04/11/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB467 | |
| SB177 | |
| HB426 | |
| HB482 | |
| HB467 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 467 | TELECONFERENCED | |
| += | HB 426 | TELECONFERENCED | |
| += | HB 482 | TELECONFERENCED | |
| += | HB 29 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 177 | TELECONFERENCED | |
| += | HB 468 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 11, 2006
3:10 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Carl Gatto
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Vic Kohring
COMMITTEE CALENDAR
HOUSE BILL NO. 467
"An Act relating to the administration of prescribed remedies
and dietary supplements by a nurse."
- MOVED CSHB 467(HES) OUT OF COMMITTEE
CS FOR SENATE BILL NO. 177(HES)
"An Act eliminating the prohibition on the use by certain
licensed professionals of titles or descriptions of services
that incorporate the terms 'psychoanalysis,' 'psychoanalyst,'
psychotherapy,' 'psychotherapeutic,' or 'psychotherapist.'"
- MOVED CSSB 177(HES) OUT OF COMMITTEE
HOUSE BILL NO. 426
"An Act relating to medical assistance eligibility and coverage
for persons under 21 years of age."
- MOVED CSHB 426(HES) OUT OF COMMITTEE
CS FOR HOUSE BILL NO. 482(EDU)
"An Act relating to harassment, intimidation, and bullying in
schools."
- MOVED CSHB 482(HES) OUT OF COMMITTEE
HOUSE BILL NO. 468
"An Act relating to disclosure of employment information on a
medical assistance application and a hospital intake report; and
requiring the Department of Health and Social Services to
prepare and publicize a report pertaining to employers who do
not provide health insurance."
- SCHEDULED BUT NOT HEARD
HOUSE BILL NO. 29
"An Act relating to health care insurance and to the
Comprehensive Health Insurance Association; and providing for an
effective date."
- BILL HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: HB 467
SHORT TITLE: ADMINISTRATION OF MEDICATION BY A NURSE
SPONSOR(s): REPRESENTATIVE(s) KELLY
02/13/06 (H) READ THE FIRST TIME - REFERRALS
02/13/06 (H) HES, FIN
03/28/06 (H) HES AT 3:00 PM CAPITOL 106
03/28/06 (H) <Bill Hearing Postponed to 03/30/06>
03/30/06 (H) HES AT 3:00 PM CAPITOL 106
03/30/06 (H) -- Meeting Canceled --
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
04/04/06 (H) <Bill Hearing Postponed to 04/06/06>
04/06/06 (H) HES AT 3:00 PM CAPITOL 106
04/06/06 (H) -- Rescheduled from 04/04/06 --
04/11/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: SB 177
SHORT TITLE: PRACTICE OF PSYCHOLOGY
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES BY REQUEST
04/15/05 (S) READ THE FIRST TIME - REFERRALS
04/15/05 (S) HES, L&C
04/20/05 (S) HES AT 1:30 PM BUTROVICH 205
04/20/05 (S) Scheduled But Not Heard
01/25/06 (S) HES AT 1:30 PM BUTROVICH 205
01/25/06 (S) Heard & Held
01/25/06 (S) MINUTE(HES)
02/01/06 (S) HES AT 1:30 PM BUTROVICH 205
02/01/06 (S) -- Rescheduled to 02/03/06 --
02/03/06 (S) HES AT 1:30 PM BUTROVICH 205
02/03/06 (S) -- Rescheduled from 02/01/06 --
02/06/06 (S) HES RPT CS 2DP 1NR NEW TITLE
02/06/06 (S) DP: DYSON, ELTON
02/06/06 (S) NR: GREEN
02/14/06 (S) L&C AT 1:30 PM BELTZ 211
02/14/06 (S) Moved CSSB 177(HES) Out of Committee
02/14/06 (S) MINUTE(L&C)
02/15/06 (S) L&C RPT CS(HES) 3DP 2NR
02/15/06 (S) DP: BUNDE, SEEKINS, STEVENS B
02/15/06 (S) NR: DAVIS, ELLIS
02/22/06 (S) TRANSMITTED TO (H)
02/22/06 (S) VERSION: CSSB 177(HES)
02/24/06 (H) READ THE FIRST TIME - REFERRALS
02/24/06 (H) HES, L&C
03/28/06 (H) HES AT 3:00 PM CAPITOL 106
03/28/06 (H) <Bill Hearing Postponed to 04/04/06>
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
04/04/06 (H) <Bill Hearing Postponed to 04/06/06>
04/06/06 (H) HES AT 3:00 PM CAPITOL 106
04/06/06 (H) -- Rescheduled from 04/04/06 --
04/11/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 426
SHORT TITLE: MEDICAL ASSISTANCE FOR PERSONS UNDER 21
SPONSOR(s): REPRESENTATIVE(s) COGHILL
02/06/06 (H) READ THE FIRST TIME - REFERRALS
02/06/06 (H) HES, FIN
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
02/28/06 (H) Scheduled But Not Heard
03/16/06 (H) HES AT 3:00 PM CAPITOL 106
03/16/06 (H) -- Meeting Canceled --
03/21/06 (H) HES AT 3:00 PM CAPITOL 106
03/21/06 (H) Heard & Held
03/21/06 (H) MINUTE(HES)
03/28/06 (H) HES AT 3:00 PM CAPITOL 106
03/28/06 (H) <Bill Hearing Postponed to 03/30/06>
03/30/06 (H) HES AT 3:00 PM CAPITOL 106
03/30/06 (H) -- Meeting Canceled --
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
04/04/06 (H) <Bill Hearing Postponed to 04/11/06>
04/11/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 482
SHORT TITLE: SCHOOL:BULLYING/HARASSMENT/INTIMIDATION
SPONSOR(s): REPRESENTATIVE(s) ANDERSON
02/13/06 (H) READ THE FIRST TIME - REFERRALS
02/13/06 (H) EDU, HES, JUD
03/16/06 (H) EDU AT 11:00 AM CAPITOL 106
03/16/06 (H) Moved CSHB 482(EDU) Out of Committee
03/16/06 (H) MINUTE(EDU)
03/20/06 (H) EDU RPT CS(EDU) 1DNP 3NR 1AM
03/20/06 (H) DNP: LYNN;
03/20/06 (H) NR: GARA, THOMAS, NEUMAN;
03/20/06 (H) AM: GATTO
04/03/06 (H) FIN REFERRAL ADDED AFTER JUD
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
04/04/06 (H) <Bill Hearing Postponed to 04/06/06>
04/06/06 (H) HES AT 3:00 PM CAPITOL 106
04/06/06 (H) -- Rescheduled from 04/04/06 --
04/10/06 (H) JUD AT 1:00 PM CAPITOL 120
04/10/06 (H) <Bill Hearing Postponed to 04/12/06>
04/11/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 468
SHORT TITLE: HEALTH CARE DISCLOSURE
SPONSOR(s): REPRESENTATIVE(s) GRUENBERG
02/13/06 (H) READ THE FIRST TIME - REFERRALS
02/13/06 (H) HES, FIN
03/28/06 (H) HES AT 3:00 PM CAPITOL 106
03/28/06 (H) <Bill Hearing Postponed to 03/30/06>
03/30/06 (H) HES AT 3:00 PM CAPITOL 106
03/30/06 (H) -- Meeting Canceled --
04/04/06 (H) HES AT 3:00 PM CAPITOL 106
04/04/06 (H) Heard & Held
04/04/06 (H) MINUTE(HES)
04/11/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
DEREK MILLER, Staff
to Representative Michael "Mike" Kelly
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced the Committee Substitute (CS) to
HB 467 on behalf of Representative Kelly, sponsor.
RICK SHIKORA, Certified Public Accountant (CPA)
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of CSHB 467, Version
F.
CATHERINE GIESSEL, Master of Science in Nursing (MSN)
Registered Nurse (RN)
Advanced Nurse Practitioner (ANP);
Chairperson, Alaska Board of Nursing (ABN)
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition of HB 467.
MICHAEL ELLENBURG, Medical Doctor (MD)
Comprehensive Medicine, Limited Liability Company (LLC)
Anchorage, Alaska
POSITION STATEMENT: Testified on HB 467.
JASON HOOLEY, Staff
to Senator Fred Dyson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SB 177 on behalf of Senator
Dyson, sponsor.
ANNE HENRY
Anchorage, Alaska
POSITION STATEMENT: Offered to respond to questions on SB 177.
JOHN MILLER, Ph.D., Psychologist;
Member, Board of Psychologists and Psychological Examiners
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 177.
RYNNIEVA MOSS, Staff
to Representative John Coghill
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced CSHB 426, Version L, on behalf
of Representative Coghill, sponsor,
STACIE KRALY, Chief Assistant Attorney General
Statewide Section Supervisor
Human Services Section;
Civil Division
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Testified on HB 426.
CRYSTAL NOVOTNEY, Staff
to Representative Tom Anderson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 482, on behalf of
Representative Anderson, prime sponsor.
KATIE SINGLETON,
Bye-Bye Bullies
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 482.
CINDY FOLSOM, Staff
to Representative Sharon Cissna
Alaska State Legislature;
Retired School Counselor
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 482, Amendment
1.
REPRESENTATIVE KELLY
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified on HB 467, as sponsor.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:10:32 PM.
Representatives Gardner, Anderson, Cissna, and Wilson were
present at the call to order. Representatives Gatto and Seaton
arrived as the meeting was in progress.
HB 467-ADMINISTRATION OF MEDICATION BY A NURSE
3:10:42 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 467, "An Act relating to the administration of
prescribed remedies and dietary supplements by a nurse."
[Before the committee was HB 467, Version 24-LS1265\G.]
3:12:13 PM
[Treated as adopted and before the committee was CSHB 467,
Version 24-LS1265\F, Mischel, 4/7/06.]
DEREK MILLER, Staff to Representative Michael "Mike" Kelly,
Alaska State Legislature, introduced the Committee Substitute
(CS) to HB 467, paraphrasing from a written statement which read
as follows [original punctuation provided]:
1)Would we be permitting nurses to administer non-
prescribed dietary supplements based on the language
in page 1, line 5?
Answer: No we would not, because the definition of
"prescribed remedy or dietary supplement" beginning on
page 1, line 14 of the bill addresses this concern.
2) Does this bill only allow the administration of
remedies and dietary supplements if an Advanced
Practice Nurse (APN) prescribes them, or does it
encompass all professionals with prescriptive
authority?
Answer: No, under Title 8 Advanced Nurse
Practitioners, physicians, physician assistants,
dentists and podiatrists can prescribe.
3) How can we insert language into the bill that will
ensure that the Board of Nursing and the nursing
community at-large incorporate safeguards or a set of
guidelines for nurses to follow for administration of
dietary supplements?
Answer: Yes, and I will provide a CS for the
committee to adopt with the language that would charge
the Board of Nursing to establish standards and
regulations for the administration of prescribed
remedies and dietary supplements.
3:15:16 PM
RICK SHIKORA, Certified Public Accountant (CPA), stated support
for CSHB 467, Version F, and paraphrased from the following
written statement [original punctuation provided]:
My 98 year old grandmother is a resident of the
Fairbanks Pioneers' home and is the reason this bill
is before you today. But i didn't ask that this issue
be addressed just for her benefit, but for many
similarly situated individuals.
The board of nursing in its own testimony has
indicated that it has not resolved this issue despite
its being up before it three or four times.
I will attend the upcoming June meeting of the board
of nursing to help them with ideas for the
regulations. I have previously provided them with
some of my thoughts in policy form and that document
could easily be a base with which to start.
I wholeheartedly support committee substitute for
hb467 as it provides clear direction for the board to
address this critical issue, yet leaves them with the
latitude to make sure that the most paramount issue,
safety of the patient, is protected.
I urge you to pass this committee substitute today.
3:17:17 PM
CATHERINE GIESSEL, Master of Science in Nursing (MSN),
Registered Nurse (RN), Advanced Nurse Practitioner (ANP);
Chairperson, Alaska Board of Nursing (ABN), testified in
opposition to HB 467 and maintained her initial concerns for
this legislation stating:
You are asking [the Board of Nursing] to establish
standards for something that is non-approved. That is
... contradictory [because] standards refer to
creating a level of quality or excellence that is
acceptable as the norm. ... I'm not sure that
[standard] is the proper term to use. ... In line 9,
page 1, it talks about the Board of Nursing including
in these standards safeguards. Essentially what
you're asking the Board of Nursing to undertake is a
task that the federal government, with all of its
resources has not undertaken to do, and that is to
assure safeguards. We have established a safeguard
and that is that these substances are not safe. ...
I'm not quite sure how ... that standard could be
attained. It goes on in the CS to say ... [page 1],
line 11, "[standards must include safeguards that
prevent the administration] ... if the prescription is
for an amount of the remedy or supplement that is
outside the manufacturer's recommended dosage for ...
a patient of the same physical condition." ... You're
asking [nurses] to go by the manufacturer's
recommended dosage. The manufacturers are the
financial beneficiaries of this product, therefore
have a vested interest in how much of it they're
selling. Why would we consider the manufacturer's
recommended dosage reliable? [Manufacturers] have no
liability for adverse responses to these products;
these substances are not regulated [and] the
recommended dosage varies between manufacturers. ...
I'm not sure you're creating a standard or a level of
excellence that is attainable. At the end of that
sentence it refers to a patient of the same physical
condition. For a registered nurse to establish the
physical condition of a patient, ... would require her
to actually do a medical examination and make a
medical diagnosis; this falls outside of her scope of
practice. When I look at the definition ... [page 2],
[line 3], ... referring to herbal, and vitamin
remedies. I would point out that the two supplements
... brought to the boards attention ... [are neither]
herbs or vitamin remedies. I would perhaps suggest
that Representative Kelly might want to look at that
definition .... I would also bring to the committee's
attention SB 313. This bill would... [place] an herb
... into the category of a class two controlled
substance. ... On a database called Up-To-Date ...
[an] article on this particular family of herbs
[describes] the kidney disease ... caused from [the
herb] ... being given in a weight reduction clinic.
... I hope [this] ... illustrate[s] to you the
unregulated and dangerous position that these herbs
and substances are in. ... I don't know if you have
yet received the letter from ... [two] pharmacist [s]
... in Anchorage. Both of these letters will be in
support of the board's position that [the
administration of supplements] is an unsafe practice.
3:23:17 PM
CHAIR WILSON asked whether Ms. Giessel could suggest language
and terms that would help to improve this bill and make it more
workable and inclusive.
3:23:52 PM
MS. GIESSEL offered the term "dietary supplement" be
incorporated to encompass some of the supplements discussed.
However, she opined that a language change would not bring the
bill into line with the Board of Nursing's stance. She offered
to provide further data to illustrate that supplements are
"dangerous" and not benign substances that can be taken without
concern.
3:25:02 PM
REPRESENTATIVE ANDERSON asked who endorses the legislation as it
is currently written.
MR. MILLER directed attention to the letters in the committee's
packet, including one from the Alaska Nurses Association (ANA)
indicating the recommendations/action they have taken on this
bill.
REPRESENTATIVE ANDERSON inquired on whose behalf Ms. Giessel was
testifying.
MS. GIESSEL indicated that she represents and speaks on behalf
of the Alaska Board of Nursing (ABN), and that she has no
affiliation with the ANA.
CHAIR WILSON pointed out the letter of support received from the
Alaska State Nursing Home Association (ASNHA).
REPRESENTATIVE ANDERSON clarified:
[Ms. Giessel] ...the Board of Nursing has authorized
you, the Board of Nursing meaning under the Department
of Occupational Licensing, ... the peer review that
licenses nurses in the industry, ... have requested
that you testify today.
MS. GIESSEL replied, "You are correct."
3:27:10 PM
CHAIR WILSON opined that the language of the bill provides
latitude for the board to comply with the nursing regulations,
and that perhaps the term "guidelines" rather than "standards"
could prove helpful. She suggested that the board could
stipulate appropriate requirements to ensure safeguards such as
a provision that a supplement must carry an endorsement stamp
from the United States Pharmacopeia (USP).
3:28:09 PM
MR. MILLER stated that these points are what the ANA expects to
bring before the Board of Nursing, for creating safeguards in
implementing this bill.
3:28:38 PM
CHAIR WILSON established that subsequently the bill will be in
the Finance Committee.
REPRESENTATIVE CISSNA described her own usage of dietary
supplements without adverse effects, concern from her health
care provider, or research literature that would cause alarm.
She asked, "Why is [taking a supplement] so dangerous?"
3:30:10 PM
MS. GIESSEL established that this bill is being written for the
use of a myriad of supplements. She pointed out that the
situation under which a healthy outpatient self administers
supplements, is a different scenario than having these
supplements administered to a category of people in resident
facilities, who may have multiple disease diagnoses and who are
taking multiple medications. She stressed the vulnerability of
this class of patients and maintained concerns for side effects,
allergic reactions, and the viability of a supplement product.
3:33:06 PM
REPRESENTATIVE CISSNA stated that it is her understanding that
current law allows nurses the choice to abstain from
administering a substance if they so choose.
3:33:32 PM
MS. GIESSEL clarified that it is not law which provides that
possibility but rather the ethical code of nursing. She offered
a summary of the position originally established by the Board of
Nursing in the late 1990's:
Because we cannot assure the purity of the
substance[s] ..., the Board of Nursing has taken the
position that it is outside the scope of practice for
a registered nurse to administer nutritional
supplements, herbal or homeopathic supplements, or
other non-FDA approved medications.
MS. GIESSEL directed attention to the committee packet and the
example provided in the Alaska Board of Nursing Position Paper,
March 2006, page 2, paragraph 3, which provides an example of
how this ethical code is implemented.
3:34:59 PM
CHAIR WILSON asked whether a nurse would have her license
revoked if she violated the code of ethics.
MS. GIESSEL responded that violations of the Nurse Practice Act
are scrutinized on an individual basis, making it difficult to
make a blanket statement of what might be imposed. However, it
is a possibility that a license could be revoked if a complaint
were filed and found to be justified.
3:35:28 PM
MR. MILLER held forth Representative Kelly's position stating:
The facilities are equipped with the proper tools to
enable them to be able to follow through with a policy
like this; between the doctors, the pharmacies and the
pharmacists, the facility, the administrators ... the
patient willingness, the willingness of the nurse, and
... the patient need for some of these supplements,
that we can go ahead and move forward with this
policy.
MR. MILLER pointed out that this effectively involves six or
seven levels of safeguards prior to a supplement reaching the
patient. Despite these layers of protection, because of the
current Board of Nursing policy, facility residents are not able
to receive these supplements, hence the frustration of those
people who would choose to receive or to administer these
supplements.
3:36:38 PM
REPRESENTATIVE GARDNER requested a synopsis of the Board of
Nursing mission statement.
3:36:51 PM
MS. GIESSEL pointed out that it is in the committee packet and
stated it as: "To ensure public safety through the regulation
of safe nursing practice." She explained that when the board
writes a policy or takes a position they look at the
implications with a broad population in mind. Referring to Mr.
Miller's remarks, she said that there are pharmacists who are
aligned with the Board of Nursing position on this issue, and
she pointed out that assisted living homes do not have
affiliated pharmacists.
3:38:09 PM
REPRESENTATIVE ANDERSON stated his understanding that the Board
of Nursing is against the administering of these remedies or
dietary substances, in residential facilities because "of the
fear that they are dangerous in many respects and the nurses may
not have an understanding of their effects."
3:38:47 PM
MS. GIESSEL clarified that it is not fear but a conclusion drawn
from documented scientific review, based on clinical evidence.
She stated:
[The board] has taken ... an objective impartial look
at the medical evidence that is available which does
not support these as safe substances. And that's the
basis of our decision.
REPRESENTATIVE ANDERSON agreed that taking an excessive amount
of a supplement may cause harm, and asked to have a doctor
provide an opinion.
MICHAEL ELLENBURG, M.D., Comprehensive Medicine, Limited
Liability Company ((LLC), agreed with the concern for
administering supplements in an assisted living home where a
formulary would need to be established and drug interaction
scrutinized. He opined that there could be various negative
results when combining supplements with other medications.
However, he opined that supplements could be used safely.
REPRESENTATIVE ANDERSON suggested that Dr. Ellenburg's testimony
is helpful in providing an additional opinion for parties
interested in this bill. As this bill passes to the Finance
Committee, he offered that it will carry with it an objective to
attempt to delineate safe quantities.
CHAIR WILSON stated that the legislature will not be making
those decisions. The bill provides for appropriate restrictions
to be made at the board level.
REPRESENTATIVE ANDERSON pointed out that it would be important
to continue the process of moving this bill, and given the
calendar it would be imperative to move it from this committee
today.
CHAIR WILSON stated that the bill would be set aside for
discussion later today.
REPRESENTATIVE GARDNER expressed her reason for not supporting
the bill, stating:
This bill is asking the Board of Nursing to make a
finding that is possibly contrary to their mission
statement. ... I ... don't feel, ... as a non-medical
professional person, ... as a legislator, that I have
the authority, the expertise to tell [the board] ...
to do something that they disagree with medically.
3:45:48 PM
MR. MILLER maintained that by denying this bill we deny access
of people in resident facilities to certain substances which
they want and need. Neither does the bill require that nurses
administer anything unwillingly. He opined that this is a
common sense approach to this problem, and further, said that it
is not contradictory to the mission of the Board of Nursing. It
could be argued that the mission is not being fulfilled by
denying the administration of these dietary supplements and
remedies that the patient's request, he suggested.
3:46:44 PM
CHAIR WILSON said that passage of this bill puts it in the hands
of the Board of Nursing for implementation.
REPRESENTATIVE GARDNER said that access to supplements is not
being denied, but if the Board of Nursing ascertains that it is
outside the scope of practice for nurses to administer
supplements, other support would need to be employed for that
service. She opined that if the Board of Nursing does not
support this action by nurses, it would not be appropriate for
the legislature to contravene that decision.
3:48:07 PM
REPRESENTATIVE CISSNA offered that the bill language affords
latitude to provide a broad spectrum result, which should
protect everyone involved. Further, she stated a personal
desire for the future possibility that supplements be
appropriately reviewed and clinically administered in
residential facilities.
3:49:33 PM
REPRESENTATIVE ANDERSON suggested holding the bill.
CHAIR WILSON set the bill aside for further consideration later
in today's meeting.
3:50:06 PM
SB 177-PRACTICE OF PSYCHOLOGY
CHAIR WILSON announced that the next order of business would be
CS FOR SENATE BILL NO. 177(HES), "An Act eliminating the
prohibition on the use by certain licensed professionals of
titles or descriptions of services that incorporate the terms
'psychoanalysis,' 'psychoanalyst,' 'psychotherapy,'
'psychotherapeutic,' or 'psychotherapist.'"
3:50:25 PM
JASON HOOLEY, Staff to Senator Fred Dyson, Alaska State
Legislature, presented SB 177, on behalf of Senator Dyson,
paraphrasing from the sponsor statement which read as follows
[original punctuation provided]:
AS 08.86.180 prohibits professionals-except for
licensed psychologists and clinical social workers-
from using certain terms to describe their services or
their titles. These terms include: "psychology,"
"psychological," "psychologist," "psychometry,"
"psychotherapy," "psychotherapeutic,"
"psychotherapist," "psychoanalysis," and
"psychoanalyst." This statute was written prior to the
licensure of professional counselors (LPCs) and
marital and family therapists (LMFTs), who also
provide these types of psychological services. LPCs
and LMFTs constitute a large portion of Alaska's
licensed mental health professional workforce, and are
an even larger percentage of professionals working in
state funded community mental health centers.
CS SB 177 (HES) was composed with the collaboration of
the Alaska Board of Licensed Professional Counselors,
the Alaska Psychological Association, the Alaska Board
of Psychologist and Psychological Associate Examiners,
the Alaska Chapter of the National Association of
Social Workers, the Alaska Board of Marital and Family
Therapists, and the Alaska Board of Social Work
Examiners.
SB 177 updates these statutes to reflect current
practice and training as well as maintaining a degree
of protection to the public. The language affects
licensed clinical social workers, licensed marital and
family therapists, and licensed professional
counselors and explicitly allows these licensed
professionals to provide and bill for these services.
3:53:26 PM
ANNE HENRY, offered to answer questions on SB 177.
3:53:44 PM
JOHN MILLER, Ph.D., Psychologist; Member, Board of Psychologists
and Psychological Examiners, stated support for SB 177, and
agreed with Mr. Hooley's testimony. He said that the licensed
mental health professionals and groups, which he has been in
contact with, also support this bill.
The committee took an at-ease from 3:54:12 p.m. to 3:54:44 p.m.
3:54:44 PM
REPRESENTATIVE ANDERSON moved to report CSSB 177(HES), Version
24-LS0893\G, out of committee with individual recommendations
and the accompanying fiscal notes. There being no objection,
CSSB 177(HES), Version G, was reported from the House Health,
Education and Social Services Standing Committee.
The committee took an at-ease from 3:55p.m. to 3:56 p.m.
HB 426-MEDICAL ASSISTANCE FOR PERSONS UNDER 21
3:56:12 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 426, "An Act relating to medical assistance
eligibility and coverage for persons under 21 years of age."
3:56:34 PM
REPRESENTATIVE ANDERSON moved to adopt CSHB 426, Version 24-
LS1602\L, Mischel, 3/24/06, as the working document. There
being no objection, CSHB 426, Version L was before the
committee.
CHAIR WILSON
3:57:02 PM
RYNNIEVA MOSS, Staff to Representative John Coghill, Alaska
State Legislature, introduced CSHB 426, Version L, on behalf of
Representative Coghill, sponsor, and explained that the
committee substitute (CS) eliminates Section 6, which considered
the father's income for Medicaid qualification. Additionally,
language was added to Section 8 in order to clarify the intent
of the bill regarding the limits for applying to receive
Medicaid. She went on to compare the amendments offered on the
bill from Representatives Cissna and Coghill pointing out the
additional language to subparagraph (C) in Version L.1:
Amendment to CSHB426, Version 24-LS1602\L.1, Mischel, 4/11/06,
offered by Representative Cissna, read:
Page 1, line 4, following "eligibility;":
Insert "relating to home and community-based
services;"
Page 7, following line 24:
Insert a new bill section to read:
"* Sec. 8. AS 47.07 is amended by adding a new
section to read:
Sec. 47.07.045. Home and community-based
services. (a) A person who is eligible for medical
assistance coverage may be paid for home and
community-based services under a waiver approved by
the federal government if the person is approved
initially and at least once a year thereafter for the
services by the department based on an assessment
described in regulation that finds that the person
meets a level of care necessary for admission to an
intermediate care facility for the mentally retarded
or to a nursing facility.
(b) The department may not terminate payment for
approved home and community-based services unless, at
any time,
(1) the recipient of the services scores
below the eligibility standard on the assessment
employed under (a) of this section; and
(2) the score is reviewed by an independent
qualified health care professional who certifies that
the recipient's condition has materially improved from
the previous assessment.
(c) In this section,
(1) "independent qualified health care
professional" means a
(A) registered nurse licensed under
AS 08.68 who is qualified to assess children with
complex medical conditions, older Alaskans, and adults
with physical disabilities for medical assistance
waivers; and
(B) a person who is qualified under 42 CFR
483.430 as a mental retardation professional for the
mental retardation and developmental disability
waiver;
(2) "materially improved" means that the
recipient has previously qualified for a waiver for
(A) children with complex medical
conditions, no longer needs technical assistance for a
life-threatening condition, and is expected to be
placed in a skilled nursing facility for less than 30
days each year;
(B) mental retardation or developmental
disability, no longer needs the level of care provided
by an intermediate care facility for the mentally
retarded either because the qualifying diagnosis has
changed or the recipient is able to demonstrate the
ability to function in a home setting without the need
for waiver services; or
(C) older Alaskans or adults with physical
disabilities, no longer has a functional limitation or
cognitive impairment that would result in the need for
nursing home placement, and is able to demonstrate the
ability to function in a home setting without the need
for waiver services."
Renumber the following bill sections accordingly.
Page 8, line 21:
Delete "sec. 11"
Insert "sec. 12"
Amendment to CSHB, Version 24-LS1602\I.1, Mischel, 3/16/06, by
Representative Coghill, read:
Page 1, line 4, following "eligibility;":
Insert "relating to home and community-based
services;"
Page 8, following line 12:
Insert a new bill section to read:
"* Sec. 9. AS 47.07 is amended by adding a new
section to read:
Sec. 47.07.045. Home and community-based
services. (a) A person who is eligible for medical
assistance coverage may be paid for home and
community-based services under a waiver approved by
the federal government if the person is approved
initially and at least once a year thereafter for the
services by the department based on an assessment
described in regulation that finds that the person
meets a level of care necessary for admission to an
intermediate care facility for the mentally retarded
or to a nursing facility.
(b) The department may not terminate payment for
approved home and community-based services unless, at
any time,
(1) the recipient of the services scores
below the eligibility standard on the assessment
employed under (a) of this section; and
(2) the score is reviewed by an independent
qualified health care professional who certifies that
the recipient's condition has materially improved from
the previous assessment.
(c) In this section,
(1) "independent qualified health care
professional" means a
(A) registered nurse licensed under
AS 08.68 who is qualified to assess children with
complex medical conditions, older Alaskans, and adults
with physical disabilities for medical assistance
waivers; and
(B) a person who is qualified under 42
C.F.R. 483.430 as a mental retardation professional
for the mental retardation and developmental
disability waiver;
(2) "materially improved" means that the
recipient has previously qualified for a waiver for
(A) children with complex medical
conditions, no longer needs technical assistance for a
life-threatening condition, and is expected to be
placed in a skilled nursing facility for less than 30
days each year;
(B) mental retardation or developmental
disability, no longer needs the level of care provided
by an intermediate care facility for the mentally
retarded either because the qualifying diagnosis has
changed or the recipient is able to demonstrate the
ability to function in a home setting without the need
for waiver services; or
(C) older Alaskans or adults with physical
disabilities, no longer has a functional limitation or
cognitive impairment that would result in the need for
nursing home placement."
Renumber the following bill sections accordingly.
Page 9, line 9:
Delete "sec. 12"
Insert "sec. 13"
MS. MOSS stated that within the last nine months, clients have
been removed from Medicaid waivers despite the fact that their
physical conditions and needs have not changed. She expressed
appreciation for the language which Representative Cissna has
provided in Amendment, Version L.1, to ensure against this type
of action continuing.
STACIE KRALY, Chief Assistant Attorney General, Statewide
Section Supervisor, Human Services Section; Civil Division,
Department of Law (DOL), stated that Amendment, Version L.1, had
been reviewed and no substantive issues were found.
4:00:15 PM
REPRESENTATIVE CISSNA moved Amendment 1, labeled 24-LS1602\L.1,
Mischel, 4/11/06, [text provided previously].
REPRESENTATIVE ANDERSON objected for discussion.
MS. KRALY explained that the purpose of this amendment was to
address a litigation issue which the Department of Health and
Social Services is currently involved with, to wit:
[The issue being] whether or not [Department of Health
and Social Services] are required to demonstrate that
an individual has materially improved prior to
terminating them from a waiver services. Home and
community based waiver services are provided to a
number of individuals in ... Alaska, and in order to
qualify for a waiver [the individual] must ... have a
qualifying diagnosis ... [or] meet a level of care
that would either be obtained in an intermediate care
facility for the mentally retarded or a nursing
facility. ... Upon assessment and eligibility [an
individual] must be annually re-assessed, by federal
and state law. ... Upon re-assessment there has been
an allegation that [the department] must show material
improvement.
MS. KRALY provided the department's position to be that the
assessment tool used by DHSS quantifies improvement, however,
this amendment would further clarify the process and allow for
an additional eligibility review; possibly bringing resolution
to the current litigation.
REPRESENTATIVE ANDERSON offered to remove his objection.
REPRESENTATIVE CISSNA echoed Ms. Kraly's explanation of the
amendment, and added that the outlook for a senior is different
than the expectation held for a child's future. She stated that
the amendment stipulates appropriate expectations for a senior;
that they may aspire to a situation of requiring the least
restrictive services.
4:03:41 PM
MS. KRALY agreed and pointed out that goals for seniors and
adults are also different. She stated that circumstances could,
given the fluidity of life, allow for someone of any age to have
a waiver terminated. What needs to be clearly articulated, she
opined, is that a waiver is not necessarily for the rest of your
life. She provided various reasons why individuals might be
terminated from a waiver program: a general improvement of
condition; non-waived services are made available; or other
support services are made available which require waiver
termination. The annual re-assessment for eligibility is
conducted for this non-presumptive reason, she pointed out.
CHAIR WILSON agreed with the need to continue the re-assessment
program for continuation of services.
4:06:10 PM
MS. MOSS stated:
The term used in this amendment, ... "materially
improved" helps in that direction, however, ... what
we would like to see happen during the interim, ...
[is legislation] to bring payment for services closer
to an acuity based schedule.
REPRESENTATIVE ANDERSON removed his objection to the amendment.
There being no further objection, Amendment 1 was adopted.
REPRESENTATIVE ANDERSON moved to report CSHB 426, Version 24-
LS1602\L, Mischel, 3/24/06, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
REPRESENTATIVE GATTO objected and asked for clarity for voting
purposes. Upon response he removed his objection.
CHAIR WILSON announced that hearing no further objection, CSHB
426(HES) was reported out of the House Health, Education and
Social Services Standing Committee.
The committee took an at-ease from 4:08:28 PM to 4:09:13 PM.
4:09:13 PM
HB 482-SCHOOL:BULLYING/HARASSMENT/INTIMIDATION
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 482, "An Act relating to harassment,
intimidation, and bullying in schools."
4:09:26 PM
REPRESENTATIVE ANDERSON moved to adopt CSHB 482, Version 24-
LS0053\L, Luckhaupt, 4/10/06, as the working document. There
being no objection, CSHB 482, Version L, was before the
committee.
4:10:12 PM
CRYSTAL NOVOTNEY, Staff to Representative Tom Anderson, Alaska
State Legislature, introduced HB 482, on behalf of
Representative Anderson, prime sponsor, paraphrasing from the
following written statement [original punctuation provided]:
Clearly, bullying in our schools is a problem. It is
an issue with lasting effects resulting in problems
from poor academic performance on one end of the
spectrum to incidents of horrific and tragic violence
on the other.
It has been suggested that on some level perhaps some
degree of bullying is "necessary" as part of growing
up and developing the coping and conflict resolution
skills required for adult life. However, there is a
vast difference between "peer conflict" and
"bullying". Granted, at some point in each of our
lives, we may be "picked on" or "put down" and
experience periods of relative unpopularity. While
these experiences are not pleasant, and may indeed be
valuable in developing critical life skills, generally
they do not rise to the level of bullying.
Bullying is a consistent and systematic process of
degradation, humiliation, and violence. Bullying is
intended to control and dominate a person by fear and
intimidation. I believe people who suggest that
bullying is a good thing; have never been exposed to
it. Some cite athletic coaches or military drill
instructors as examples of those who use bullying
effectively. However the challenges, difficulties and
motivational techniques those positions, and others
like them, employ are ultimately designed to improve a
person, to encourage a person to challenge themselves
and to exceed their own expectations. Coaches and
drill instructors gain no benefit in exposing those in
their charge to routine and systematic humiliation
with no other end than the ultimate destruction of a
person's self-esteem and self-worth. To the contrary,
their sometimes-harsh treatment is designed to build
them up.
Furthermore addressing bullying is as critical to the
victims as to the bully themselves. There is no
question the damage bullying inflicts on the victim,
but in considering this issue, we often overlook the
long-term social damage to and from bullies by, at
least, tacitly condoning their behavior. A number of
studies have shown that bullies are at a much greater
risk of criminal conduct and substance abuse. One
study shows that 60% of males who were identified as
bullies during grades six through nine were convicted
of at least one crime as an adult and that thirty-five
(35%) to forty (40%) had three or more convictions by
the age of 24. As policymakers it is as much our
obligation to protect those victimized by bullies, as
it is to correct bullying behavior that prevents some
of our young people from realizing a successful life
and the behavior that ultimately costs us so much.
4:13:45 PM
REPRESENTATIVE ANDERSON suggested that Ms. Novotney direct the
committee through the [sub]sections of HB 482 and highlight the
important aspects of each. Demonstrating, he said:
That first [sub]section [(a)] ... [says that] a school
district may adopt by 2007 a policy prohibiting
harassment, intimidation, and bullying of any student.
And then the district shares this policy with parents
and guardians, students, volunteers, school employees,
... basically saying ... we have a policy .... ...
[subsection] (b) ... where [the districts] adopt the
standard policy for procedures for everyone to follow.
REPRESENTATIVE ANDERSON stressed that these (sub)sections inform
school districts that they may adopt a policy.
MS. NOVOTNEY explained that (sub)section (c) establishes the
deadline of January 1, 2007, when the Department of Education
(DOE), and other interested or related community parties, may
provide a school with a model policy particular to the interests
of the district.
REPRESENTATIVE GATTO noted the change in this section from the
original language.
MS. NOVOTNEY pointed out that Version I used the word "shall" in
(sub)section (c), but that word and other language has been
changed in Version L.
4:16:46 PM
REPRESENTATIVE ANDERSON asked for an explanation of the
rationale behind establishing the 2007-2008 scholastic year for
school districts to initiate reporting to DOE.
MS. NOVOTNEY explained that by setting the date forward it would
provide time for the school districts to amalgamate their
efforts in creating and implementing policy and procedures.
Further, the November 30, 2007, date for the districts to
provide data to DOE allows time for the department to compile a
report for the legislature in January, 2008.
4:17:59 PM
CHAIR WILSON noted that information in the committee packet
indicates that school districts have already taken up the task
of dealing with harassment, intimidation, or bullying.
MS. NOVOTNEY responded that 21 states have existing bullying
statutes and another 24 states are currently introducing
legislation. She explained that this bill revises current
Alaska statute (Article 4] Section 14.33.110.
CHAIR WILSON inquired whether the intent of this bill is to
establish statute for what the districts have already
implemented.
MS. NOVOTNEY clarified that the cited statute, entitled "Purpose
of school disciplinary, and safety program," does not mention
aspects of harassment, intimidation, or bullying. She explained
that HB 482 directs school districts to take measures focused on
these issues, pertinent to their locales. To assist the
districts, she said, the bill provides for model information and
training option resources.
4:20:06 PM
REPRESENTATIVE ANDERSON asked how many school districts exist in
Alaska.
MS. NOVOTNEY responded, "Fifty-four; fifty three, or fifty-
four."
REPRESENTATIVE ANDERSON said:
Keep in mind I didn't create this. ... an attorney
from Anchorage [called] and said, "I've litigated so
much of this that I think you need to codify in
statute a parameter upon which school districts may
utilize your verbiage in adopting their own policies
and procedures." ... Is it true that every school
district doesn't have a comprehensive, detailed
bullying policy, hence the bill.
MS. NOVOTNEY confirmed, stating that approximately 13 school
districts have adopted specific harassment and bullying
policies.
REPRESENTATIVE ANDERSON forewarned that some school districts
may oppose this bill by protesting that action around these
issues can and will be dealt with appropriately under current
law. However, he opined that the legislative is obligated to
provide specific direction and statutory language to eliminate
harassment, intimidation, and bullying. He illustrated his
point, citing the mandatory Native studies issue as a parallel
situation which required statute to assure educational
compliance.
4:22:58 PM
REPRESENTATIVE CISSNA observed that the most damaging harassment
would be of a sexual orientation, and asked whether that aspect
is covered in the CS.
MS. NOVOTNEY confirmed that sexual harassment is herein
addressed.
REPRESENTATIVE CISSNA asked permission to have her aide speak on
the sexual harassment issue, from her experience as a retired
school counselor.
4:24:22 PM
REPRESENTATIVE GARDNER inquired why the "shall" was rewritten as
"may" in the CS.
MS. NOVOTNEY stated that this language was altered in a previous
committee for legal reasons.
CHAIR WILSON interjected that the term "shall" would require
that the bill be attached with a fiscal note.
REPRESENTATIVE ANDERSON offered his understanding that a lawsuit
could be brought if there is not a formal policy in place. He
also opined that "shall" provides a flexibility to the school
districts, which will be important when the bill comes before
the House.
4:25:57 PM
REPRESENTATIVE GARDNER stated that "shall" enforces the
intention of the bill, whereas "may" does not. Without this
language she asked, "Why bother with the bill, they already can
do it?"
4:26:14 PM
REPRESENTATIVE GATTO recalled from previous committee work on
this bill, that "shall" was not, nor is it now, terminology
which he is able to support. He related details of a recent
successful lawsuit, lodged against the Anchorage School
District, which was based on a student's off campus actions. He
opined that this lawsuit came about because there was not a
comprehensive policy in place. Echoing Representative Gardner's
concern, he stated, "This bill has no value." Further, he
inquired, "What do we gain here, ... by saying ... let's allow
them to do something they're allowed to do."
CHAIR WILSON opened public testimony.
4:29:23 PM
KATIE SINGLETON, Bye-Bye Bullies, stated support for HB 482, and
paraphrased from the following statement [original punctuation
provided]:
There are a few reasons I think this bill is important
and should be passed.
1st - Bullying is bad for everyone involved. Many
bullies become convicted criminals as adults. Victims
drop out of school or become rageful against other
students.
Even By-standers are negatively affected - they can
become apathetic toward the violence.
There are experts all over N. America and Europe that
have proven that children who are taught how to deal
with bullying can change the culture of a school so
that bullying and harassment are not tolerated. And
also these skills taught to children in school can
serve them well as adults. We all knew bullies as
children, and we probably all know bullies now. It can
be life changing for a young person to have the skills
to deal with bullies.
Another good reason for this legislation is that
schools should be held responsible for the safety of
their students. Most schools have anti-bullying
policies. A lot of these can be useless at best, but
can even be harmful if victims are punished under zero
tolerance policies. Victims of bullying can turn on
their school - using vandalism and lethal violence -
like that at Columbine and even in Bethel a few years
ago. Research based anti-bullying programs, not just
vague policies are needed to actually reduce bullying
in a school.
I don't necessarily believe our schools need to be
legislated at every turn - but we know that research-
based anti-bullying programs can reduce school
violence and dropout rates - this can save money in
the long run. It can create a culture that is
intolerant of bullying in all of Alaska's schools.
Teachers can teach. Students can learn. Money won't be
wasted on lawsuits, vandalism, discipline and
enforcement of bad policy.
Students, Teachers, Parents & Schools will benefit
from this legislation."
4:31:56 PM
REPRESENTATIVE GATTO referred to Ms. Singleton's mention of the
Bethel and Columbine murders and asked how an anti-bullying bill
could have prevented these incidents.
MS. SINGLETON pointed out that the perpetrators at Bethel and
Columbine were victims of bullying. She opined that if these
rage filled students had received appropriate support or had
learned other ways to vent their anger the outcome may have been
very different, and she related her own experience of being
bullied as a child.
4:33:25 PM
REPRESENTATIVE GATTO asked for substantiation of her statement:
"We know that we can reduce violence in the long run."
MS. SINGLETON responded that the research based programs
currently in use have statistically shown a reduced violence in
schools. She named two programs that are currently instituted
in schools, as proven models.
4:34:50 PM
REPRESENTATIVE GARDNER stated and moved Amendment 1, to read as
follows:
Page 3, line 14,
Following "creed,"
Insert "sexual orientation,"
4:36:03 PM
REPRESENTATIVE ANDERSON objected to the amendment for the
purpose of discussion.
4:37:02 PM
CINDY FOLSOM, Staff to Representative Sharon Cissna, Alaska
State Legislature, Retired School Counselor, stated support of
HB 482, Amendment 1, and said that in her seventeen year career,
she experienced an 80-90 percent rate of bullying complaints to
have sexual connotations. This is an important aspect to be
considered, she said. Responding to a question, she explained
that casual comments may strike students very differently
depending on the individual's situation, cautioning how harmless
a negative remark may seem on the surface.
4:38:59 PM
REPRESENTATIVE GATTO provided his observation of the casual use
of negative terminology by today's teenagers. He asked whether
a teenager's casual comments should be taken literally.
CHAIR WILSON recalling her experience as a school nurse, stated
that on some level comments may need to be taken seriously.
REPRESENTATIVE GARDNER echoed that for some students a comment
may be meaningless and taken casually in the manner it was
intended. However, for a student who is struggling
emotionally/socially, the same comment could have a harsh,
deleterious effect. She pointed out that a challenged student
who does not have adequate coping abilities may respond
negatively to stereotypical terminology when it does not apply
directly to them but possibly to a family member.
REPRESENTATIVE ANDERSON removed his objection to the amendment.
Further, he pointed out that the bill language provides latitude
for school administrators to report aggressive comments or acts
of disparagement, in a discretionary manner.
4:41:23 PM
REPRESENTATIVE GATTO inquired whether the 80-90 percent
estimate, provided by Ms. Folsom, represented substantiated
harassment incidents or if it also included reports of casual
comments.
4:41:40 PM
CHAIR WILSON stated:
I believe that ... administrators ... are not going to
zero in on ... flippant words. ... They will ... zero
in ... when things ... [need] attention ....
Administrators in schools ... have a good idea of
what's real and what's not.
4:42:19 PM
REPRESENTATIVE GATTO suggested that if the numbers quoted by
Ms. Folsom are credible then a horrendous situation must exist.
He questioned the validity of the numbers, and he opined that
this bill could not possibly address a situation of the
magnitude implied.
REPRESENTATIVE ANDERSON offered that Ms. Folsom's testimony
indicated that 80-90 percent of harassment claims were egregious
enough for students to seek counseling. Additionally, he said
that this bill has merit to continue deliberation.
4:43:08 PM
CHAIR WILSON announced that hearing no further objection,
Amendment 1 was adopted.
4:43:25 PM
REPRESENTATIVE GARDNER stated and moved Amendment 2, to read as
follows:
Page 1, line 6,
Delete "may"
Insert "shall"
REPRESENTATIVE GARDNER stated:
I do understand the concern about liability issues,
nevertheless, without "shall" there is not much point
in this ... bill. If we believe school districts
should have an anti bullying policy then let's work on
this bill and pass it out.
REPRESENTATIVE ANDERSON stated and moved Amendment 1, to
Amendment 2, to read as follows:
Page 2, line 5,
Delete "may"
Insert "shall"
Hearing no objection Amendment 1, to Amendment 2, was adopted.
REPRESENTATIVE GATTO objected to Amendment 2, and pointed out
that this amendment would require the bill to have a finance
referral, thus sending the bill to another committee.
CHAIR WILSON confirmed that the bill would be reported to the
finance committee.
REPRESENTATIVE SEATON pointed out that with the deadline for
hearing bills in the House approaching, adopting Amendment 2
would essentially be "killing the bill," and he stated objection
to the amendment.
REPRESENTATIVE GATTO pointed out that by removing Amendment 2,
the amendment to the amendment would also be removed.
REPRESENTATIVE GARDNER asked for further affirmation that this
bill would not be able to pass the House this year if a fiscal
note were attached.
REPRESENTATIVE GARDNER withdrew Amendment 2.
4:46:57 PM
REPRESENTATIVE ANDERSON asked MS. Novotney how the bill could be
altered to avoid a fiscal note attachment.
MS. NOVOTNEY pointed out that striking page 2, subsection (c),
would eliminate that concern. Further, she stated that
maintaining the page 2, line 5, "may" would also avoid a fiscal
note.
4:48:04 PM
REPRESENTATIVE GARDNER stated:
Understanding that each school district shall adopt a
policy, but not requiring the department ..., to
provide a model policy, allows an amendment ...
CHAIR WILSON offered that the School Board Association (SBA) has
several model policies that are available to schools.
4:48:33 PM
MS. NOVOTNEY reported that the Fairbanks North Star Borough
School District is implementing the Safe Schools/Healthy
Students initiative.
REPRESENTATIVE GARDNER stated and moved Amendment 3, to read as
follows:
Page 1, line 6,
Delete "may"
Insert "shall"
There being no objection, Amendment 3 was adopted.
4:49:23 PM
REPRESENTATIVE SEATON directed the sponsor's attention to page
2, line 11, and read the sentence beginning: "The department
shall post ...." He asked whether that language would invoke a
fiscal note.
REPRESENTATIVE ANDERSON recommended that the sentence be struck.
Responding to a question, he clarified that an amendment to
strike the language [page 2, lines 11-13] through the word
"provide" would be acceptable and would not invoke a fiscal
note.
4:51:44 PM
REPRESENTATIVE SEATON stated and moved Amendment 4, to read as
follows:
Page 2,
Line 11,
Delete "also post"
Line 12,
Delete "a brief summary of the policies,
programs, partnership, vendors, and instructional and"
Line 13,
Delete "training materials for each school
district and"
There being no objection, Amendment 4 was adopted.
4:52:23 PM
REPRESENTATIVE ANDERSON moved to report CSHB 482, Version 24-
LS0053\L, Luckhaupt, 4/10/06, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
4:52:40 PM
REPRESENTATIVE SEATON objected, and pointed out that the Council
on Domestic Violence & Sexual Assault should be involved in the
development of this bill. He reminded the committee that the
Council's purview is to coordinate and to develop programs. He
opined that this aspect will be brought forward in the judiciary
committee.
REPRESENTATIVE SEATON removed his objection.
4:53:27 PM
REPRESENTATIVE GATTO objected, and opined that this type of
legislation continues to remove responsibility for children's
behavior from parents and places more responsibility on school
officials. He pointed out that although many schools have
already adopted a policy to address this issue, the bill
mandates that every school must implement a policy. He
reiterated that this bill provides fodder for attorneys, and
further expounded his original reservations.
4:54:36 PM
REPRESENTATIVE GARDNER stated an understanding of Representative
Gatto's concerns, but stated, "This bill isn't about the
bullies, it's about the victims, and that is where we all have a
responsibility."
4:54:56 PM
REPRESENTATIVE GATTO withdrew his objection.
4:55:17 PM
CHAIR WILSON announced that there being no further objection,
CSHB 482(HES) was reported out of the House Health, Education
and Social Services Standing Committee.
4:55:44 PM
HB 467-ADMINISTRATION OF MEDICATION BY A NURSE
CHAIR WILSON announced that the final order of business would be
further committee attention to HOUSE BILL NO. 467, "An Act
relating to the administration of prescribed remedies and
dietary supplements by a nurse." [Before the committee was HB
467, Version 24-LS1265\G.]
[Treated as adopted and before the committee was CSHB 467,
Version 24-LS1265\F, Mischel, 4/7/06.]
4:56:22 PM
REPRESENTATIVE MICHAEL "MIKE" KELLY, Alaska State Legislature,
testified as sponsor of HB 467, and stated that support for this
bill has been provided from doctors, nurses, assisted living
facility administrators, and Pioneers' home administrators. He
opined that there is general consensus for the need to provide
this service to facility residents. He reiterated the intent
for safeguards provided in the bill, and reminded the committee
that other states have adopted similar statute, thus models
exist which the Board of Nursing may choose to implement. Given
the examples of professional support and the patients awaiting
assistance, he urged the passage of the bill.
4:59:42 PM
REPRESENTATIVE SEATON inquired whether the language change in
Version F creates a mandate that nurses "shall", versus the
permissive language of Version G which read "may".
CHAIR WILSON pointed out that the page 1, line 6, "shall" is a
direction to the board regarding the establishment of standards.
REPRESENTATIVE SEATON clarified that the board would have the
latitude to adopt appropriately permissive language.
REPRESENTATIVE ANDERSON offered to make a motion to move the
bill.
5:01:13 PM
REPRESENTATIVE GATTO recalled that a previous version of the
bill, provided language which allowed a nurse to decline
administration of a substance.
REPRESENTATIVE KELLY clarified that Version F maintains that a
nurse is allowed to decline to administer a substance. This
legislation authorizes but does not order a nurse to administer
substances, therefore, the nurse will still be protected. He
reminded the committee that the bill addresses prescribed
substances only.
5:02:01 PM
REPRESENTATIVE GATTO stated his understanding that prescription
medicine is regulated by accurate dosage, but over-the-counter
remedies are unregulated and the dose may vary. He indicated
concern for a nurse administering non-USP certified substances
when the nurse is held liable [the substances he/she
administers]. While this legislation doesn't require a nurse to
administer supplements, he inquired whether there was language
in Version F to allow a nurse to "opt out" of administering non-
prescriptive substances.
REPRESENTATIVE KELLY pointed out that Version G included the
following language: "A registered nurse may administer a
prescribed remedy." Responding to a question, he opined that
the term "may" implies that the nurse can refuse to administer a
prescribed remedy.
5:05:40 PM
REPRESENTATIVE KELLY explained that the current CS [Version F]
goes further than the previous version, by authorizing the Board
of Nursing to establish appropriate standards for
administration. Further, he said if those standards follow what
has occurred in other states, there will be a list of
requirements that must occur. Those requirements include the
following: the facility desires to establish a procedure for
administration of supplements; a physician prescribes and
specifies a dosage for a supplement; control procedures for the
dating, lot identification, and sealing of supplements are
implemented; and the patient or representative signs a
request/release form to authorize the administration. Version F
stipulates that the Board of Nursing will establish such
procedures and provides a nurse the authority for administration
[of prescribed remedies and dietary supplements].
5:07:19 PM
REPRESENTATIVE SEATON stated:
I'm concerned ... about the same point. ... If I could
ask [Madam Chair] as a nurse. ... The Board of Nursing
shall establish these standards. That means it's
going to bring [administration of supplements] within
the scope of practice for a nurse. If it's within the
scope of practice for a nurse, and there's a
prescription, does the nurse have the ability to say
she doesn't want to administer [the substance] ....
CHAIR WILSON replied, "Always."
5:08:12 PM
REPRESENTATIVE GATTO asked whether the sponsor would approve the
addition of the following language: "Nothing in this statute
shall require a nurse to administer nonprescription medication."
CHAIR WILSON said that the proposed legislation specifies that
the substance to be administered must be prescribed.
5:08:29 PM
REPRESENTATIVE KELLY interjected that the substance must be
prescribed and the board imposed requirements met. He
highlighted that several barriers of scrutiny will be required
before a substance may be administered, and pointed out that the
nurse is provided the right to refuse to participate.
5:09:01 PM
REPRESENTATIVE GATTO related his understanding that the term
"prescription" is defined as something a pharmacist must
distribute. However, a physician can prescribe Vitamin A, which
he characterized as different than a prescription with clear
dosage specifications.
CHAIR WILSON pointed out that on page 1, line 5, the legislation
refers to "Administration of prescribed remedies and dietary
supplements", and reiterated that it won't even be considered if
it isn't prescribed. She then drew Representative Gatto's
attention to page 2, lines 2-4, which define "prescribed
remedy".
5:10:17 PM
REPRESENTATIVE GARDNER opined that Representative Gatto's
concern is at the heart of the concern of the Board of Nursing
in that the legislation addresses remedies and supplements that
have no established safeguards since they aren't approved by the
Federal Drug Administration (FDA).
CHAIR WILSON said the aforementioned is why the Board of Nursing
is going to review it and grapple with this issue after the
legislation passes.
5:11:23 PM
REPRESENTATIVE GARDNER said she didn't understand that to be
what the legislation is doing. She asked if Chair Wilson was
saying the Board of Nursing will review each [substance] and
approve and disapprove [substances]. She further asked if that
is the sponsor's intent.
5:11:43 PM
REPRESENTATIVE KELLY said that the Board of Nursing will need to
exercise its judgment in screening these substances.
Furthermore, the legislation has so many steps that it creates a
safer environment, he opined.
5:12:41 PM
REPRESENTATIVE GARDNER commented that the intent makes sense.
However, she related her understanding that the Board of Nursing
has already exercised its judgment and has drawn the line at
FDA-approved [substances] because those have been tested with
regard to dosage, quantity, and purity of the substance. The
aforementioned testing has not occurred or has not been
independently verified by an external body with these substances
that aren't FDA-approved.
REPRESENTATIVE KELLY said that's the case now. However, many
believe that is too restrictive. Therefore, [Version F] asks
the Board of Nursing, with its professional ability, to
establish standards to permit these substances [not approved by
the FDA] to be administered.
5:14:26 PM
REPRESENTATIVE SEATON opined that Representative Gardener's
concern is satisfied because the Board of Nursing will make the
decisions for what and how standards are upheld, as well as
establish standards for supplement authorization and the scope
of service.
REPRESENTATIVE ANDERSON moved to report CSHB 467, Version 24-
LS1265\F, Mischel 4/7/06, out of committee with individual
recommendations and the accompanying fiscal notes.
An objection was stated.
A roll call vote was taken. Representatives Seaton, Anderson,
Cissna, and Wilson voted in favor of CSHB 467, Version F.
Representatives Gatto and Gardner voted against it. Therefore,
CSHB 467(HES) was reported out of the House Health, Education
and Social Services Standing Committee by a vote of 4-2.
5:16:06 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:16 p.m.
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