Legislature(2005 - 2006)CAPITOL 106


Download Mp3. <- Right click and save file as

Audio Topic
03:56:40 PM Start
03:57:29 PM HB442
04:42:07 PM Overview(s) || Alaska Mental Health Board: Advisory Board on Alcoholism and Drug Abuse (abada)
05:29:02 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
<Bill Hearing Rescheduled to 2/28/06>
<Bill Hearing Rescheduled to 2/28/06>
<Bill Hearing Rescheduled to 2/28/06>
<Bill Hearing Rescheduled to 2/28/06>
+ Bills Previously Heard/Scheduled TELECONFERENCED
Heard & Held
Scheduled But Not Heard
Scheduled But Not Heard
                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       February 23, 2006                                                                                        
                           3:56 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Tom Anderson                                                                                                     
Representative Sharon Cissna                                                                                                    
Representative Berta Gardner                                                                                                    
MEMBERS ABSENT                                                                                                                
Representative Carl Gatto                                                                                                       
Representative Vic Kohring                                                                                                      
COMMITTEE CALENDAR                                                                                                            
HOUSE BILL NO. 442                                                                                                              
"An  Act  relating  to  the   validity  of  advance  health  care                                                               
directives,  individual  health  care instructions,  and  do  not                                                               
resuscitate orders; relating to  the revocation of advance health                                                               
care directives; relating to do  not resuscitate orders; relating                                                               
to resuscitative  measures; relating  to the liability  of health                                                               
care  providers and  institutions;  relating  to an  individual's                                                               
capacity for making  health care decisions; and  providing for an                                                               
effective date."                                                                                                                
     - HEARD AND HELD                                                                                                           
OVERVIEW(S):   ALASKA  MENTAL HEALTH  BOARD:   ADVISORY BOARD  ON                                                               
ALCOHOLISM AND DRUG ABUSE (ABADA)                                                                                               
     - HEARD                                                                                                                    
HOUSE BILL NO. 258                                                                                                              
"An Act relating to aggravating factors at sentencing."                                                                         
     - BILL HEARING POSTPONED TO 2/28/06                                                                                        
HOUSE BILL NO. 412                                                                                                              
"An Act  relating to the  waiver of undergraduate expenses  for a                                                               
spouse  or dependent  of  a deceased  resident  peace officer  or                                                               
member of the armed services or fire department."                                                                               
     - BILL HEARING POSTPONED TO 2/28/06                                                                                        
HOUSE BILL NO. 426                                                                                                              
"An Act relating to medical assistance eligibility and coverage                                                                 
for persons under 21 years of age."                                                                                             
     - BILL HEARING POSTPONED TO 2/28/06                                                                                        
HOUSE JOINT RESOLUTION NO. 31                                                                                                   
Relating to designating September 9, 2006, as Fetal Alcohol                                                                     
Spectrum Disorders Awareness Day.                                                                                               
     - BILL HEARING POSTPONED TO 2/28/06                                                                                        
HOUSE BILL NO. 271                                                                                                              
"An Act relating to limitations on overtime for registered                                                                      
nurses in health care facilities; and providing for an effective                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
HOUSE CONCURRENT RESOLUTION NO. 5                                                                                               
Relating to support of community water fluoridation.                                                                            
     - SCHEDULED BUT NOT HEARD                                                                                                  
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: HB 442                                                                                                                  
SHORT TITLE: HEALTH CARE DECISIONS                                                                                              
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH                                                                                         
02/10/06       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/10/06       (H)       HES, JUD                                                                                               
02/21/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/21/06       (H)       Scheduled But Not Heard                                                                                
02/23/06       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
WITNESS REGISTER                                                                                                              
JACQUELINE TUPOU, Staff                                                                                                         
to Representative  Bruce Weyhrauch                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 442 on behalf of                                                                              
Representative Weyhrauch, sponsor.                                                                                              
JAMES BROOKS, Administrator                                                                                                     
Anchorage Anesthesia Group                                                                                                      
Providence Alaska Medical Center                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Responded to questions on HB 442.                                                                          
MICHAEL NORMAN, Anesthesiologist                                                                                                
Alaska Physicians and Surgeons                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Responded to questions on HB 442.                                                                          
TERRI BANNISTER, Attorney                                                                                                       
Legislative Legal and Research Services                                                                                         
Legislative Affairs Agency                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Responded to questions on Amendment 1, and                                                                 
Amendment 2, to HB 442.                                                                                                         
JOHN DAWSON, Attorney                                                                                                           
Davis Wright and Tremaine Limited Liability Partnership (LLP);                                                                  
Representative, Providence Anchorage Anesthesia Medical Group                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Responded to questions on HB 442.                                                                          
JIM DUNCAN, Chairman                                                                                                            
Advisory Board on Alcoholism and Drug Abuse (ABADA)                                                                             
Soldotna, Alaska                                                                                                                
POSITION STATEMENT:  Co-presenter of the overview for the Alaska                                                                
Board on Alcoholism and Drug Abuse (ABADA).                                                                                     
LONNIE WALTERS, Chief Petty Officer, Naval Retiree;                                                                             
Vice Chair, Advisory Board on Alcoholism and Drug Abuse (ABADA);                                                                
President, Substance Abuse Directors Association;                                                                               
Executive Director of Communities Organized for Health Options                                                                  
on Prince of Wales Island (COHO)                                                                                                
Craig, Alaska                                                                                                                   
POSITION STATEMENT:  Co-presenter of the overview for the Alaska                                                                
Board on Alcoholism and Drug Abuse (ABADA).                                                                                     
CARL WEBB, Ketchikan School Board                                                                                               
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT:  Testified on behalf of the Alaska Board on                                                                 
Alcoholism and Drug Abuse (ABADA).                                                                                              
ROSALIE NADEAU, Executive Director                                                                                              
Akeela Drug and Alcohol Treatment Services                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Co-presenter of the overview  by the Alaska                                                               
Mental Health Board.                                                                                                            
VERNER STILLNER, MD                                                                                                             
Specialist, Alcohol and Drug Dependencies                                                                                       
Psychiatrist, Bartlett Regional Hospital;                                                                                       
Member, Advisory Board on Alcoholism and Drug Abuse (ABADA)                                                                     
POSITION STATEMENT:   Testified on behalf of the  Alaska Board on                                                               
Alcoholism and Drug Abuse (ABADA).                                                                                              
FRED GLENN (ph)                                                                                                                 
Moose Pass, Alaska                                                                                                              
POSITION STATEMENT:   Testified on behalf of the  Alaska Board on                                                               
Alcoholism and Drug Abuse (ABADA).                                                                                              
KAT MCELROY, Clinical Supervisor,                                                                                               
Substance Abuse Treatment Service                                                                                               
Railbelt Mental Health Addiction;                                                                                               
Member, Advisory Board on Alcoholism and Drug Abuse (ABADA)                                                                     
Nenana, Alaska                                                                                                                  
POSITION STATEMENT:   Testified on behalf of the  Alaska Board on                                                               
Alcoholism and Drug Abuse (ABADA).                                                                                              
ACTION NARRATIVE                                                                                                              
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 3:56:40  PM.                                                             
Representatives  Anderson,  Cissna,   Gardner,  and  Wilson  were                                                               
present at the  call to order.  Representative  Seaton arrived as                                                               
the meeting was in progress.                                                                                                    
HB 442-HEALTH CARE DECISIONS                                                                                                  
CHAIR WILSON announced that the  first order of business would be                                                               
HOUSE BILL NO. 442, Version  24-LS1618\G, "An Act relating to the                                                               
validity  of advance  health care  directives, individual  health                                                               
care  instructions, and  do not  resuscitate orders;  relating to                                                               
the revocation of advance health  care directives; relating to do                                                               
not  resuscitate  orders;  relating  to  resuscitative  measures;                                                               
relating  to   the  liability  of   health  care   providers  and                                                               
institutions;  relating to  an individual's  capacity for  making                                                               
health care decisions; and providing for an effective date."                                                                    
3:57:29 PM                                                                                                                    
JACQUELINE  TUPOU,  staff   to  Representative  Bruce  Weyhrauch,                                                               
Alaska  State  Legislature,  presented   HB  442,  on  behalf  of                                                               
Representative Weyhrauch, paraphrasing  from a written statement,                                                               
which read as follows [original punctuation provided]:                                                                          
     Passage  of  the  Health Care  Decisions  Act  ("Alaska                                                                  
     Act")  in  2004,  was  an  important  step  forward  in                                                                    
     modernizing  and improving  Alaska's  health care  laws                                                                    
     for  the  terminally  ill, their  families,  and  loved                                                                    
     ones. House Bill 442 makes  minor changes to the Alaska                                                                  
     Act  in order  to  provide clearer  direction to  those                                                                    
     implementing health care decisions.                                                                                        
     Current  law  imposes  a  duty  of  investigation  upon                                                                    
     doctors when  carrying out  the health  care directives                                                                    
     of their  patients. House Bill  442 amends  the current                                                                    
     statute to  conform the language  in the Alaska  Act to                                                                    
     Uniform Act  language, thus requiring  a doctor  to act                                                                    
     in "good faith"  when time is often  critical for their                                                                    
     patients.   The   bill   also  substitutes   the   word                                                                    
     "physician" for  "attending physician", to  clarify the                                                                    
     intent that  all physicians  treating a  patient adhere                                                                    
     to  the  patient's  advanced  health  care  directives.                                                                    
     Finally,  House  Bill 442  clarifies  when  CPR may  be                                                                    
     used,  addresses  the  validity of  orders  from  other                                                                    
     jurisdictions, and  indicates under  what circumstances                                                                    
     a Do Not Resuscitate order may be revoked.                                                                                 
     The Health  Care Decisions Act has  been beneficial and                                                                    
     important for  all Alaskans  in letting  terminally ill                                                                    
     patients have their wishes heard.  House Bill 442 helps                                                                    
     caregivers carry out those wishes.                                                                                         
3:59:55 PM                                                                                                                    
REPRESENTATIVE  GARDNER asked  whether this  bill provides  for a                                                               
distinction between  a physician and an  attending physician, and                                                               
the need for each to act  in good faith regarding their patient's                                                               
health care instructions.                                                                                                       
4:00:37 PM                                                                                                                    
JAMES   BROOKS,   Administrator,  Anchorage   Anesthesia   Group,                                                               
Providence  Alaska Medical  Center, pointed  out that  it is  not                                                               
unusual for  a patient  to have  several physicians.   Nor  is it                                                               
uncommon, he explained  for a patient to arrive  in the operating                                                               
room  (OR)  and  request  that  the  anesthesiologist  waive  the                                                               
existing  do not  resuscitate  (DNR) order  to  ensure that  they                                                               
survive  the anesthesia  and surgical  processes.   If a  patient                                                               
makes  this type  of request,  it would  be important  to respect                                                               
that choice  without delaying the  patient's care  while locating                                                               
the attending  physician.  He  stressed the importance  for every                                                               
physician  involved  in a  patient's  care  to be  authorized  to                                                               
adhere  to  a  patient's  DNR  orders  without  constraint.    In                                                               
response to  Representative Gardner,  he said that  the attending                                                               
physician is the primary physician on a patient's chart.                                                                        
4:02:53 PM                                                                                                                    
MICHAEL NORMAN,  Doctor of Anesthesiology, Alaska  Physicians and                                                               
Surgeons,  clarified that  "admitting physician"  is the  correct                                                               
term,  and the  term "primary  physician"  is no  longer used  in                                                               
modern practice.                                                                                                                
4:03:25 PM                                                                                                                    
REPRESENTATIVE  ANDERSON, referenced  page  3,  lines 16-27,  and                                                               
asked whether the  language "the patient requests",  refers to an                                                               
oral  or a  written  request,  and should  it  refer  to an  oral                                                               
directive, how would that directive be verified.                                                                                
DR. NORMAN responded that it  relates to an oral request, notated                                                               
in the patient's chart by whomever  it is provided to, and signed                                                               
by the patient.                                                                                                                 
CHAIR  WILSON drawing  from her  nursing experience  said that  a                                                               
request  of  this  nature  may  be stated  by  a  patient  to  an                                                               
attendant and witnessed by any available second party.                                                                          
4:06:17 PM                                                                                                                    
REPRESENTATIVE ANDERSON  directed the witness' attention  to page                                                               
4, lines 26-31,  and asked Dr. Norman to explain  the addition of                                                               
sub-paragraphs (C) and (D).                                                                                                     
DR.  NORMAN  addressed  sub-paragraph   (D),  stating  that  this                                                               
language is  to provide clarity  in a situation where  someone is                                                               
arriving in surgery  for a reason unrelated to  the condition for                                                               
which  they  have initiated  a  DNR  order,  and he  provided  an                                                               
example.  Further,  he said that sub-paragraph  (C) addresses the                                                               
situation of  a child being  affected by whatever happens  to the                                                               
MS.  TUPOU  added that  sub-paragraph  (C)  provides clarity  for                                                               
secondary conditions  which are not  related to the  original DNR                                                               
order qualifying condition.                                                                                                     
CHAIR WILSON hypothesized,  "Like maybe they broke  their arm and                                                               
it has to be set under anesthesia, ...."                                                                                        
4:09:09 PM                                                                                                                    
REPRESENTATIVE  SEATON requested  further  clarity regarding  how                                                               
the DNR order qualifying condition  effects a secondary condition                                                               
that may arise.                                                                                                                 
DR. NORMAN  stated that at issue  is a doctor's ability  to treat                                                               
whatever condition arises during  a procedure, and to resuscitate                                                               
the patient  appropriately.  Currently,  it is not clear  who can                                                               
revoke a DNR  order.  If a  patient requests that a  DNR order be                                                               
revoked, the  doctor would  like to be  able to  correct anything                                                               
that  is  not related  to  the  qualifying  illness, such  as  an                                                               
anesthetic, or  an error made with  a scalpel.  These  are errors                                                               
which a  doctor can rectify  and then continue with  the intended                                                               
4:11:12 PM                                                                                                                    
REPRESENTATIVE SEATON asked how the  language on page 3, lines 25                                                               
and 26, relates to the revocation of a DNR order.                                                                               
DR. NORMAN  defined a qualifying  condition as an  untreatable or                                                               
incurable disease, and provided examples.                                                                                       
4:12:18 PM                                                                                                                    
REPRESENTATIVE  ANDERSON   noted  that   there  is   a  statutory                                                               
definition of what constitutes a qualifying condition.                                                                          
TERRI  BANNISTER,   Attorney,  Legislative  Legal   and  Research                                                               
Services,   Legislative  Affairs   Agency,  read   the  statutory                                                               
definition of a qualifying condition  which refers to a "terminal                                                               
condition"  or a  "permanent unconsciousness"  in a  patient, and                                                               
stated that statute also defines  a "terminal condition", as well                                                               
as "permanent unconsciousness".                                                                                                 
MS. TUPOU  cited AS  13.52.160 for  further details  and clarity,                                                               
and deferred  to John Dawson,  who worked with the  physicians in                                                               
drafting the bill.                                                                                                              
4:13:56 PM                                                                                                                    
JOHN  DAWSON,   Attorney,  Davis  Wright  and   Tremaine  Limited                                                               
Liability    Partnership   (LLP);    Representative,   Providence                                                               
Anchorage   Anesthesia  Medical   Group,  stated   that  he   was                                                               
significantly  involved in  the preparation  of the  analysis and                                                               
also the drafting of the amendment.                                                                                             
4:14:27 PM                                                                                                                    
REPRESENTATIVE SEATON referred to page  4, lines 28-31, and asked                                                               
whether  a person  undergoing a  procedure unrelated  to the  DNR                                                               
order  qualifying  condition,  who   looses  vital  signs  during                                                               
surgery, could  have the DNR  order disregarded by  the physician                                                               
and thus be inappropriately resuscitated.                                                                                       
MR.  DAWSON confirmed  Representative  Seaton's understanding  of                                                               
the language.   He highlighted,  however, that the  language does                                                               
not require  the physician  to resuscitate,  but rather  that the                                                               
physician will  not be  held liable if  he elects  to resuscitate                                                               
under such circumstances.                                                                                                       
4:16:28 PM                                                                                                                    
REPRESENTATIVE  SEATON  asked whether  the  language  on page  3,                                                               
[lines 25 and 26] also allows  the physician to make a unilateral                                                               
determination and disregard the DNR order.                                                                                      
MR. DAWSON stated:                                                                                                              
     If  he  [a  physician]  believes  reasonably  that  the                                                                    
     patient does not have a  qualifying condition, which is                                                                    
     defined  in  the  statute, then  that  physician  could                                                                    
     rescind  the   DNR  order.  ...   As  opposed   to  ...                                                                    
     performing cardio pulmonary  resuscitation (CPR) in the                                                                    
     face of an order.                                                                                                          
4:17:48 PM                                                                                                                    
REPRESENTATIVE  SEATON asked  that the  qualifying conditions  be                                                               
read once again.                                                                                                                
4:18:01 PM                                                                                                                    
MS. BANNISTER read from statute [AS 13.52.390(42)]:                                                                             
     A "qualifying  condition" means a  "terminal condition"                                                                    
     or "permanent unconsciousness".                                                                                            
          (42) "terminal condition" means an incurable or                                                                       
     irreversible illness or injury                                                                                             
          (A)   that   without   administration   of   life-                                                                    
     sustaining procedures  will result in death  in a short                                                                    
     period of time;                                                                                                            
          (B) for which there is no reasonable prospect of                                                                      
     cure or recovery;                                                                                                          
          (C) that imposes severe pain or otherwise imposes                                                                     
     an inhumane burden on the patient; and                                                                                     
          (D) for which, in light of the patient's medical                                                                      
     condition,  initiating  or  continuing  life-sustaining                                                                    
     procedures will provide only minimal medical benefit.                                                                      
MS. BANNISTER responding to further  inquiry, stated that someone                                                               
who is  aged, exhausted from life,  and ready to pass,  would not                                                               
qualify under statute to hold a DNR order.                                                                                      
4:20:10 PM                                                                                                                    
REPRESENTATIVE CISSNA referred to page  2, lines 7-17, and stated                                                               
that this section appears to be contradictory.                                                                                  
CHAIR  WILSON pointed  out that  this section  represents current                                                               
statute,  and  pertains  to  patients  "in  the  case  of  mental                                                               
illness" where a  guardian or other third party  is involved, and                                                               
needing to make decisions for the principal [patient].                                                                          
MS.  TUPOU confirmed  that  this section  sets  forth a  decision                                                               
making process for a patient who is deemed to be incompetent.                                                                   
4:23:56 PM                                                                                                                    
MR.  DAWSON  stated that  this  bill  does  an excellent  job  of                                                               
remedying a number of significant  issues that were raised by the                                                               
original  statute, which,  given  the situations  faced daily  by                                                               
health care  professionals, effectively requires doctors  to make                                                               
legal decisions.                                                                                                                
4:25:13 PM                                                                                                                    
CHAIR WILSON  requested further clarity  regarding when  a doctor                                                               
can override a DNR order.                                                                                                       
MR.  DAWSON  provided two  examples  to  illustrate key  decision                                                               
situations, which  a doctor  may be  faced with:   A  patient who                                                               
holds  a DNR  order  for  a terminal  cancer  condition, and  who                                                               
arrives in need  of a medical procedure for an  acute reaction to                                                               
a bee  sting, which requires  resuscitative measures; and  when a                                                               
surgeon's  own   actions  precipitate   a  problem  such   as  an                                                               
anesthesiologist administering  too much medication,  requiring a                                                               
reversal  of  procedure.   He  opined  that  in either  of  these                                                               
situations the  physician should be able  to take life-sustaining                                                               
actions, as provided for in HB 442.                                                                                             
4:27:04 PM                                                                                                                    
REPRESENTATIVE  GARDNER requested  further clarity  on whether  a                                                               
family  member, of  an infirm  patient, could  insist that  a DNR                                                               
order be  upheld over the  physician's desire to recover  from an                                                               
error, thus negating the DNR order.                                                                                             
4:28:01 PM                                                                                                                    
REPRESENTATIVE  ANDERSON asked  whether  there  is a  delineation                                                               
between surgical procedures which  may require resuscitation, and                                                               
being sustained on a life support system.                                                                                       
MS.  TUPOU  said that  this  bill  provides permissive  language,                                                               
which  allows for  appropriate medical  action based  on "a  good                                                               
faith belief".                                                                                                                  
4:29:25 PM                                                                                                                    
REPRESENTATIVE SEATON  expressed his concerns that  this language                                                               
continues   to  impose   legal   decisions   on  the   physician.                                                               
Furthermore, he  stated that when  a physician chooses  to ignore                                                               
the  desire of  a  patient  by rescinding  a  DNR  order for  any                                                               
reason, it is  a violation of the patient's wishes.   He said, "I                                                               
don't think that's where we want to be."                                                                                        
CHAIR  WILSON  pointed out  that  a  permit  is signed  prior  to                                                               
surgery  which  provides  for certain  assumptions  of  procedure                                                               
while a patient  is undergoing anesthesia.   However, current law                                                               
is not clear when a doctor is  to be held liable and in violation                                                               
of a DNR order, if they resuscitate for certain circumstances.                                                                  
4:31:48 PM                                                                                                                    
DR.  NORMAN  confirmed  that  two  separate  contexts  are  being                                                               
addressed  here namely,  the  OR surgical  release,  and the  DNR                                                               
order for a qualifying condition.  He explained:                                                                                
     The decision of  what we are going to do  in surgery is                                                                    
     made before we enter the  operating room.  [As] pointed                                                                    
     out ... where the person  did not want to have anything                                                                    
     done no matter  what, that was honored.   If the person                                                                    
     says I  want to have  anything done that's  not related                                                                    
     to my illness,  if I have ... a cardiac  arrest or if I                                                                    
     have one of these events  I want you to resuscitate me.                                                                    
     I  don't believe  the intent  of the  law is  to change                                                                    
     your  plan  of  attack  after  you're  already  in  the                                                                    
     operating room,  ... before we  start we have  rules of                                                                    
     engagement established.   We're trying to  clarify what                                                                    
     those rules are,  ... these things are  gray areas, and                                                                    
     we're trying to change that.                                                                                               
4:33:05 PM                                                                                                                    
REPRESENTATIVE  SEATON  said  that  if a  patient  has  signed  a                                                               
surgical order which stipulates  resuscitative measures are to be                                                               
taken, then that would negate  the implementation of a DNR order.                                                               
However, this  language allows  a doctor  to make  an independent                                                               
decision outside of these established qualifications.                                                                           
4:33:38 PM                                                                                                                    
MR. DAWSON highlighting the crux of the issue, stated:                                                                          
     If a physician is not  permitted to correct his mistake                                                                    
     ... the fact [that] there's  a DNR order in place, does                                                                    
     not  mean   that  the  physician  can't   be  sued  for                                                                    
     malpractice ....   So you've  put the physician  in the                                                                    
     untenable  position  of  ...  [not  being]  allowed  to                                                                    
     correct his own  error, and yet he can then  be sued by                                                                    
     the  family for  that error.    There does  seem to  be                                                                    
     something  unfair about  that. ...  When somebody  goes                                                                    
     into surgery,  ... the game  plan is to bring  them out                                                                    
     of  surgery. ...  It seems  ... to  be against  medical                                                                    
     practice and  medical common sense to  suggest that, if                                                                    
     somebody because of something  the surgeon does, is put                                                                    
     in  a  position  where  they need  CPR,  that  ...  the                                                                    
     physician  should   be  helpless  to  ...   [perform  a                                                                    
     corrective  procedure].   Obviously, the  patient hopes                                                                    
     to be  able to  come out  of this  surgery ...  and the                                                                    
     physician  expects to  be able  to do  his job  without                                                                    
     being  afraid  of being  sued.  ...  It's important  to                                                                    
     remember that we're only talking  about patients with a                                                                    
     qualifying  condition,  and  ...  dementia  [previously                                                                    
     mentioned] ...  is not in fact  a qualifying condition.                                                                    
     ...  The places  where this  is  going to  come up  are                                                                    
     going to be very few, and  ... in those places we ought                                                                    
     to err  on the  side of good  medicine. ...  That's ...                                                                    
     what the doctor's  who are hoping to  see these changes                                                                    
     come  about ...  are hoping  that the  legislature will                                                                    
     look to:   what's  good medicine; what  makes practical                                                                    
     sense  when  we're  trying   to  actually  minister  to                                                                    
4:35:36 PM                                                                                                                    
REPRESENTATIVE GARDNER  restated her concern, that  if a conflict                                                               
should arise  for the physician,  for philosophical  or liability                                                               
reasons, that his/her needs should  not "trump the express desire                                                               
of the patient and the patient's family."                                                                                       
MR.  BROOKS explained  that an  ethical matrix  exists to  ensure                                                               
that a  physician is chosen  who is able  to go into  surgery and                                                               
appropriately  honor  the  patient's or  the  guardian's  wishes.                                                               
Furthermore, this occurs everyday,  and upholding DNR requests is                                                               
a priority in the profession, he said.                                                                                          
REPRESENTATIVE GARDNER pointed  out that what Mr.  Brooks does in                                                               
his own practice may not be  what is upheld across the board, and                                                               
therein lies the importance of passing this legislation.                                                                        
4:38:31 PM                                                                                                                    
CHAIR WILSON announced that HB 442  would be held in committee to                                                               
allow for  further testimony  and amendment  opportunities, prior                                                               
to moving it to the Judiciary Committee.                                                                                        
4:40:25 PM                                                                                                                    
^ALASKA MENTAL  HEALTH BOARD:   ADVISORY BOARD ON  ALCOHOLISM AND                                                             
DRUG ABUSE (ABADA)                                                                                                            
CHAIR WILSON announced that the  final order of business would be                                                               
a  presentation by  the  Advisory Board  on  Alcoholism and  Drug                                                               
Abuse (ABADA).                                                                                                                  
4:42:07 PM                                                                                                                    
JIM  DUNCAN,  Chairman, Advisory  Board  on  Alcoholism and  Drug                                                               
Abuse (ABADA), introduced the presentation  for the Alaska Mental                                                               
Health Board (AMHB) by the  Advisory Board on Alcoholism and Drug                                                               
Abuse  (ABADA),  and  stated  that   over  54,000  Alaskan's  are                                                               
impacted  by  drug and  alcohol  use,  as  reported by  a  recent                                                               
McDowell Group survey, provided in the committee packet.                                                                        
LONNIE WALTERS,  Chief Petty Officer, Naval  Retiree; Vice Chair,                                                               
Advisory Board  on Alcoholism and Drug  Abuse (ABADA); President,                                                               
Substance  Abuse  Directors  Association; Executive  Director  of                                                               
Communities  Organized  for Health  Options  on  Prince of  Wales                                                               
Island (COHO), provided  a personal history of  his experience as                                                               
a  long-term  alcoholic,  and he  described  the  four  treatment                                                               
processes that  he participated in  during his 22 year  career in                                                               
the  Navy.    Referring  to his  alcoholic  experiences  and  the                                                               
subsequent 24 years of sobriety , he said:                                                                                      
     Treatment  works;  it may  not  always  work the  first                                                                    
     time, but  it works. ... I  didn't get a choice,  I was                                                                    
     coerced into treatment. ... I  hear ... people say that                                                                    
     treatment doesn't work  if it's coerced.   Of course it                                                                    
     ... works  if it's  coerced. ... I  was able  to change                                                                    
     and ... go into sobriety.                                                                                                  
MR. WALTERS listed the tragic  alcoholic history in his immediate                                                               
family and reported  that he has raised two children  who are not                                                               
substance  abusers, thus  breaking the  cycle.   He stressed  the                                                               
importance of  treatment and the  profound impacts  that treating                                                               
an alcoholic has  on the family and acquaintances  of the treated                                                               
alcoholic.  Further, he stated:                                                                                                 
     I was ...  told to ... tell you what  works.  Treatment                                                                    
     works, prevention  works, support for  treatment works.                                                                    
     I  don't only  need  money, I  need emotional  support;                                                                    
     people  on  this  hill  ... talking  about  this  as  a                                                                    
     disease,  not  as a  social  problem,  not as  a  moral                                                                    
     problem, but as a disease.                                                                                                 
4:46:53 PM                                                                                                                    
MR. WALTERS continued  with an analogy of  alcohol prevention and                                                               
other  industries,   which  have  had  success   with  prevention                                                               
programs such  as tobacco  and dental health.   He  stressed that                                                               
for  prevention to  work, a  program  must be  sustained and  on-                                                               
going.    Additionally,  he   said,  treating  substance  abusers                                                               
locally is  more cost effective than  sending them to jail  or to                                                               
out-of-state for treatment facilities.                                                                                          
4:48:51 PM                                                                                                                    
MR. WALTERS provided  an example of three  substance abusers whom                                                               
he  has worked  with  on Prince  of Wales  Island.   These  three                                                               
clients  have appeared  in  court  on 52,  56,  and 45  different                                                               
occasions and represent  a combined 21 years of prison  time.  He                                                               
reported that each have attended  a residential program, Nugent's                                                               
Farm,  Wasilla,   Alaska,  and  following  that   treatment  have                                                               
incurred no further costs to the  state.  He pointed out the cost                                                               
effectiveness of providing the one  and a half years of treatment                                                               
versus   court  and   incarceration  costs   expended  on   these                                                               
individuals.   Despite  these type  of success  stories, he  said                                                               
that there continues  to be a reduction of  treatment capacity in                                                               
Alaska.  He stated:                                                                                                             
     We even have  a phenomenon now that  didn't happen when                                                                    
     I  was a  counselor and  moved  to Alaska.  ... We  are                                                                    
     losing  counselors  to  the lower  48  because  they're                                                                    
     paying better in the lower  48. ... For 15 years, since                                                                    
     I've been  in this field  in Alaska, we haven't  had an                                                                    
     increase in our  budget, we've even had  decreases.  We                                                                    
     haven't even  had a  cost of  living increase.  ... The                                                                    
     myth is ... you have to  want treatment for it to work;                                                                    
     that's absolutely  untrue, you  don't have to  want it.                                                                    
     You have  to get  in the  doors.  Once  you get  in the                                                                    
     doors it's the counselor's jobs to make you want it.                                                                       
4:50:47 PM                                                                                                                    
REPRESENTATIVE SEATON referred to  a presentation provided by the                                                               
Petersburg Mental Health Services  (PMHS) [HESS meeting 1/16/06].                                                               
Recalling a  young testifier who  was asked to  compare substance                                                               
abuse experiences in Utah versus Petersburg, he said:                                                                           
     His comment was that  [underage] alcohol [use] was much                                                                    
     more tolerated  ... [in] Petersburg  than ...  in Utah.                                                                    
     ...  The attitude  among adults  here was  that they're                                                                    
     going to it  anyway so it's OK, and  [adults] would buy                                                                    
     booze for  [teens]. ... There  seems to be  an attitude                                                                    
     shift ... that  needs to take place  not just treatment                                                                    
     of  individuals, but  ...  individuals  are picking  up                                                                    
     cues of what's acceptable  from their community. ... It                                                                    
     was quite  revealing ... it  was alcohol which  was ...                                                                    
     basically accepted  among the members of  the community                                                                    
     for  underage people  to participate  in ....   It's  a                                                                    
     tough thing to figure out  where the prevention line on                                                                    
     this  is  too,  and  how  we get  there  ...  with  the                                                                    
     attitude shift.                                                                                                            
4:52:48 PM                                                                                                                    
MR. DUNCAN  stated that, although  funds are  limited, prevention                                                               
is a target  area for ABADA, and to that  end "inroads" are being                                                               
made.   He reported that  25 percent of Alaska's  population does                                                               
not drink, however, he said  that ABADA has focused outreach into                                                               
the rural areas  of the state where alcohol abuse  is at "crisis"                                                               
4:54:27 PM                                                                                                                    
CHAIR  WILSON provided  a  personal story  of  alcoholism in  her                                                               
family, and she said:                                                                                                           
     We made inroads with ...  smoking and heart disease ...                                                                    
     because  people  in   society  started  changing  their                                                                    
     philosophy.  ... When  I look  at  the numbers,  54,000                                                                    
     Alaskans, and  how many  times do  we put  them through                                                                    
     [rehabilitation  programs] ...  it's an  impossibility.                                                                    
     We have  to find ...  ways to  help it work  because we                                                                    
     don't have the money to do  it.  [Alaska] is number one                                                                    
     in  ...  alcohol  related problems.  ...  Economically,                                                                    
     it's very, very difficult.                                                                                                 
4:55:41 PM                                                                                                                    
REPRESENTATIVE  GARDNER  referred  to  current  youth  prevention                                                               
programs,  such  as  "Protecting   You,  Protecting  Me"  (PY/PM)                                                               
[Mother's  Against  Drunk  Drivers (MADD)  elementary  curriculum                                                               
program] and "Drug Abuse Resistance  Education" (DARE).  Although                                                               
these   are  high   profile   programs,   she  questioned   their                                                               
effectiveness,  and   asked  whether   Mr.  Duncan   could  offer                                                               
suggestions  for  outreach  programs,  which  he  would  consider                                                               
beneficial for youth and elementary age children.                                                                               
MR.  DUNCAN opined  that peer  generated programs  are especially                                                               
helpful, but  he said that gaining  access to the schools  can be                                                               
difficult.   The  schools are  understandably cautious  to engage                                                               
new programs.                                                                                                                   
CHAIR WILSON  pointed out  that the  communities youth  corps has                                                               
been a successful program.                                                                                                      
4:57:36 PM                                                                                                                    
CARL  WEBB,  Ketchikan  School Board,  introduced  himself  as  a                                                               
recovering alcoholic and a treatment program alumnus.  He said:                                                                 
     I  believe   if  we  could  implicate   prevention  and                                                                    
     education in  ... [kindergarten] through  sixth [grade]                                                                    
     throughout the state  it's going to be  huge in keeping                                                                    
     these students  ... from using  drugs and  alcohol. ...                                                                    
     It's  been proven  ... that  children and  students who                                                                    
     don't use  drugs and alcohol  and tobacco ...  are less                                                                    
     likely  to  have  problems with  [substance  abuse]  in                                                                    
     their productive lives.                                                                                                    
CHAIR  WILSON   described  her  experience  as   a  school  nurse                                                               
providing  smoking prevention  classes  for  first through  third                                                               
grade  classes.   She  said  that  using  the  visual of  a  doll                                                               
breathing in  smoke was a  helpful visual aid, but  conceded that                                                               
it would be  difficult to illustrate the effects of  alcohol in a                                                               
similar way.                                                                                                                    
4:59:59 PM                                                                                                                    
REPRESENTATIVE  SEATON offered  that the  adults who  counsel the                                                               
children  not  to drink,  do  not  provide  a personal  model  of                                                               
abstinence, thus  the young child  receives a mixed message.   He                                                               
pointed out that community events  often include alcohol, as well                                                               
as other  public gatherings, which may  highlight activities such                                                               
as wine tasting.   He maintained that it becomes  confusing for a                                                               
young person, when two different messages are being modeled.                                                                    
5:01:12 PM                                                                                                                    
MR. WEBB underscored the need for  the adults of the community to                                                               
set the  right example.  To  this end the Ketchikan  School Board                                                               
recently  did  a voluntary  drug  test  for the  school  district                                                               
staff.  He  reported that one member of the  board challenged the                                                               
effectiveness of  such role setting,  expecting that  the gesture                                                               
would  essentially go  unnoticed  by the  students; however,  the                                                               
member was  proven wrong when  the community's youth  appeared in                                                               
numbers at  a subsequent board  meeting to testify.   Further, he                                                               
said that  since being  in treatment and  becoming sober,  he has                                                               
been  able to  pay  restitution to  the state  for  the costs  he                                                               
incurred, and has also become a productive member of society.                                                                   
5:02:51 PM                                                                                                                    
REPRESENTATIVE  CISSNA offered  that, with  the availability  and                                                               
acceptance of alcohol, it is important  to get to the grass roots                                                               
to change a culture that values drinking.                                                                                       
5:04:10 PM                                                                                                                    
MR.  DUNCAN directed  attention  to the  graph  in the  committee                                                               
packet  titled   Funding  Sources  for  Alaska   Substance  Abuse                                                               
Spending, prepared by  AMHB/ABADA, 2/22/06,  He  pointed out that                                                               
the majority  of funds in the  last two years have  been received                                                               
from  alcohol  taxes, and  the  federal  government.   The  state                                                               
funding has not been increased,  which has prevented the addition                                                               
of treatment  programs within the state.   He said that  only two                                                               
long-term programs  exist, Nugent's Ranch of  Wasilla, and Akeela                                                               
in Anchorage.                                                                                                                   
CHAIR WILSON  asked what  the lengths  of the  long-term programs                                                               
are and what the resident capacity is for these two facilities.                                                                 
MR. WALTERS provided that Nugent's Ranch has a one year program.                                                                
ROSALIE  NADEAU,  Executive  Director, Akeela  Drug  and  Alcohol                                                               
Treatment Services,  interjected that the Akeela  program extends                                                               
to a maximum  of two years.  Further, she  said that the facility                                                               
has 48 beds, but the funding provides for 20 beds.                                                                              
MR.  WALTERS  agreed  that  an   attitude  shift  in  our  entire                                                               
population is required to effect change.  He said:                                                                              
     I do a  lot of public speaking and every  time I go any                                                                    
     place in Alaska  and I say, "Why do you  think there is                                                                    
     so  much drinking  in Alaska?"  ... Every  single group                                                                    
     will tell  me, "There's  nothing to  do." ...  I always                                                                    
     back  that  up  with,  "Well,  why  is  there  so  much                                                                    
     drinking in New York, or  San Diego, or Los Angeles, or                                                                    
     Las  Vegas, where  there's everything  in the  world to                                                                    
5:07:23 PM                                                                                                                    
REPRESENTATIVE  GARDNER   asked  to  follow-up  on   whether  the                                                               
Ketchikan School Board took the drug test.                                                                                      
MR.  WEBB  responded  that  several did,  not  everyone,  and  he                                                               
reported that the gesture was viewed  by the public in a positive                                                               
way.   Ketchikan  is one  of the  few communities  which requires                                                               
that student  activity participants submit to  random drug tests,                                                               
as  a means  to promote  abstinence; a  positive example  for the                                                               
aspiring athletes in the lower grades.                                                                                          
5:09:41 PM                                                                                                                    
VERNER STILLNER,  MD, Specialist, Alcohol and  Drug Dependencies,                                                               
Psychiatrist, Bartlett Regional  Hospital; Member, Advisory Board                                                               
on Alcoholism and Drug Abuse (ABADA), stated:                                                                                   
     We have no money.  There  is a $19 million amount right                                                                    
     now  in  the  alcohol  tax   that  could  be  used  for                                                                    
     prevention ...  and treatment efforts.   When that bill                                                                    
     passed a couple  of years ago ... it  was to supplement                                                                    
     the  current activities.   Unfortunately,  those monies                                                                    
     have been used  to supplant current activities.   It is                                                                    
     an attitudinal  issue in my  mind, ... not only  in the                                                                    
     general  public,   but  in  the   legislature,  towards                                                                    
     prevention and treatment of  Alaska's number one public                                                                    
     health problem.   And I also think that  no other state                                                                    
     can boast $30 billion in  their coffers.  [Thus], if we                                                                    
     are not able to deal with  this issue, I don't know who                                                                    
     will.  I urge your  committee to investigate the use of                                                                    
     these monies, and use them  as they were intended, even                                                                    
     though  they  cannot  be designated  ....    Also,  the                                                                    
     wholesale  taxes have  not  been  increased on  spirits                                                                    
     since  statehood, and  they're  also capped  at a  very                                                                    
     unreasonably low  number, so there's another  source of                                                                    
     new revenue ....                                                                                                           
5:11:15 PM                                                                                                                    
CHAIR  WILSON invited  the gallery  to attend  the House  Finance                                                               
Committee meeting, at 7:00a.m.,  2/24/06, where $20 million would                                                               
be  taken  out  of  the governor's  budget;  primarily  affecting                                                               
prevention programs across the state.                                                                                           
CHAIR  WILSON announced  that she  would turn  the gavel  over to                                                               
Vice Chair Seaton for the remainder of the ABADA overview.                                                                      
VICE CHAIR  SEATON clarified the  meeting to be the  HESS Finance                                                               
Subcommittee, at 7:00a.m., in room 519 of the Capital building.                                                                 
5:12:51 PM                                                                                                                    
MS. NADEAU, stated that Akeela  provides a significant prevention                                                               
programs and a long-term program, and she said:                                                                                 
     Prevention  has  been  decimated already  to  a  large,                                                                    
     large  extent.    We  ran  a  primary  substance  abuse                                                                    
     library  [providing]  ...  documents  ...  to  programs                                                                    
     throughout  the  state.   It  has  operated for  twenty                                                                    
     years.   This year the  department refused to  fund it.                                                                    
     ... That library ... no  longer exists; ... it was part                                                                    
     of our prevention funding and it disappeared.                                                                              
MS. NADEAU  described the  Strengthening Families  program, which                                                               
is a nationally tested, recognized,  and respected model aimed at                                                               
dealing with  families at risk who  have children age 6-12.   She                                                               
stated, "It's a  great program; we've less than  $100,000 in that                                                               
program so  it's a  kind of  intensive program  without a  lot of                                                               
money to  it."   The Primed  for Life  program, she  explained is                                                               
aimed  at   school  age   children,  which   Akeela  administered                                                               
throughout the  Anchorage school  district, as did  Volunteers of                                                               
America  (VOA).   Due to  funding cuts,  Akeela now  operates the                                                               
Primed for  Life program on a  minimal basis, in a  district with                                                               
50,000  children;   however  VOA   continues  to   provide  these                                                               
MS.  NADEAU stated  that Akeela  provides services  "in 18  rural                                                               
communities ... with  a program that's not funded  by the state."                                                               
She  explained  that Akeela  has  subcontracted  with an  outside                                                               
institute for research and evaluation, and she stated:                                                                          
     What we're doing  ... is looking at  what we're calling                                                                    
     legal,  harmful products,  and that  would  be the  kid                                                                    
     whose inhaling; those kinds of  activities.  We started                                                                    
     out with programs aimed at  the communities, [and] with                                                                    
     a community  organizer. ...  We now  are in  the second                                                                    
     phase of  that, which  is in  the schools.   So  we are                                                                    
     dealing  with  the  superintendents  in  all  of  those                                                                    
     communities. ...  It'll be about  a five  year project.                                                                    
     When we complete it, we're  going to be able to provide                                                                    
     some data about  what does and does not  work with this                                                                    
5:17:05 PM                                                                                                                    
MS. NADEAU  stated her  understanding that  state funding  can be                                                               
based on outcome data and she said:                                                                                             
     I have [a] great hope that  ABADA is going to step into                                                                    
     ...  a  leadership void  in  what  needs to  happen  in                                                                    
     [that] area. ... I know  ... that lack of outcome data,                                                                    
     ... 'are we  throwing good money after  bad,' fears are                                                                    
     there, and so I think it's  incumbent upon us.  But one                                                                    
     of the messages  that I want to bring to  you is [that]                                                                    
     those  of us  who  are individual  providers have  very                                                                    
     little control over that.   That is a state bureaucracy                                                                    
     kind of  issue.  I can  tell you what my  program does.                                                                    
     I  can tell  you the  severity  of the  illness of  the                                                                    
     people who come into my  treatment program.  I can tell                                                                    
     you  what they're  doing as  they're  released and  for                                                                    
     about  a five  year period.   I  can't tell  you what's                                                                    
     going  on statewide,  because I  don't  have access  to                                                                    
     that.  You  don't fund individual programs,  you fund a                                                                    
     state department.                                                                                                          
MS. NADEAU  opined that the  $20 million  in budget cuts,  are in                                                               
part  frustration that  the legislature's  not receiving  outcome                                                               
information and stated:                                                                                                         
     That  kind  of  cut,  although   it  may  be  aimed  at                                                                    
     delivering a  message to the  department, ... is  a cut                                                                    
     at the  local provider level.   When that cut  comes to                                                                    
     me,  I   cut  my  Strengthening  Families   program;  a                                                                    
     nationally tested, respected,  and revered ... program.                                                                    
     ...  I  urge  you  to  share  that  message  with  your                                                                    
     colleagues ...  [to] find another  way to  hit somebody                                                                    
     other than the small provider  over the head with a big                                                                    
     stick,  because we're  the ones  on  the front  line[s]                                                                    
     trying to help folks.                                                                                                      
MS. NADEAU directed attention to  the committee's packet, and the                                                               
new McDowell  Group study.   She compared the funding  figures of                                                               
the current  one page  summary with the  figures on  the previous                                                               
summary, prepared  in 2001.   Referring to the static  figure for                                                               
public assistance,  she opined  that the  figure has  not changed                                                               
over the  past five years  because of  the state having  placed a                                                               
cap on welfare.  However, she said:                                                                                             
     It's not  getting less expensive  to provide  this kind                                                                    
     of service, and to pay for  not providing it.  We pay a                                                                    
     lot more for not providing it  than we do for even what                                                                    
     somebody may regard as 'failure  to follow through with                                                                    
     legislative intent'  from the department.   Please talk                                                                    
     to  your colleagues  about finding  another way  to get                                                                    
     that message in.                                                                                                           
5:21:33 PM                                                                                                                    
FRED GLENN (ph),  provided a personal history of  raising a child                                                               
in a small  community where drinking was touted  as acceptable by                                                               
the child's peers.  He explained  that despite the failure of his                                                               
counseling the  child subsequently  became a  successful graduate                                                               
of the DARE program.                                                                                                            
5:24:00 PM                                                                                                                    
KAT  MCELROY,  Clinical  Supervisor,  Substance  Abuse  Treatment                                                               
Service,  Railbelt  Mental  Health  Addiction;  Member,  Advisory                                                               
Board  on Alcoholism  and  Drug Abuse  (ABADA),  as a  recovering                                                               
third generation  alcoholic she provided a  brief history, praise                                                               
and  gratitude  for  the state  mandated  intervention  programs,                                                               
which eventually lead to her recovery.  She said:                                                                               
     I pay taxes  today.  I can't tell you  how wonderful it                                                                    
     is not to  have to be a recipient for  food stamps.  To                                                                    
     not have to  be a recipient for energy  assistance.  To                                                                    
     not have  to be a  person who  lives at the  expense of                                                                    
     the state,  but as  a person  who is  able to  work and                                                                    
     support themselves.   My  daughter ...  is a  mother of                                                                    
     three.   She does  not drink, and  she does  not smoke,                                                                    
     and she  does not get  in trouble  with the law.  ... I                                                                    
     think that is  a direct result of my  treatment ... and                                                                    
     of the  prevention programs that  were in  place during                                                                    
     her formative years.                                                                                                       
MS.  MCELROY said  that  every year  which she  has  worked as  a                                                               
substance abuse  counselor for  the state,  the funding  has been                                                               
"cut, cut,  cut," and yet  the agency  has been asked  to provide                                                               
more assistance "with less and less."  She stated:                                                                              
     In the jails today ...  we do not provide treatment for                                                                    
     the  captive audience.  ... People  are  in jail,  they                                                                    
     aren't going  anywhere, let's talk  to them  about what                                                                    
     got them  there. ... It  certainly has to be  more cost                                                                    
     effective than  what we're doing;  that cycling  in and                                                                    
     out  of those  jails, and  mental hospitals,  and other                                                                    
     emergency  rooms, and  detox [units].   Everybody  says                                                                    
     that  we can't  afford treatment,  but we  can't afford                                                                    
     not to provide treatment.                                                                                                  
MS. MCELROY  described an  incident as a  counselor with  a seven                                                               
year old child  in Nulato, who was able to  detail the makings of                                                               
home brew.   Further,  the child related  what would  happen when                                                               
the "hootch"  was ready for  consumption; she would hide  as "all                                                               
hell breaks loose  in her home.  She said  that despite the heart                                                               
break  of these  tragic stories,  she carries  a message  of hope                                                               
when she speaks with children,  because their lives don't need to                                                               
be like those of their parents.  She stated:                                                                                    
     It's important  that we  put our  money to  that avail.                                                                    
     It's  important that  we make  that decision,  and it's                                                                    
     important  that we  have  our voices  be  heard.   That                                                                    
     we're  not  talking  about  dollars  and  cents,  we're                                                                    
     talking  about people's  lives. ...  The money  that we                                                                    
     spend  on   treatment,  intervention,   and  prevention                                                                    
     services will [be] pay[ed] back  to the state ten times                                                                    
     over. ... I'm living proof to that.                                                                                        
REPRESENTATIVE  GARDNER stated,  "I  just want  to  stand up  and                                                               
applaud you."                                                                                                                   
5:29:02 PM                                                                                                                    
VICE  CHAIR SEATON  stressed the  importance  and helpfulness  of                                                               
everyone's testimony.                                                                                                           
There being no  further business before the  committee, the House                                                               
Health, Education and Social  Services Standing Committee meeting                                                               
was adjourned at 5:29:02 PM.                                                                                                  

Document Name Date/Time Subjects