a tip that Barker was deliberately trying to infect women with AIDS, Stewart said. Police found Barker and the women in a motel room. She became hysterical when officers told her Barker had AIDS." Senator Taylor added that any one of us would probably become hysterical to find out such information after the fact. SENATOR TAYLOR directed the committee's attention to the article about a homosexual who knowing that he was diagnosed with AIDS had a sexual relationship with a 17-year-old boy. He noted that the United States military doesn't handle it quite the same way as Governor Edgar, and instead dishonorably court martialed him and he is serving 10 years. His crime is, "He was likely to transmit HIV. The crime of transmitting HIV or being likely to transmit and engaging in such acts that would transmit it in Texas is a felony." SENATOR TAYLOR said this issue was brought to his attention by a friend, John Walsh, of America's Most Wanted television show. Before Mr. Walsh started his television program, he came to Alaska and worked with many individuals to bring about changes concerning lost and sexually abused children and background checks for people who deal with children. On one of Mr. Walsh's programs, he asked the public to call in if they knew of a heterosexual man from Georgia who was estimated to have infected at least 30 women. They believed he could be hiding out in any one of the states that did not have a law against this type of conduct. A map was displayed on the television screen and to Senator Taylor's chagrin, Alaska was one of those states which attracts people like that. The most risk an individual would run is being prosecuted for reckless endangerment, which is a misdemeanor and carries a maximum of one year in jail. He informed the committee that CSSB 91(HES) passed overwhelming in the Senate. SENATOR TAYLOR said that Illinois' law was taken to the state Supreme Court to find out if it was constitutional. He noted the legislation before the committee was taken directly off the Illinois legislation. The case was upheld by the Illinois Supreme Court and at the time it was upheld, there were two cases pending. In one case a woman was charged with knowingly spreading the virus when she had sex without telling her partner. In the second case a man was charged with raping a woman when he knew he was infected with the virus. Senator Taylor said he couldn't understand why anyone would want to protect and make life more comfortable for a person that fails to inform their sexual partners they are infected with this virus and knowing full well they could be transmitting not a disease, but a death sentence. He said he didn't understand it and would like to be informed of what the reasons are because he certainly hopes they are sufficient that if in fact there are people in Alaska currently (latest indications are there are over 500 who are currently infected) if there is only one or two individuals who are being so cavalier or who are so filled with anger and rage over contracting this disease, do we really want to risk that? Will it have a "chilling" effect on people coming forward to being examined? The response is no. Illinois prosecuted only three people, but at least those three were prosecuted and he would be willing to bet that Governor Edgar was not going to turn any more of them loose. In fact, Governor Edgar is quoted as saying, "In the future, if he has a clemency request from a person like that, he wants to do a much more careful examination of whether or not they are going to survive if the are turned loose." SENATOR TAYLOR commented that Miami had the very same problem several years ago and Florida passed similar legislation. A trial judge in Miami had a lady who was a prostitute before him for the third time and was in the final stages of AIDS. The judge knew she was in that condition when she was released the two previous times, but the third time the judge locked her up because she was trying to kill people. He commented the social libertarians however thought she was being denied her freedom and added for some reason there seems to be a bizarre schizophrenic twist in American society today. SENATOR TAYLOR informed the committee of an incident involving a local sandwich shop who had an employee with hepatitis. The shop was closed down and every employee was tested to find out who had the disease, who was spreading it and why. That's not even being done with the AIDS virus. He remarked that hepatitis kills; his brother-in-law died because of hepatitis. He asked what was being done in the world today about typhus, and where is "Typhoid Mary"? Do we allow her to work in the school kitchens? No, she is charged with a crime if she does that. Does it prevent people from being tested for typhus? No, in fact barriers have been established to ensure that people who work in those facilities are tested for that disease. He asked how comfortable do you feel getting on an airplane knowing what is happening with tuberculosis today? Does it keep people from getting tested for TB? The answer is no. Do we as responsible citizens take actions that will hopefully prevent that from ever being transmitted to another person? He thought people did. SENATOR TAYLOR said criminal activity is just another form of irresponsible activity. He questioned if that was any more irresponsible than Mr. Richmond, the wealthy, playboy, race car driver who wants to infect women all over the country and decides he's not going to tell anyone. Four of the infected women have already died, and there are estimates of another 30 waiting. He wondered how anyone would explain to any of the family members that he was a super hero and shouldn't have been charged with any criminal activity. On the other hand if he had been charged, it probably would have been on national news and had a deterring effect on other individuals from trying the same irresponsible, deadly act. He encouraged committee members to pass CSSB 91(HES) from committee. CO-CHAIR TOOHEY asked if there were any questions of Senator Taylor. Number 1583 REPRESENTATIVE ROKEBERG asked Senator Taylor to explain the concept of intent in criminal law. SENATOR TAYLOR said there was a legal opinion from the Attorney General's Office in the packet, stating that intent would be required. In this instance, the intent that is required is within the bill. It's a general intent crime, that a person merely intends to do this act. It has to be done knowingly, and the only way to get to knowingly is the person has to be knowingly diagnosed as having AIDS. Once that diagnosis has been made, if a person participates in a sexual act with another consenting adult, they must inform the other adult of the AIDS diagnosis and give that other person the opportunity to know and to take additional precautions or not participate in that act. REPRESENTATIVE ROKEBERG asked about the defense of wearing a prophylactic in that case? SENATOR TAYLOR replied this has nothing to do with wearing a prophylactic, but merely notifying the sexual partner. That is the only act that is required by this legislation. REPRESENTATIVE ROKEBERG asked what would happen if the individual with HIV took a preventive measure, but did not inform the sexual partner? SENATOR TAYLOR responded the person would be guilty if he/she did not inform the partner. He emphasized that if an individual knew they had AIDS, did not inform their sexual partner and went forward with an act likely to transmit would be guilty. REPRESENTATIVE ROKEBERG thought there would be a problem with criminal intent under criminal construction if there was no intent to transmit by wearing a prophylactic. SENATOR TAYLOR remarked that an individual cannot avoid it by doing that. He added that if an individual with HIV has informed their sexual partner of the virus, it doesn't matter if the individual is wearing a prophylactic or not because the knowledge has been communicated to the person who may be the victim, and that person then has the consensual right to risk that activity if they wish to do so. He emphasized the important thing is that the potential victim know and have the opportunity to make a rational decision. CO-CHAIR TOOHEY asked if there were other questions of Senator Taylor? Hearing none, she invited testimony from individuals via teleconference. Number 1784 BARBARA BRINK, Attorney, Alaska Public Defender Agency, testified from Anchorage that unlike Senator Taylor, she believes that Alaska law already covers this type of behavior. She said Senator Taylor had questioned why the state would want to protect a person who is engaging in this risky behavior to which she responded, Alaska does not protect this person; Alaska punishes this person and punishes the person severely. She did not understand at the beginning the impetus for this legislation, because if the legislature wants to prosecute someone who is deliberately and recklessly setting about to infect someone with the virus, Alaska laws already exist that provide a range of prosecutorial charges and punishment to cover every set of conduct mentioned by Senator Taylor. She disagreed with the analysis that the only thing a person could be charged with is reckless endangerment. The assault statutes in the state of Alaska were constructed as a whole to deal with any situation where violence is perpetrated upon a person, and as a whole they cover every situation where an act or acts intentionally, recklessly or even just carelessly in causing harm to another person. The assault statutes also prosecute differently, depending on the actual seriousness of the harm caused. She said the behavior described by Senator Taylor could be prosecuted as attempted murder, assault in the first degree, assault in the second degree and all the way down to reckless endangerment depending upon the actual harm caused. Alaskans are protected from this type of behavior and this legislation is unnecessary in order to prosecute someone who infects the virus deliberately, recklessly or knowingly. MS. BRINK further stated in contrast, drafting a piece of legislation to cover a particular crime has raised a host of problems. She said, "it makes this a Class B felony offense for a person who has tested positive for the HIV virus, and I want to distinguish that from someone who is diagnosed with AIDS - those are two different things. A person who is (indisc.) positive for the HIV virus may engage in sexual activity with someone and be prosecuted and charged with this crime, even though they never develop the AIDS virus and the person they've engaged in conduct with never actually develops the virus." To have this thrown in the middle of the assault statutes is out of whack proportionally with the danger and with the harm. She pointed out there is epidemiological evidence that the risk of transmission of the HIV from a single incident is only 1 in 1,000. She said that Representative Rokeberg had raised a good question about when a person wears a prophylactic or a condom and under those circumstances, the chance of transmission is about 1 in 10,000. This legislation would make this a Class B felony with a 10-year sentence when there is little danger and little harm. By creating a special class of people she was concerned that this bill, if enacted, would violate the equal protection. She said we have taken a single class of people, those persons infected with HIV, and set about criminalizing their conduct. What about people who knowingly infect others with syphilis, gonorrhea, herpes or as Senator Taylor mentioned, tuberculosis or hepatitis - why isn't that behavior being criminalized? To single out this class of persons is not rationally related to protection to the health of the public. Additionally, it is over broad and interferes with Alaskans' right to privacy. The sexual behavior of an entire class of people is being damned when it is not necessary and not productive. MS. BRINK remarked she has real and demonstrable concerns that this will accomplish just the opposite of what Senator Taylor wants to accomplish. Everyone wants to slow down the spread of HIV and protect people. Public education regarding transmission of the HIV virus to enable people to voluntarily modify their behavior is far more cost effective than punishing it after the fact. If people are told we want them to get tested but they cannot engage in intimate sexual conduct if they test positive, will have a negative effect on the number of people getting tested. This legislation would have a definite impact of deterring people. Therefore, rather than reducing the risk of the spread of HIV, she believes this legislation will increase it. Increasing public education and removing restrictions on the availability of sterilized, disposable hypodermic needles and encouraging hygienic HIV practices would be far more cost effective in stopping the spread of HIV than this bill. TAPE 96-38, SIDE A Number 001 REPRESENTATIVE ROKEBERG asked if Ms. Brink was suggesting that incarceration is not a deterrent to criminal activity? MS. BRINK replied no, she never suggested that. REPRESENTATIVE ROKEBERG said he asked the question because he thought that's what she had said. MS. BRINK said when she had spoken of deterrents, she believed that criminalizing the conduct of whether or not a person knows they are HIV positive would deter people from getting tested. CO-CHAIR TOOHEY asked if there were further questions of Ms. Brink. Hearing none, she asked Amy Eilertsen to present her testimony. Number 064 AMY EILERTSEN, Director, Stop AIDS Project, testified from Anchorage. As a former student of Representative Bunde's at UAA, she urged him to pay special attention to the repercussions of CSSB 91(HES). She commented that as a registered nurse directing the safer techniques of a prevention project, her goal is to reduce the spread of HIV in the injectable drug users in Anchorage. She said in a high risk population such as this, denial and fear of knowing one's HIV status is a big barrier to HIV testing. The important and indispensable part of HIV testing protocol is the risk reduction counseling that people receive. This counseling informs people on how not to get (indisc.) spread HIV and other sexually transmitted diseases. She believed this bill would reduce the number of people being tested for HIV. People would not only be afraid to know their status because of the shock and social stigma surrounding HIV, but people would be terrified of the legal repercussions regarding being tested and perhaps finding out they have HIV. Not being tested would mean not receiving this life- saving personalized risk reduction counseling. Without this counseling, those who do not have HIV would probably be at greater risk for getting HIV. In the state of Alaska, there have been approximately 87,000 tests going through the state laboratory of which 560 have come up positive as of December 31, 1995. MS. EILERTSEN said according to the Center for Disease Control and prevention statistics, 9 out of 10 people who have HIV are not being tested for HIV. She commented, "So Senator Taylor, we can say that between 3,000 and 5,000 residents of the state of Alaska have HIV; 560 of these have been counseled on how not to give HIV to people, the other 1,000 have not." She believes the solution is further education. She reiterated her belief that this legislation would reduce the number of people being HIV tested and would probably increase the spread of HIV. She called the committee's attention to page 1, line 12, which indicates that a woman who knowingly passes HIV to her fetus purposefully will not be prosecuted, and yet a person who has HIV can have sex with someone who does not have HIV transmitted to them and be prosecuted under this bill. She thanked the committee for giving her the opportunity to testify. Number 320 SENATOR TAYLOR asked Ms. Eilertsen if all the people she counsels follow her directions and to the best of her knowledge have all those people informed their sexual partners? Or does she have people she is counseling who continue to have an active sex life without informing any of their sexual partners? MS. EILERTSEN asked what would they be informed their sexual partners of? SENATOR TAYLOR responded informing them of the fact they have been diagnosed. MS. EILERTSEN interjected the people she has been counseling have not necessarily been diagnosed or tested positive for HIV. She maintained that was her point - if people come in to be tested, they may come up negative and this is an opportunity to coach people on how to stay negative. If people don't come in to be tested because they are afraid of being criminally prosecuted, the opportunity for individualized education does not exist. SENATOR TAYLOR reiterated his question that of those people Ms. Eilertsen knows to have tested positive and infected with AIDS that she is counseling, are they restricting their sexual activity or does she in fact have people who are sexually active and not telling their sexual partners they have been diagnosed? MS. EILERTSEN apologized for not quite understanding the question in that people who have tested positive for HIV don't necessarily (indisc.), so she doesn't know about people with AIDS. SENATOR TAYLOR thought she was in charge of a center that had something to do with AIDS. MS. EILERTSEN said the center counsels people on how not to get HIV. Number 447 JOHN MIDDAUGH, MD., Chief, Epidemiology Section, Division of Public Health, Department of Health & Social Services, testified that he has been responsible for overseeing the development of the AIDS policies and enhancing the prevention efforts since 1982, when the first person was diagnosed in Alaska with AIDS. He appreciated the very grave concerns that have been reflected in the submission of Senator Taylor's bill and he believed that everyone shared the goal in an abhorrence of the idea that a person would knowingly and intentionally attempt to infect other individuals with a disease, regardless of what that disease is. He believed that current statutes and policies exist in the state to take care of the instances when it is able to be shown that that intention exists. He said the department, division, AIDS program and AIDS task force oppose this legislation and it's difficult to sort out some of the issues in this very powerful and important area about why that is. DR. MIDDAUGH said this legislation adds two major new components to the existing statutes and procedures. One is it removes the issue of intention and it does not take into account whether transmission of HIV does or does not occur. It also fails to include any scientific information about the likelihood or infectiousness of an individual attempting to infect another. Now, that's not the (indisc.-paper shuffling) support anything, it's simply to say that we know that during the period of infectivity with HIV, that at some times individuals are not infectious at all. Late in the course of illness when AIDS occurs, then it's been able to be shown that the virus is more present and the person is presumably more infectious. However, none of this information is reflected in the proposed legislation. He said what we are doing then is criminalizing an infectious agent in the absence of disease or potentially in the absence of a degree of infectiousness to another person. As the committee had heard, that analogy then occurs in that we have a registry of 1400 Alaskans who are hepatitis B surface antigen carriers. The risk of transmission of hepatitis B through sexual contact is far greater than HIV, perhaps as much as 10,000 to 100,000 times greater. Dr. Middaugh said we have an ability today to diagnose and fingerprint many kinds of viruses and infectious agents. Would we propose that we would criminalize the behavior of a mother who dropped her child at a daycare center with a fever, conjunctivitis, or a little rash and then learned the child had measles and had infected another child at the daycare center. The history of public health is that the ability to prevent infections generally requires the enrollment of individuals in a manner to prevent disease transmission and that often attempts to prevent or criminalize diseases has in fact had the opposite effect and led to the lack of early detection, the lack of effective prevention, and has led to greater problems of disease transmission. Dr. Middaugh said because of these reasons, he feels it is very important that this type of legislation not be supported. It would have very little benefit to either attempting to punish individuals who have an intention to attempt to harm another through transmission. Frankly, if a person was attempting to do a person in, the infection of HIV is a very inefficient way to do it because of its low risk of transmission during an individual or several encounters. DR. MIDDAUGH pointed out there were additional housekeeping type problems with this legislation. One is that the legislation discusses an affirmative defense that the defendant knew he/she was infected and informed the other individual, and that consent was given. He said, "Well, we know that many individuals who are engaged in different activities, occasionally use drugs or alcohol and that later recall of what was or wasn't transmitted and what consent or level of knowledge was given, can be quite problematic." He mentioned another problem is the definition of any contact between one or another that might or could result in the transmission of HIV. He said, "Does that mean theoretically could or is likely to; in other words, we know that for hospital workers taking care of persons with AIDS, who have been stuck with a needle after the needle has been first in the person with AIDS, that the risk of the hospital person becoming infected from being stuck is 1 or 2 in 1,000 needle sticks. It's not a highly infectious agent, but circumstances and risk factors are able to be weighed and are being increasingly understood about the likelihood of transmission." DR. MIDDAUGH stated another housekeeping problem with the bill is that under the provision related to "dispenses, delivers, exchanges, sells, or in any manner transfers to another person any nonsterile intravenous or intramuscular drug paraphernalia." He said that a person with diabetes who is HIV infected would have no legal mechanism of disposing of their diabetes syringe and in fact would be committing a criminal act if they turned it over to another person under this legislation. He knew that wasn't intended by the sponsor, but the problem with trying to legislate specifically against one single disease in order to accomplish a different goal he thinks is very counter-productive to the combined efforts of 1) to make sure there are mechanisms to avoid an intentional transmission of any lethal or potentially lethal infection and 2) more importantly, to try to prevent the disease. The final point he wished to make is that we have an effort that's in place to work with individuals who are infected with HIV and enlist their cooperation in identifying all of their contacts. He remarked that what ensued when Magic Johnson announced his HIV status was that thousands of people went and got tested because they were concerned they may have HIV and almost none were infected. In other words, huge numbers of tests of low risk, but worried persons. Alaska is a low prevalence HIV state and our greatest efforts to prevent transmission are to work with all infected persons, identify their contacts who are the most likely themselves to be infected and to enlist and work with them to change their behaviors in order to prevent opportunities for the virus to be transmitted in the future. For the multiplicity of these reasons, he urged the committee to make a difficult decision, but not to pass this bill. Number 923 REPRESENTATIVE ROKEBERG referenced Dr. Middaugh's concerns about intimate contact and asked if kissing would be a method of transmitted the HIV virus? DR. MIDDAUGH responded that it is not thought to be a likely transmission, but it potentially, theoretically could be considered to result if, for instance, there was a cut in one person's mouth and the other person had blood in their mouth from dental work, vigorous brushing of teeth or braces abrading the mouth. He added this is one of the difficulties of attempting to achieve a goal by legislating against the disease that has a complicated scientific epidemiology and mode of transmission. REPRESENTATIVE ROKEBERG asked about the known cases of the disease being transmitted by dental practitioners. DR. MIDDAUGH said no one knows for certain, but in the Kimberly Burgelis tragedy, there is suspicion that that particular dentist may have wilfully infected others to call attention to the plight of the absence of funding and support to deal with the disease, but it is also clear there was inadequate sterilization of the dental instruments in that instance. He commented there was also quite a bit of IV drug abuse in that practice and among many of the individuals who were found to have been infected. Number 1022 REPRESENTATIVE ROBINSON asked Dr. Middaugh if he was aware of any case in Alaska where someone knowingly transmitted HIV? DR. MIDDAUGH replied no. CO-CHAIR TOOHEY said there had been testimony on Representative Ogan's bill, which is basically the same as Senator Taylor's, from a woman who had prosecuted an individual who knowingly had infected others in Juneau. DR. MIDDAUGH said he was unaware of the case. CO-CHAIR TOOHEY offered to provide him with the tape of the committee hearing. Number 1069 REPRESENTATIVE VEZEY said there had been previous testimony to the effect that this legislation was unnecessary because it is already a crime to do the things mentioned in this bill. There has also been testimony in opposition because it may discourage people from being tested for HIV. He felt this was putting into statute what constitutes a convictable offense; however, he did feel this legislation was ahead of the curve in terms of perpetrators and victims. He viewed this bill as simply saying that a person has committed a crime if he/she knowingly infects another person, whether or not you kill the victim and that we as a society can recognize that that form of behavior is not acceptable and can remove such a person from society where innocent victims are exposed. He commented that's what most of the laws do - they remove people from society. He noted there had been discussions about people with tuberculosis and we have tried to address them with great compassion, but we have allowed people with tuberculosis to be arrested and removed from society until the disease can be brought under control. DR. MIDDAUGH said Representative Vezey's points were important ones, but in the case of tuberculosis, that is only done when a person is highly infectious with pulmonary tuberculosis. He added there is an effective drug which totally eliminates the infectiousness and there's an accurate test to both detect the infectiousness as well as detect when the infectiousness goes away. He added it is their hope to soon have some drugs and weapons that will be able to eliminate infectiousness. He said, "The state of being HIV positive is one where not only is it not infectious during the whole period of many years, but unlike tuberculosis where if I had tuberculosis I could give it to you in just our discussion regardless of your behavior. With HIV, just my own behavior in the absence of another criminal offense, such as forced criminal sexual penetration or rape or some form of assault, you would not be at risk of getting HIV regardless of my HIV status and infectiousness because it is not transmitted to you by the air or easily like tuberculosis." He didn't totally disagree with the concepts, but the different behaviors, medically and biologically, of the risk factors and likelihood of transmission make a big difference in this disease versus others and he felt there were (indisc.) consequences of criminalizing a diagnosis in the absence of disease or potential infectiousness or in fact, potential harm. This bill does also not require that a person be infected in order to have the defendant found guilty of a criminal act. Number 1248 REPRESENTATIVE VEZEY said he appreciated Dr. Middaugh's comments, but this bill does not make a crime out of social intercourse. It does establish that it is a crime to engage in sexual intercourse or other form of bodily fluid transmission if a person knows their body fluids may carry a contagion. He said he related this more to rabies than to tuberculosis or a lot of other diseases. He added we would not allow a rabid person to wander in society and the public would insist this person be removed from society. He viewed this as a tool which would allow us to remove from society this infinitesimal small number of persons who are infected because their social behavior is totally unacceptable. DR. MIDDAUGH said he agreed with that intent when the behavior is unacceptable and removal is necessary. He said, "I think the problem that I would view is that the consequences of this legislation could be very negative in terms of being able to both identify and elicit partners from individuals infected and to work with them to identify their contacts and that the likelihood that we would be able to then effectively use the legislation to achieve a goal, which is to try to remove individuals who may be wilfully attempting to infect others, would be a very small benefit compared to the existing legislation that we have which does still provide in our existing legislation for weighing, as you heard before, the likelihood of risk and consequences." The concern with this bill is that it does not do that. CO-CHAIR TOOHEY asked if there were further questions for Dr. Middaugh. Hearing none, she called on Jayne Andreen to testify. Number 1398 JAYNE ANDREEN, Executive Director, Council on Domestic Violence & Sexual Assault, Department of Public Safety, expressed the council's concern with CSSB 91(HES). She said last year one of the strongest concerns the council had related to the potential transmission of the mother to an unborn fetus whether or not she knows that she is an HIV carrier. She pointed out that issue has been dealt with on page 1, line 12. She stated this is a difficult bill and it's difficult to listen to the testimony, but basically the council feels that current offenses covered under this bill can already be charged under state law. She echoed the concern expressed that this legislation would decrease the amount of voluntary testing that would take place for people throughout Alaska. She said it was interesting to note how conversations have a tendency to "mushroom off" when discussing bills, and as the council was discussing this bill, one of the issues that came up was sexual assault victims and the potential risk they face being exposed to HIV. She said that issue had been discussed before the legislature previously and currently there is legislation which gives the victim the opportunity to have the alleged offender tested. The council proposed, for future reference, having some type of aggravator added for sexual offenses when the offender knows he/she is an HIV carrier. Number 1475 REPRESENTATIVE VEZEY said he finally understood that the assumption exists that fewer people will get tested for HIV if they think it might be associated with a crime. According to the legal experts however, it's already a crime to recklessly expose another person to HIV, so he didn't think anything would change in that regard. He added that it kind of defies logic that we know for a medical fact that drugs are available currently that will extend the life of AIDS patients and will reduce symptoms and side effects of the disease. He questioned if people would knowingly forego the possibility of meaningful medical treatment to avoid the possibility of criminal prosecution for something they can already be prosecuted for? It just didn't make any sense to him. MS. ANDREEN said that is one of the council's concerns and there is no way to gauge what the outcome would be. She said, "The concern I think primarily is the way it currently exists, there isn't anything in the statutes that says if you are HIV positive and you have unprotected sex with someone and don't tell them about it, you would be charged with these offenses. It's when it actually is put -- you know, it's under existing assault and attempted murder and murder offenses that a person could be charged at this time. When you have a bill that actually lists out that if you are HIV, this is what can happen to you if you do X, Y, Z is what the concern is, is that it will really focus the attention in for people." Number 1589 SENATOR TAYLOR remarked that of all the people who testified on the Senate side who testified that they feared a reduction in the number of people coming forward to be tested, not one of the people who so testified called one state where this has been criminalized and asked them what happened; Senator Taylor had and no one single state has seen any decline in testing after passing and criminalizing conduct where a person fails to notify their partner. He affirmed that is all that is required - just notify your partner before engaging in sex with them. For those people who testify there will be a "chilling effect" he would like to see their statistics, because he was not able to find any such statistics from the 22 different states he contacted. Number 1643 REPRESENTATIVE ROKEBERG was curious and disturbed by Ms. Andreen's comment regarding an aggravator provision in terms of developing statutes relating to domestic violence victims. He inquired if Ms. Andreen was implying that victims of domestic violence should receive special statutory treatment as opposed to something like this. MS. ANDREEN hoped that wasn't what she had said and thanked Representative Rokeberg for allowing her to clarify. What she had been talking about in cases of sexual assault, sex offenses, was that if the offender knows that he/she is HIV positive, that an aggravator be written into the statute that could be reviewed at the time of sentencing to increase the sentence. REPRESENTATIVE ROKEBERG thought that was what this bill was all about. CO-CHAIR TOOHEY said no, she thought it was Representative Kott's bill last year that addressed the person who knowing had HIV and was convicted of sexual assault. REPRESENTATIVE ROKEBERG asked if that had been enacted? CO-CHAIR TOOHEY responded it was passed. Number 1710 LYNN STIMLER, Executive Director, American Civil Liberties Union of Alaska, said the ACLU opposes CSSB 91(HES). She wanted to point out why the ACLU thinks this legislation is particularly vague and over broad, so that people with common intelligence can't really guess at the meaning of it. She noted that in the statute, intimate contact can mean any contact, because it's sexual penetration or contact in which the body of one person and the body fluid of another in a manner that could result. She said, "Potentially that raises the issue because HIV has been detected in minute amounts in saliva, perspiration and tears -- it raises the issue of whether an athlete - a young high school student whose gotten HIV and was participating in sports and got a bloody nose, would he be theoretically possible and under this statute, I think it would be grounds for prosecution, that the intimate contact provision if an HIV positive high school athletic was playing in a field." She questioned if all HIV people should be quarantined from all athletic activity under this statute? The New England Journal of Medicine in 1987 said it is unrealistic to require proof with absolute certainty that HIV is not transmitted in certain ways, which means because we don't know, this statute is on its face vague. The other issue the ACLU wished to address was that the National Academy of Sciences in 1986 said any admonition to avoid intimate bodily contact and the exchange of bodily fluid can convey at best a vague message; it is not specific enough. The ACLU believes that because the point of testing is for people who don't know about their status, to come in and get information and counseling which can keep them from transmitting this virus, it's very important that testing be as open as possible. The ACLU does not agree with Senator Taylor in that they feel Hepatitis B and tuberculosis are being tested for the very purposes that they are not criminalized. Additionally, this bill shifts the burden of proof. Normally the state of Alaska has to prove every element of a crime which is part of the due process guarantee. In this bill, instead of the state having to prove the defendant did not inform their partner, the defendant has to somehow prove that he did. She further commented she believes CSSB 91(HES) violates privacy and equal protection. Number 1898 RACHEL KING, Board Member, Alaskan AIDS Assistance Association, testified from Anchorage that she had been involved with AIDS education for the past 10 years. She has seen a tremendous amount of fear and loathing around the whole issue of AIDS and HIV. She believes that two big fears - the fear of homosexuality and the fear of IV drug use has kept education from going forward as it should. She stated that education is the best weapon against AIDS and the board's biggest concern with CSSB 91(HES) is that the provision that requires people to know they are infected with HIV will in fact prevent people from wanting to find out their HIV status. Senator Taylor had pointed out that in doing surveys from other states the rate of testing did not decline due to the criminalization of HIV; however, she said that didn't mean that more people wouldn't have gotten tested had those laws not gone into effect. Testing is on the rise everywhere and perhaps it would have continued to go up in those states. CO-CHAIR TOOHEY asked Anne Carpeneti from the Department of Law to present her testimony. Number 1981 ANNE CARPENETI, Assistant Attorney General, Criminal Division, Department of Law, testified there are two reasons the Department of Law opposes CSSB 91(HES). First, the department agrees with Barbara Brink in that this behavior is already covered by other criminal statutes, beginning with attempted murder in the first degree which is an unclassified felony. Secondly, the people who are in risk groups who fear the diagnosis, wouldn't be tested and this would not encourage testing by criminalizing a person who knows that he/she is infected by their behavior, but not criminalizing the behavior of people who don't know. Number 2024 REPRESENTATIVE ROKEBERG commented that Ms. Brink had spoke to the litany of assault statutes and asked if there was anything specifically defined in the assault statutes which addresses the transmission of the HIV virus. MS. CARPENETI responded the statutes do not specify HIV transmission. REPRESENTATIVE ROKEBERG asked how those statues would have any deterring effect on this type of activity if they are not specific? MS. CARPENETI said they are specific in terms in outlawing the egregious behavior that Senator Taylor has described; that being a person intentionally going around having sex with people and transmitting the virus. She added that Alaska's statutes don't specify generally a particular activity, but rather prohibit general activity. Number 2057 REPRESENTATIVE ROKEBERG commented he was not familiar with the state's criminal statutes, but he wondered if Alaska has a felony aggravated assault statute. MS. CARPENETI responded the state has felony assault statutes. Assault in the first, second and third degree are felonies and assault in the fourth degree is a misdemeanor. REPRESENTATIVE ROKEBERG inquired about assault as opposed to battery. MS. CARPENETI said the criminal code revision committee did away with the distinction between battery and assault. REPRESENTATIVE ROKEBERG asked if assault in the state of Alaska is physical contact? MS. CARPENETI said it includes battery. Number 2090 REPRESENTATIVE DAVIS asked if any of the other 20+ states had existing statutes they believed would have covered this type of behavior? MS. CARPENETI said she didn't know, but she would be happy to work with the sponsor to obtain that information. SENATOR TAYLOR commented that every state had the same generic type assault, intentional murder - everything that Alaska has, and every state decided they couldn't keep a prostitute off the street or couldn't convict under those statutes. CO-CHAIR TOOHEY asked if the committee had any further questions. Number 2132 SENATOR TAYLOR asked if we still intend to require consent for sexual acts in the state. Also, could he give his consent to a sexual act with someone if he does not know what they may bring with them? CO-CHAIR TOOHEY speaking as a nurse said any woman or any man in this state or any state that has sex without being protected deserves to get sick. Anyone that has sex in this day and age with an unknown partner, will get some type of disease. SENATOR TAYLOR commented that Co-Chair Toohey had used the word "unknown." He questioned if a wife was consenting to have sex with a husband who finds out that he has HIV but fails to notify her? He didn't think so, because the wife didn't know the full facts. When that husband lies and misleads and does it intentionally, knowing he has the illness, yet chooses to go forward with the act, the wife then becomes a nonconsensual victim. In Senator Taylor's opinion it is very close to rape, but our laws don't cover it. That is why this bill is before the committee. CO-CHAIR TOOHEY asked if there were any further questions. Hearing none, she closed public testimony. ADJOURNMENT CO-CHAIR TOOHEY adjourned the meeting of the House Health, Education and Social Services Committee at 5:28 p.m.