02/28/2006 04:05 PM House HES
| Audio | Topic |
|---|---|
| Start | |
| HB442 | |
| HJR31 | |
| HB271 | |
| HCR5 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 28, 2006
4:05 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Vic Kohring
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
Representative Carl Gatto
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."
- MOVED HB 442(HES) OUT OF COMMITTEE
HOUSE JOINT RESOLUTION NO. 31
Relating to designating September 9, 2006, as Fetal Alcohol
Spectrum Disorders Awareness Day.
- MOVED HJR 31 OUT OF COMMITTEE
HOUSE BILL NO. 271
"An Act relating to limitations on overtime for registered
nurses in health care facilities; and providing for an effective
date."
- MOVED CSHB 271(HES) OUT OF COMMITTEE
HOUSE CONCURRENT RESOLUTION NO. 5
Relating to support of community water fluoridation.
- MOVED HCR 5 OUT OF COMMITTEE
HOUSE BILL NO. 426
"An Act relating to medical assistance eligibility and coverage
for persons under 21 years of age."
- SCHEDULED BUT NOT HEARD
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."
- SCHEDULED BUT NOT HEARD
HOUSE BILL NO. 258
"An Act relating to aggravating factors at sentencing."
- 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
02/23/06 (H) Heard & Held
02/23/06 (H) MINUTE(HES)
02/28/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HJR 31
SHORT TITLE: FETAL ALCOHOL SPECTRUM DISORDERS DAY
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH
02/08/06 (H) READ THE FIRST TIME - REFERRALS
02/08/06 (H) HES
02/23/06 (H) HES AT 3:00 PM CAPITOL 106
02/23/06 (H) <Bill Hearing Rescheduled to 2/28/06>
02/28/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 271
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES
SPONSOR(s): REPRESENTATIVE(s) WILSON
04/15/05 (H) READ THE FIRST TIME - REFERRALS
04/15/05 (H) L&C, HES, FIN
04/30/05 (H) L&C AT 1:00 PM CAPITOL 17
04/30/05 (H) Moved Out of Committee
04/30/05 (H) MINUTE(L&C)
05/02/05 (H) L&C RPT 4DP 3NR
05/02/05 (H) DP: CRAWFORD, LYNN, GUTTENBERG,
ANDERSON;
05/02/05 (H) NR: LEDOUX, ROKEBERG, KOTT
05/03/05 (H) HES AT 3:00 PM CAPITOL 106
05/03/05 (H) Heard & Held
05/03/05 (H) MINUTE(HES)
08/29/05 (H) HES AT 1:30 PM Anch LIO Conf Rm
08/29/05 (H) Heard & Held
08/29/05 (H) MINUTE(HES)
09/23/05 (H) HES AT 8:00 AM Anch LIO Conf Rm
09/23/05 (H) Heard & Held
09/23/05 (H) MINUTE(HES)
01/24/06 (H) HES AT 3:00 PM CAPITOL 106
01/24/06 (H) Heard & Held
01/24/06 (H) MINUTE(HES)
02/14/06 (H) HES AT 3:00 PM CAPITOL 106
02/14/06 (H) Scheduled But Not Heard
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
02/23/06 (H) Scheduled But Not Heard
02/28/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HCR 5
SHORT TITLE: FLUORIDATION
SPONSOR(s): REPRESENTATIVE(s) SEATON
03/09/05 (H) READ THE FIRST TIME - REFERRALS
03/09/05 (H) CRA, HES
02/02/06 (H) CRA AT 8:00 AM CAPITOL 124
02/02/06 (H) Moved Out of Committee
02/02/06 (H) MINUTE(CRA)
02/03/06 (H) CRA RPT 5DP
02/03/06 (H) DP: SALMON, NEUMAN, CISSNA, THOMAS,
OLSON
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
02/23/06 (H) Scheduled But Not Heard
02/28/06 (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, Version G, and HJR 31, on
behalf of Representative Weyhrauch, Sponsor and Prime Sponsor,
respectively.
JOHN DAWSON, Partner
Davis Wright and Tremaine Limited Liability Partnership (LLP);
Representative, Providence Anchorage Anesthesia Medical Group
Anchorage, Alaska
POSITION STATEMENT: Responded to questions regarding HB 442,
Version G.
JOHN BITNEY, Lobbyist
Alaska Nurses Association (ANA)
Juneau, Alaska
POSITION STATEMENT: Testified in support of CSHB 271, Version
P.
CINDY FOLSOM, Staff
to Representative Sharon Cissna
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Responded to questions on
LAURIE HERMAN, Regional Director
Government Affairs
Alaska State Hospital and Nursing Home Association (ASHNHA)
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified in support for CSHB 271, Version
P, save opposition for Section 18.09.010.
KATHERINE SHOWS, Staff
to Representative Paul Seaton
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HCR 5 on behalf of Representative
Seaton, Prime Sponsor.
WILLIAM MARLEY, Doctor of Dental Surgery (DDS)
Chairman, Fluoridation Committee
Alaska Dental Society (ADS)
Homer, Alaska
POSITION STATEMENT: Testified in support of HCR 5.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 4:03:48 PM.
Representatives Seaton, Cissna, Gardner, and Wilson were present
at the call to order. Representative Kohring arrived as the
meeting was in progress.
HB 442-HEALTH CARE DECISIONS
4:04:12 PM
CHAIR WILSON announced that the first order of business would be
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."
4:04:18 PM
JACQUELINE TUPOU, Staff to Representative Bruce Weyhrauch,
Alaska State Legislature, presented HB 442, Version G, on behalf
of Representative Weyhrauch, Sponsor, and stipulated that no
changes were made subsequent to the committee's previous review.
REPRESENTATIVE SEATON moved to adopt Amendment 1, 24-LS1618\G.1,
Bannister, 2/24/06, which read [original punctuation provided]:
Page 3, lines 24 - 26:
Delete "or if the physician reasonably believes
that the patient does not have a qualifying condition"
Page 4, line 25, following "chapter;":
Insert "or"
Page 4, lines 27 - 31:
Delete "or
(D) because the health care provider or
institution has a good faith belief that the condition
requiring cardiopulmonary resuscitation or other
resuscitative measures is not precipitated by a
qualifying condition;"
4:05:57 PM
REPRESENTATIVE SEATON explained that on page 3, lines 24-26, and
page 4, lines 27-31, Version G allows a physician to override a
do not resuscitate (DNR) order, which "is against what we were
doing in the adoption of the five wishes bill, ... and so I
offer Amendment 1." He continued, stating that the provisions
in the amendment allow a physician to disregard a DNR order when
a procedure is being performed that is not related to the
qualifying condition of the DNR order and resuscitation becomes
necessary. To further comply with the five wishes bill, the
amendment deletes the clause which allows a physician to
disregard a DNR directive when they believe that the patient
does not have a qualifying condition.
4:08:57 PM
REPRESENTATIVE CISSNA described her experience of doctors being
loathe to allow people to die unless everything is specifically
spelled out and the DNR order is at hand.
4:09:33 PM
CHAIR WILSON withdrew her objection, and there being no further
objection, Amendment l was adopted.
4:09:45 PM
REPRESENTATIVE GARDNER referred to the document labeled
Amendment 24-LS1618\G.2, Bannister 2/28/06, [subsequently
adopted as Amendment 2] which read [original punctuation
provided]:
Page 1, line 4:
Delete "of health care providers and
institutions"
Insert "and discipline of health care providers,
institutions, and facilities"
Page 2, line 25, through page 3, line 10:
Delete all material.
Renumber the following bill sections accordingly.
Page 4, line 25, following "chapter;":
Insert "or"
Page 4, lines 27 - 31:
Delete "or
(D) because the health care provider or
institution has a good faith belief that the condition
requiring cardiopulmonary resuscitation or other
resuscitative measures is not precipitated by a
qualifying condition;"
Page 5, lines 3 - 12:
Delete all material and insert:
"* Sec. 7. AS 13.52.080 is amended by adding a new
subsection to read:
(c) A health care provider, health care
institution, or health care facility is not subject to
civil or criminal liability, or to discipline for
unprofessional conduct, if a do not resuscitate order
prevents the health care provider, health care
institution, or health care facility from attempting
to resuscitate a patient who requires cardiopulmonary
resuscitation or other resuscitative measures because
of complications arising out of health care being
administered to the patient by the health care
provider, health care institution, or health care
facility. This subsection does not apply if the
complications suffered by the patient are caused by
reckless or intentional actions on the part of the
health care provider, health care institution, or
health care facility."
Renumber the following bill sections accordingly.
Page 6, line 4:
Delete "sec. 7"
Insert "sec. 5"
4:10:33 PM
REPRESENTATIVE GARDNER explained that this amendment is designed
to ensure that, when a conflict arises between the needs of the
care provider and the needs of the patient holding a DNR order,
that "the needs of the care provider could never trump the
confirmed DNR desires of the individual even if the
circumstances weren't dealing with the fatal illness." Further,
she explained that the amendment inserts the terms "discipline"
and "facilities" in title of the bill. The addition of
"discipline", she said, "Is to avoid a care provider having an
internal punishment for not resuscitating someone who held a DNR
order." Because the contents of this amendment overlap with the
previously adopted Amendment G.1, she noted that two deletions
would need to be made. She instructed the committee to make the
following change to the document [subsequently adopted as
Amendment 2], by deleting the language on page 1, lines 5-6,
which read:
Page 2, line 25, through page 3, line 10:
Delete all material.
4:14:40 PM
JOHN DAWSON, Partner, Davis Wright and Tremaine Limited
Liability Partnership (LLP); Representative, Providence
Anchorage Anesthesia Medical Group, explained that this
amendment eliminates the provisions which would allow a doctor
to correct a physician error or disregard a DNR order, when the
need for resuscitation is the result of a procedure not related
to the qualifying condition. Although this effectively "ties
the doctor's hands" the amendment provides the doctor with
liability immunity for honoring a DNR order at all costs.
4:15:47 PM
REPRESENTATIVE SEATON pointed out that Mr. Dawson was addressing
the amendment, page 1 beginning with line 20, but not the lines
of the bill itself, page 4, lines 26-27, which he understood to
be the area that Representative Gardner was referencing.
REPRESENTATIVE GARDNER concurred and directed the committee to
disregard her pervious request and to delete from the amendment
[subsequently adopted as Amendment 2], page 1, lines 4-19, thus
this ensures that a care provider who follows a DNR order, is
not subject to a law suit.
CHAIR WILSON clarified and confirmed the changes to the
amendment.
4:17:19 PM
REPRESENTATIVE GARDNER moved to adopt Amendment 2, 24-
LS1618\G.2, Bannister 2/28/06.
4:19:05 PM
CHAIR WILSON clarified that Amendment 2 would now read as
follows:
Page 1, line 4:
Delete "of health care providers and
institutions"
Insert "and discipline of health care providers,
institutions, and facilities"
Page 5, lines 3 - 12:
Delete all material and insert:
"* Sec. 7. AS 13.52.080 is amended by adding a new
subsection to read:
(c) A health care provider, health care
institution, or health care facility is not subject to
civil or criminal liability, or to discipline for
unprofessional conduct, if a do not resuscitate order
prevents the health care provider, health care
institution, or health care facility from attempting
to resuscitate a patient who requires cardiopulmonary
resuscitation or other resuscitative measures because
of complications arising out of health care being
administered to the patient by the health care
provider, health care institution, or health care
facility. This subsection does not apply if the
complications suffered by the patient are caused by
reckless or intentional actions on the part of the
health care provider, health care institution, or
health care facility."
Renumber the following bill sections accordingly.
Page 6, line 4:
Delete "sec. 7"
Insert "sec. 5"
4:20:37 PM
REPRESENTATIVE SEATON asked whether Amendment 2 affects [page 4]
line 26, which refers to a woman of childbearing age.
REPRESENTATIVE GARDNER clarified that this amendment provides
liability immunity to a physician who honors a DNR order, save
for reckless or intentional actions which do not uphold a
professional standard of care.
4:21:12 PM
REPRESENTATIVE SEATON pointed out that Amendment 1 dealt with
[page 4] lines 28-31 including the preceding "or" [line 27], and
not line [26] which refers to a woman of child bearing age, thus
it remains within the bill. He stated that his understanding of
the intent of Amendment 2, is to protect the health care
provider/institution from liability. He asked whether this
language would allow a physician to demonstrate gross negligence
and not be held responsible for their actions.
4:22:17 PM
REPRESENTATIVE GARDNER asked for the legal difference of
negligent and reckless.
MS. TUPOU stated that negligence means "of neglecting to do
things" and that's what you are allowing in this legislation;
for the physician to not act and not correct an error, which is
what precipitated the inclusion of the language "intention to be
reckless" and "intentional action".
REPRESENTATIVE GARDNER stated that it is her understanding that
under the usual standard of care a doctor could be found
negligent; however, in the case of a DNR order a doctor is
acting in an intentionally negligent manner. By following the
patients DNR order, the doctor should not be held responsible or
legally liable.
REPRESENTATIVE SEATON provided that it would be an egregious
oversight if this bill provided language which would allow a
doctor the latitude to err, for example "operate on the wrong
leg," and be absolved of the responsibility.
4:23:54 PM
JOHN DAWSON said that the focus of the bill is to hold doctors
free of liability where complications result from negligence.
The bill does not distinguish between negligence and gross
negligence because the distinction between the two terms is
difficult even for the courts to determine. However, the
distinction between negligence and recklessness is clear-cut and
a liability release for recklessness is excluded from this bill.
A surgeon is negligent, if he overlooks something or makes a
mistake, but if he knows that what he is engaging in will result
in a particular complication, such conduct could be termed
reckless. Disregarding a known risk is what constitutes
recklessness and the courts are able to clearly delineate
between these two terms. He conceded that he is not sure how
the "wrong leg" scenario would be considered given these two
terms, but he opined that it would be considered to represent
more than negligence.
4:25:22 PM
REPRESENTATIVE SEATON maintained his concern for "the wrong leg"
scenario and suggested that gross negligence should be included
in the language of this bill. He stressed that a liability
release for an act constituting gross negligence is not
allowable under any circumstances.
REPRESENTATIVE GARDNER agreed, and stated that if complications
arise from negligence, the doctor should be held liable, but if
death occurs due to negligence for the purpose of honoring a DNR
order, the doctor should be protected.
4:27:05 PM
MS. TUPOU stated:
It gets to what is the intent of the amendment. ...
at what point do you want the doctor to rectify his
... mistake. That's why we're trying to deal with
this in the liability section.
MS. TUPOU pointed out that if negligence is the action which the
committee wishes a doctor to take then the original language of
the bill should be maintained, and she reiterated the original
bill language regarding secondary and qualifying conditions.
She stressed that these two amendments disallow a doctor to
correct a procedural error when a DNR order is in place, and
said:
If you want doctors to carry that [DNR order] out I
think you need to be clear ... about what [the
doctors] ... liability is, here in this liability
section, because if not, you're not going to get the
patient's wishes honored, and ... [doctors] are going
to correct their mistakes for that secondary
condition, which is what the bill initially did."
4:28:08 PM
REPRESENTATIVE CISSNA provided a hypothetical situation of a
person who holds a DNR order and who manages to extricate
theirself from a life support intensive care unit (ICU) system,
only to be resuscitated and have the life support replaced by a
health care provider. She asked how an intervention of this
type would be handled.
MS. TUPOU responded that if a patient required life support for
their primary qualifying condition, that would be specified in
their DNR order, and this legislation only addresses secondary
conditions. She requested clarity regarding the language of the
amendments, and where the committee would like to place the
responsibility for liability as discussed.
REPRESENTATIVE SEATON provided that the intent of this amendment
is to hold a doctor liable for reckless behavior, and he
stressed that it should also include language stipulating gross
negligence. He suggested that the sponsor will have the
opportunity to incorporate the intent of the amendment into the
bill, prior to its review in a subsequent committee.
4:31:29 PM
REPRESENTATIVE SEATON moved Amendment 1 to Amendment 2 as
follows:
Page 2, line 7, between the words "by" and "reckless"
Insert "gross negligence,"
There being no objection, Amendment 1 to Amendment 2 was
adopted.
There being no further objection, Amendment 2, as amended, was
adopted.
4:32:12 PM
REPRESENTATIVE SEATON moved to report HB 442, Version 24-
LS1618\G, as amended, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 442(HES) was reported out of the House
Health, Education and Social Services Standing Committee.
HJR 31-FETAL ALCOHOL SPECTRUM DISORDERS DAY
4:32:36 PM
CHAIR WILSON [announced] that the next order of business would
be HOUSE JOINT RESOLUTION NO. 31, Relating to designating
September 9, 2006, as Fetal Alcohol Spectrum Disorders Awareness
Day.
4:32:58 PM
JACQUELINE TUPOU, Staff to Representative Bruce Weyhrauch,
Alaska State Legislature, presented HJR 31 on behalf of
Representative Weyhrauch, Prime Sponsor, paraphrasing from the
sponsor statement, which read as follows [original punctuation
provided]:
House Joint Resolution 31 designates September 9, 2006
Fetal Alcohol Spectrum Disorders Awareness Day. Fetal
Alcohol Spectrum Disorders are the single largest
cause of mental retardation in Alaska and are one
hundred percent preventable.
International FAS Awareness Day was first observed on
September 9, 1999. It began when a small group of
adoptive and foster parents of children afflicted with
FAS and Fetal Alcohol Effect (FAE) came together on
the Internet to ask this compelling question, "What if
a world full of FAS and FAE parents all got together
on the ninth hour of the ninth day of the ninth month
of the ninth year and asked the world to remember that
during the nine months of pregnancy a woman should not
consume alcohol?"
The designation of FASD Awareness Day is intended to
focus attention on the high cost of Fetal Alcohol
Spectrum Disorders to our state and the ease of
prevention. Currently, more American babies are born
with FAS than with Down Syndrome, Muscular Dystrophy,
and HIV combined. The simple fact is no alcohol
consumed during pregnancy has been established safe
for the fetus. If women do not drink any alcohol
during their nine months of pregnancy, alcohol-related
birth defects would be eliminated.
We ask Alaskans to come together at 9:09 am on
September 9, 2006 for a "pregnant pause" to reflect on
preventing FASD's and also to remember throughout the
year to continue to reach for the goal of eradicating
Fetal Alcohol Spectrum Disorders.
The committee took an at-ease 4:34:39 PM from to 4:35:11 PM.
[The committee returned to HJR 31 later in the meeting.]
4:35:16 PM
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES
4:35:29 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 271, "An Act relating to limitations on overtime
for registered nurses in health care facilities; and providing
for an effective date."
CHAIR WILSON described the two subcommittee meetings that were
held, resulting in the new version of the bill. She pointed out
that the Governor's budget includes funding to increase the
state employed nurses wages, providing a market competitive
compensation. During the second meeting of the subcommittee,
she reported, nurses from New Jersey, Oregon, and Washington
responded to inquiries regarding the recently implemented bans
on mandatory overtime in their states, and how it has been
working for them. She explained that these states have each
implemented a system which requires a nurse to lodge a
complaint, thus instigating an investigation to identify and
deal with a possible overtime infraction. The nurses who
testified, unanimously affirmed that this system works well;
however, there is no data available to back up their testimony,
and the hospitals contacted did not offer comment.
CHAIR WILSON delineated the specific changes that the concerned
"stakeholders" agreed to in the bill: the penalty aspect was
removed, facilities will not incur a penalty should they use
mandatory overtime; the bill excludes Certified Nurses Aides
(CNAs), critical access hospitals are included in the bill; each
facility is required to provide a semiannual report [to
Department of Health and Social Services] showing monthly totals
of mandatory overtime hours, voluntary overtime hours, on-call
hours, and contract nurses hours; and the state nursing wage
will be increased in the 2007 budget. She stressed the
importance for having the data reported, and explained how it
will be crucial for future analysis and planning. In response
to a question, she explained that the CNAs were excluded, as
they are not affected by the mandatory overtime issue.
4:43:15 PM
CHAIR WILSON moved to adopt CSHB 271, Version 24-LS0j838\P,
Bullock, 2/23/06, as the working document. There being no
objection, Version P was before the committee.
4:44:04 PM
JOHN BITNEY, Lobbyist, Alaska Nurses Association (ANA), stated
support for Version P, as a reasonable compromise that
establishes a policy to allow nurses to say "no" to working
overtime without fear of retribution, and the language
acknowledges and respects a nurses' professional standard for
responsive patient care.
4:46:00 PM
CHAIR WILSON directed the committee's attention to the written
testimony provided by Rod Betit, President of the Alaska State
Hospital & Nursing Home Association (ASHNHA), and suggested that
they take a moment to review its contents.
The committee took an at-ease from 4:46:47 PM to 4:47:13 PM.
[The committee returned attention to HB 271 later in the
hearing.]
4:47:22 PM
HJR 31-FETAL ALCOHOL SPECTRUM DISORDERS DAY
CHAIR WILSON returned the committee's attention to HOUSE JOINT
RESOLUTION NO. 31, Relating to designating September 9, 2006, as
Fetal Alcohol Spectrum Disorders Awareness Day.
4:47:33 PM
JACQUELINE TUPOU, Staff to Representative Bruce Weyhrauch,
Alaska State Legislature, resumed the presentation of HJR 31 on
behalf of Representative Weyhrauch, Prime Sponsor, and pointed
out that each year more children are born in America with fetal
alcohol spectrum disorders (FASD) than with Down Syndrome,
muscular dystrophy, and human immunodeficiency virus (HIV)
combined. In urging the committee to swiftly pass this joint
resolution, she stated that if mothers are aware not to consume
alcohol during pregnancy FASD is entirely avoidable.
CHAIR WILSON stressed that it is not often that there is a
disease that is 100 percent avoidable as is FASD.
4:48:21 PM
REPRESENTATIVE GARDNER asked about the reference on page 1, line
14, to mental illness, and stated that she has not heretofore
heard that FASD is a cause of mental illness.
MS. TUPOU responded that she is not qualified to answer that
question, but stated that the language for this resolution
primarily reflects what was drafted for a nation wide bill
provided by the office of United States Senator Lisa Murkowski.
REPRESENTATIVE CISSNA interjected that some conduct and
behavioral disorders of young children have been attributed to
FASD, and asked her staff member, Cindy Folsom, to offer her
opinion.
MS. TUPOU conjectured that perhaps mental illness is considered
a secondary disability caused by FASD.
4:50:22 PM
CINDY FOLSOM, Staff to Representative Sharon Cissna, Alaska
State Legislature, speaking from her experience as a retired
school counselor, stated that it is true that FASD can cause
conduct disorders, thus providing a context that could relate
FASD to mental illness.
4:50:50 PM
REPRESENTATIVE GARDNER moved to report HJR 31, Version 24-
LS1530\G, out of committee with individual recommendations and
the accompanying fiscal notes. There being no objection, HJR 31
was reported out of the House Health, Education and Social
Services Standing Committee.
4:51:01 PM
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES
CHAIR WILSON returned the committee's attention to HOUSE BILL
NO. 271, "An Act relating to limitations on overtime for
registered nurses in health care facilities; and providing for
an effective date."
4:51:04 PM
LAURIE HERMAN, Regional Director, Government Affairs, Alaska
State Hospital and Nursing Home Association (ASHNHA), Providence
Alaska Medical Center, stated support for CSHB 271, Version P,
save opposition for Section 18.09.010, which provides that the
nurse will be the sole determiner of whether overtime is
appropriate, thus removing management from the process.
4:52:27 PM
REPRESENTATIVE GARDNER asked why it would not be appropriate for
the individual to decide whether they could safely continue to
work.
LAURIE HERMAN explained that the nurse makes the decision
whether the overtime was mandatory or voluntary, for the
purposes of filling out the monthly overtime report.
CHAIR WILSON clarified that the reports are generated by the
hospitals, and it will be apparent to the individuals involved
whether the overtime was mandatory or voluntary. She said,
"That's the reality of what started the bill to begin with."
4:53:55 PM
REPRESENTATIVE GARDNER moved to report CSHB 271, Version 24-
LS0838\P, Bullock, 2/23/06, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 271(HES) was reported out of the
House Health, Education and Social Services Standing Committee.
4:54:21 PM
HCR 5-FLUORIDATION
CHAIR WILSON announced that the final order of business would be
HOUSE CONCURRENT RESOLUTION NO. 5, Relating to support of
community water fluoridation.
4:54:38 PM
KATHERINE SHOWS, Staff to Representative Paul Seaton, Alaska
State Legislature presented HCR 5 on behalf of Representative
Seaton, Prime Sponsor, paraphrasing from the sponsor statement,
which read as follows [original punctuation provided]:
House Concurrent Resolution 5 resolves to provide
fluoridation in all Alaskan water systems.
Fluoridated water has been shown to dramatically
reduce dental carries, especially in children. It is
one of the most efficient ways of providing cost
effective preventative health care; every $1 spent on
fluoridation saves $37 in future dental expenses.
Currently, all cities in Alaska with a population
exceeding 30,000 have access to fluoridated water. The
benefits of fluoridated water should be extended to
all Alaskans.
HCR 5 would also require all new water systems to be
engineered with the capacity for incorporating
fluoride. Communities would not be required to add
fluoride but would have the ability to do so at a
later date without costly retrofitting.
Tooth decay is a serious problem in Alaska,
particularly in rural areas that do not exercise
proper dental hygiene or eating habits, and where
access to dentists is not available. Poor dental
health puts a major burden upon Medicaid/Medicare
programs.
Fluoridating community water systems is an investment
in Alaska's public health that produces great returns.
HCR 5 makes it clear that the State supports
communities in taking this step to improve the dental
health of their residents.
MS. SHOWS pointed out the letters of support in the committee
packet, but also noted letters of opposition which she
attributes to the fact that fluoride is a toxic chemical and can
be harmful. She stated that the only known fatality from
fluoride occurred in Hooper Bay, due to sustained over-
fluoridation to the municipal water system. However, she noted
that more strict regulations have been implemented by the
Department of Environmental Conservation (DEC), since the Hooper
Bay incident, which should preclude a recurrence of that type.
Finally, she said that fluoride has been used in public water
systems for about sixty years, its effectiveness is
statistically supported by numerous studies, and 17 states
currently require fluoridation in their public water systems.
4:57:18 PM
CHAIR WILSON pointed out that this bill in no way mandates a
community to fluoridate their water, but does require that all
new water systems be engineered to allow for the future
administration of fluoride.
4:58:03 PM
REPRESENTATIVE GARDNER stated her support for the resolution,
but expressed a concern for fluoridation and provided a brief
history of her experience in Colorado Springs, Colorado, where
clinical fluoride levels are natural to the water presenting
adverse effects to some residents.
4:59:01 PM
REPRESENTATIVE KOHRING asked whether one of the primary chemical
components of fluoride is not also a primarily ingredient in rat
poison. Further, he asked why it would be necessary to drink,
bathe, and otherwise inundate our bodies via a systemic intake
of fluoride versus requesting a topical, localized, personal
application by a dental care provider.
MS. SHOWS responded that she is not familiar with the contents
of rat poison. She said that the levels of fluoride provided in
community water systems are at a low level and not considered
harmful to humans. She pointed out that one of the greatest
benefits of fluoride in a public water system is for people who
do not have alternative access to fluoride or regular dental
care.
REPRESENTATIVE KOHRING stated, "I'd be very concerned about
having my children consume a chemical." Further, he asked if
the sponsor had completed an in-depth analysis of the potential
health risks associated with systemic ingestion of fluoride.
MS. SHOWS stated that the health problems are primarily
fluorosis, which is a discoloration of the teeth, and possible
bone density loss. She maintained that the Hooper Bay incident
was an anomaly which cannot occur again provided the new
administration standards. She reiterated that this is a bill
which allows each community to choose fluoridation and does not
impose a mandate.
REPRESENTATIVE KOHRING maintained his concern for encouraging
the use of a chemical that carries a risk for potential health
problems. He also questioned the oversight for its proper
administration into the public water supply, and the possibility
for concentrations of fluoride to occur in different parts of a
water system.
5:03:50 PM
REPRESENTATIVE CISSNA has primarily lived where fluoridation is
utilized, and the dentists and health professionals that she has
consulted support the use of fluoride. She described the
problems that she has witnessed in the remote villages due to
the lack of dental care, where an eroded dental condition often
results in a patient undergoing a costly emergency medical
evacuation.
5:06:08 PM
WILLIAM MARLEY, Doctor of Dental Surgery (DDS), Chairman,
Fluoridation Committee, Alaska Dental Society (ADS), stated
support for HCR 5, which does not impose a mandate, or represent
a cost to the state, but does provide leadership for state
agencies to function in a unified manner. He suggested that the
committee refer to the booklet Fluoride Facts, published in
1999, by the American Dental Association (ADA), for an in-depth
understanding of the benefits of fluoridation. One study done
in Alaska has indicated that children who drink fluoridated
water experience 50 percent less dental disease. He maintained
that fluoridation is an effective means to help people curb
dental disease, especially if they fall in a lower socio-
economic, class or otherwise have limited access to dental care.
The Center for Disease Control (CDC) has begun the Healthy
Families Initiative (HFI) which has issued a goal to fluoridate
75 percent of the United States water supply systems by the year
2010. The Alaska Department of Health and Social Services has
signed onto the HFI.
5:11:33 PM
DR. MARLEY acknowledged the Hooper Bay casualty and explained
how the oversight has been corrected with a certified two-
operator system designed to eliminate errors in administration
of this toxic chemical. He also described the natural
fluoridated water phenomena of the southwest United States,
explaining how in some cases the fluoride is removed as the
recommended dosage is only one part per million. This allows
for minimal incidents of negative health side effects, which, he
opined, are overridden by the dental health benefits.
Continuing, he stressed that by encouraging the bush communities
to fluoridate their water supplies, the dental needs of the
residents would be reduced to the point that the dental care
available in any village would be adequate. Finally, he pointed
out that Article 7, Section 2, of the Alaska State Constitution
says that "the legislature shall provide for the promotion and
protection of the public health," and to that end, studies show
that healthy teeth play an important role.
The committee took an at-ease from 5:18:12 PM to 5:18:37 PM
5:18:38 PM
REPRESENTATIVE CISSNA moved to report HCR 5, Version 24LS0327\Y
out of committee with individual recommendations and the
accompanying fiscal notes. There being no objection, HCR 5,
Version Y was moved out of the House Health, Education and
Social Services Standing Committee.
5:18:58 PM
CHAIR WILSON announced that, due to scheduling difficulties, the
House Health, Education and Social Services Standing Committee
meetings would be postponed until further notice.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:19:20 PM.
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