Legislature(2023 - 2024)DAVIS 106
04/02/2024 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s)|| Board of Chiropractic Examiners|| Board of Pharmacy|| Board of Psychologists and Psychological Associate Examiners | |
| HB191 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 191 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 2, 2024
3:04 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
Board of Chiropractic Examiners
John Lloyd - Anchorage
- CONFIRMATION(S) ADVANCED
Board of Pharmacy
Ashley Schaber - Anchorage
- CONFIRMATION(S) ADVANCED
Board of Psychologists and Psychological Associate Examiners
Bradley McConnel - Anchorage
Lorin Bradbury - Bethel
- CONFIRMATION(S) ADVANCED
HOUSE BILL NO. 191
"An Act relating to medical care for major emergencies."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 191
SHORT TITLE: MEDICAL MAJOR EMERGENCIES
SPONSOR(s): REPRESENTATIVE(s) MINA
05/03/23 (H) READ THE FIRST TIME - REFERRALS
05/03/23 (H) HSS, FIN
04/02/24 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
JOHN LLOYD, Appointee
Board of Chiropractic Examiners
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Board of
Chiropractic Examiners.
ASHLEY SCHABER, Appointee
Board of Pharmacy
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Board of
Pharmacy.
BRANDY SEIGNEMARTIN, Executive Director
Alaska Pharmacy Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of Ms. Schaber's
appointment.
BRADLEY MCCONNEL, Appointee
Board of Psychologists and Psychological Associate Examiners
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Board of
Psychologists and Psychological Associate Examiners.
LORIN BRADBURY, Appointee
Board of Psychologists and Psychological Associate Examiners
Bethel, Alaska
POSITION STATEMENT: Testified as appointee to the Board of
Psychologists and Psychological Associate Examiners.
REPRESENTATIVE GENEVIEVE MINA
Alaska State Representative
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, presented HB 191.
KATY GIORGIO, Staff
Representative Genevieve Mina
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for HB
191, on behalf of Representative Mina, prime sponsor.
MIKE LEVY, MD, representing self
Anchorage, Alaska
POSITION STATEMENT: Gave invited testimony in support of HB
191.
EUGENE "GENE" WISEMAN, Chief
Section of Rural and Community Health Systems
Division of Public Health
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
191.
ACTION NARRATIVE
3:04:56 PM
CHAIR PRAX called the House Health and Social Services Standing
Committee meeting to order at 3:04 p.m. Representatives
McCormick, Ruffridge, Saddler, Mina, and Prax were present at
the call to order. Representatives Sumner and Fields arrived as
the meeting was in progress.
^CONFIRMATION HEARING(S)
^Board of Chiropractic Examiners
^Board of Pharmacy
^Board of Psychologists and Psychological Associate Examiners
CONFIRMATION HEARING(S)
Board of Chiropractic Examiners
Board of Pharmacy
Board of Psychologists and Psychological Associate Examiners
3:07:02 PM
CHAIR PRAX announced that the first order of business would be
confirmation hearings on the governor's appointees to various
boards.
3:07:27 PM
JOHN LLOYD, Appointee, Board of Chiropractic Examiners, informed
the committee that he has been a chiropractor for 26 years with
his own practice in Anchorage. He said serving the board has
been a wonderful experience and he would like to go "one more
round."
3:08:33 PM
REPRESENTATIVE SADDLER asked whether chiropractors in Alaska
practice to the full extent of their practice.
MR. LLOYD acknowledged that chiropractic care in Alaska has a
wide scope and encompasses almost all of what is taught in
chiropractic school. He listed acupuncture and animal
chiropractic adjustments as areas that are not allowed in
Alaska.
REPRESENTATIVE SADDLER asked what issues the board would be
facing in the next several years.
MR. LLOYD answered scientifically backed techniques to treat
"long covid," such as infusions and ozone therapy. In addition,
he referenced downturns in insurance reimbursements.
3:11:35 PM
REPRESENTATIVE FIELDS sought further information on best
practices and treatments for long covid and how that information
is disseminated to providers and patients.
MR. LLOYD said a number of weekend seminars focus on treatment
strategies for long covid. Communities of providers in Alaska
also share successful treatment outcomes via Facebook messaging
groups.
3:13:24 PM
CHAIR PRAX opened public testimony on Mr. Lloyd's appointment;
after ascertaining that no one wished to testify, he closed
public testimony.
3:14:25 PM
ASHLEY SCHABER, Appointee, Board of Pharmacy, informed the
committee that her service on board started in July 2021, and
she has served as chair since December 2022. She said she has
been a licensed pharmacist in Alaska for over 16 years and
expounded on her personal and professional background.
Currently, she said the board is focused on HB 226, which
improves access to safe pharmacy services. During her time as
chair, efficiency has been a priority, advocating for online
license applications and subcommittees to complete work between
quarterly meetings. Overall, she said she's looking for ways to
use her background in leadership to improve safety and welfare
for all Alaskans.
3:18:17 PM
REPRESENTATIVE FIELDS asked how the state could better support
aspiring pharmacists and their training.
MS. SCHABER responded that the board has supported
apprenticeship programs to foster workforce development by
passing a regulation that allows pharmacy technicians to become
licensed as young as 16 if they are in an approved
apprenticeship program.
3:19:53 PM
REPRESENTATIVE SADDLER asked for Ms. Schaber's general thoughts
on the state of pharmacy in Alaska.
MS. SCHABER characterized it as fragile due to the limited
infrastructure.
3:21:42 PM
REPRESENTATIVE RUFFRIDGE asked how the board has managed its own
bills with a balanced budget while reducing license fees. In
addition, he asked Ms. Schaber to speak to her restoration of
regulatory oversight with regard to investigations and onsite
visits.
MS. SCHABER acknowledged that the board typically ends the year
with a surplus with the goal of keeping license fees as low as
possible. She emphasized the importance of state-specific
investigators to routinely inspect Alaska pharmacies and said
the board works closely with the investigation team on these
issues.
3:24:55 PM
CHAIR PRAX opened public testimony on Ms. Schaber's appointment.
3:25:44 PM
BRANDY SEIGNEMARTIN, Executive Director, Alaska Pharmacy
Association, shared the Alaska Pharmacy Association's unwavering
support for Ms. Schaber's continued service. She said Ms.
Schaber has done excellent work in leading the board and is
highly regarded across the state and the pharmacy profession.
3:26:55 PM
BRADLEY MCCONNEL, Appointee, Board of Psychologists and
Psychological Associate Examiners, informed the committee that
he began his service on the board in February 2020, during which
time, in the midst of the COVID-19 Pandemic, they provided
emergency courtesy licenses for outof-state psychologists whose
patients returned to Alaska. Since his time on the board, he
has expanded cross cultural education requirements so
individuals are better prepared to serve Alaskans in response to
the influx of telehealth service provisions from individuals in
the Lower 48 who may not be aware of Alaska's unique needs. He
concluded by further detailing his professional background.
3:30:09 PM
REPRESENTATIVE SADDLER asked what issues the board would be
facing in the upcoming term.
MR. MCCONNEL listed two significant issues: the attraction of
Alaska to psychologists and the need for telehealth supervision.
REPRESENTATIVE SADDLER asked whether the general state of mental
health in Alaska tends to be an attractant or repellant to the
practice of psychology.
MR. MCCONNEL responded that pay is an issue for attracting
psychologists to serve in the public sector in Alaska.
3:34:47 PM
REPRESENTATIVE MINA asked about Mr. McConnel's experience as the
chief forensic psychologist at the Alaska Psychiatric Institute
(API) and asked him to comment on the state of forensic
psychology and competency restoration.
MR. MCCONNEL recounted his experience running a jail-based
competency restoration program in California, which had a 76-86
percent success rate and saved the state approximately $365,000
per person. He said API lacked programming while he was there,
so many individuals were deemed incompetent and released after
charges were dropped only to come back through later. He
reported that Alaska's rate of competency restoration is 36-44
percent at best. He advocated for the legislature implementing
a jail-based competency restoration program due to its high
success rate.
CHAIR PRAX asked whether [competency restoration programming] is
done via telehealth.
MR. MCCONNEL indicated that specialists would come up and
establish a program in the jail, which would save the state an
exorbitant amount of money. He explained that the programming
would allow incarcerated individuals to be evaluated every day
to see whether they might be ready to be assessed by a
psychologist for competency to stand trial.
3:40:13 PM
CHAIR PRAX opened public testimony on Mr. McConnel's
appointment; after ascertaining that no one wished to testify,
he closed public testimony.
3:41:32 PM
LORIN BRADBURY, Appointee, Board of Psychologists and
Psychological Associate Examiners, informed the committee that
he previously served on the board for seven years starting in
2012. He said he had lived most of his life in rural Alaska and
expounded on his personal and professional life. He described
his time on the board as a valuable lesson in ethics.
3:46:39 PM
REPRESENTATIVE FIELDS asked how many other psychologists serve
in Bethel.
MR. BRADBURY responded that he is the only licensed psychologist
in Bethel. In response to a follow-up question, he said he does
not condone or offer conversion therapy.
REPRESENTATIVE FIELDS asked how Mr. Bradbury approaches LGBTQ
clients given his sermons.
MR. BRADBURY answered that he explains his core beliefs and will
refer clients elsewhere if he is unable to help.
CHAIR PRAX asked Mr. Bradbury to explain what forensic
psychology entails in Bethel.
MR. BRADBURY said the majority of his work involves deciphering
an individual's competency to wave Miranda rights, continue with
legal proceedings, or grant civil guardianship.
3:49:16 PM
CHAIR PRAX opened public testimony on Mr. Bradbury's
appointment; after ascertaining that no one wished to testify,
he closed public testimony.
[The confirmations of John Lloyd to the Board of Chiropractic
Examiners, Ashley Schaber to the Board of Pharmacy, and Bradley
McConnel and Lorin Bradbury to the Board of Psychologists and
Psychological Associate Examiners were advanced for
consideration in the joint session of the House and Senate.
Signing the reports regarding appointments to boards and
commissions in no way reflects individual members' approval or
disapproval of the appointees, and the nominations are merely
forwarded to the full legislature for confirmation or
rejection.]
3:52:01 PM
The committee took a brief at-ease at 3:52 p.m.
HB 191-MEDICAL MAJOR EMERGENCIES
3:52:50 PM
CHAIR PRAX announced that the final order of business would be
HOUSE BILL NO. 191, "An Act relating to medical care for major
emergencies."
3:53:12 PM
REPRESENTATIVE MINA, as prime sponsor, presented HB 191. She
paraphrased the sponsor statement [included in the committee
packet], which read as follows [original punctuation provided]:
A coordinated statewide system of care enhances the
chance of survival in life-threatening, time-critical
emergencies in adults and children. Trauma and
specific medical emergencies addressed within this
system ensure that Alaskans receive care from the
"right person, at the right place, at the right time."
Trauma, strokes, and heart attacks represent the
leading causes of death in Alaska. In 2022 alone, 744
Alaskans died from trauma, 217 died from strokes, and
510 died from died from cardiovascular disease such as
a heart attack. By enabling a statewide systems of
care approach for major emergencies, death rates
caused by these "time-sensitive emergencies" can
improve. Importantly, these are conditions for which
interventions exist that can markedly alter their
otherwise dismal prognoses.
HB 191 seeks to expand the scope of the Office of
Emergency Medical Services within the Department of
Health (DOH) to include strokes and severe heart
attacks in:
• Developing training programs for ambulance and
first responder services on a standardized
protocol.
• Communicating the urgency of the patient's
condition to the local receiving hospital or
clinic.
• Assist in establishing statewide guidelines,
helping physicians and advanced practice
practitioners determine if local treatment is
appropriate or to expedite transport to the
suitable treatment facility.
This legislation also focuses on expanding AS
18.08.010 and AS 18.08.200, allowing the Department of
Health (DOH) to replicate those systems and processes
that have improved trauma care and apply those
principles to stroke and severe heart attacks.
With the success of the Trauma Center program, HB 191
will ensure that the receiving specialty hospitals
meet DOH-adopted national criteria for being a
voluntary stroke or heart attack center. It also
establishes a registry specific to these major
emergencies, a means to measure outcomes, and guide
changes that will inevitably be needed.
The overall goal of HB 191 is that a trauma, cardiac,
or stroke patient returns home as a functional member
of the community and embraces life changes that will
improve their future health.
3:59:55 PM
KATY GIORGIO, Staff, Representative Genevieve Mina, Alaska State
Legislature, on behalf of Representative Mina, prime sponsor,
presented the sectional analysis for HB 191 [included in the
committee packet], which read as follows [original punctuation
provided]:
Section 1. Amends AS 18.08.010
Section 1, subsections 1-3 adds "major medical
emergencies" to the existing emergency medical
services (EMS) system. Currently, only trauma
care appears in statute, and the addition of
"major medical emergencies" will allow the
Department of Health (DOH) to include
timesensitive emergencies such as heart attacks
and strokes to their EMS review system.
Section 1, subsection 4, addresses the trauma
center designation status for hospitals and
clinics and gives the statutory authority for DOH
to adopt criteria for those health centers to
represent themselves as being capable of treating
major emergencies.
Section 2. Amends AS 18.08.200 by adding a new
paragraph:
This is the definition section for the chapter,
and "major emergency" is added and defined as
heart attack and stroke.
4:00:56 PM
MIKE LEVY, MD, representing self, informed the committee that he
is the chief medical officer for the Anchorage Areawide
Emergency Medical Services (EMS) and the medical director for
agencies including the Anchorage Fire Department. He stated his
support for HB 191, which seeks to ensure that Alaskans
suffering from medical crises receive care by the right person,
at the right place, at the right time. Trauma, strokes, and
heart attaches are a major cause of death and disability in
Alaska, but at present there are no coordinated systems of care
for these emergencies. He said the bill would expand the
success of 2010 trauma legislation and lay the foundation for
similar care of strokes and heart attacks. It would allow DOH
to replicate those systems and processes that have improved
trauma care and apply those principles to stokes, sepsis, and
heart attacks, as well as define major emergencies as inclusive
of heart attacks and strokes. Furthermore, the proposed
legislation would ensure that receiving specialty hospitals
remain in compliance and that their processes meet national
criteria for stroke and heart attack centers. Lastly, the bill
would establish a registry to allow these practices to be
measured and improved.
4:04:14 PM
REPRESENTATIVE FIELDS cited a New York Times article that said
states have been slow to roll out an effective intervention for
heart attacks and extracorporeal cardiopulmonary resuscitation
(ECPR). He asked whether Dr. Levy had observed that in Alaska.
DR. LEVY pointed out that Alaska lacks any type of ECPR program
for acute emergencies. He was unsure whether it would be
included in the scope of HB 191 but said it would certainly be
aspirational in terms of elevating the level of care for
critical emergencies.
REPRESENTATIVE FIELDS shared his understanding that HB 191 would
enable the state to seek grants and aid for heart attack
treatments.
REPRESENTATIVE MINA deferred to Mr. Wiseman.
EUGENE "GENE" WISEMAN, Chief, Section of Rural and Community
Health Systems, Division of Public Health, Department of Health
(DOH), responded that the Office of EMS facilitates grant
delivery when available; however, he was not familiar with any
grants focused on strokes at present.
REPRESENTATIVE SADDLER said he did not understand the reason for
the bill. He asked whether emergency rooms are incapable of
treating major emergencies.
REPRESENTATIVE MINA explained that the goal of the bill is to
improve the statewide system of care. It focuses on the
coordination between hospitals and clinics, especially in
relation to the sharing of data and screenings.
DR. LEVY gave an example of strokes centers and the difficulty
of coordinating time-sensitive, critical emergencies between
facilities in Alaska's remote geographic communities that lack
certain technological capabilities.
REPRESENTATIVE SADDLER asked whether each hospital has a list of
designations or whether stroke and heart attack designations
need to be added.
DR. LEVY said designation should come from the state. He
detailed the trauma system in Alaska, which involves 4 levels of
trauma designation based on national standards that's assigned
to each facility. This allows patients to be better triaged
based on their needs.
REPRESENTATIVE SADDLER asked how state designation provides
additional value to the healthcare system.
DR. LEVY answered that the added value comes from better
identifying criteria that would otherwise be housed internally
and providing guidance which facilities would better treat
stroke patients. In response to a series of follow-up
questions, he confirmed that there are national levels of care
for heart attacks centers.
4:17:40 PM
REPRESENTATIVE RUFFRIDGE asked whether there is a level 1 stroke
center in Alaska.
DR. LEVY answered yes, there is a comprehensive stroke center,
which is the highest level that's recognized. In response to a
follow up question, he described the process of treating a
stroke patient in the stroke centers.
REPRESENTATIVE RUFFRIDGE shared his understanding that a care
fund was created to promote increased care designations in
Alaska. He asked whether the intention is to increase the
number of high-capacity care organizations in the state and
whether a funding element is included to promote these care
centers.
DR. LEVY explained that comprehensive stroke centers require
sophisticated and expensive equipment, as well as
neurointerventionists, who are in short supply, so the
likelihood of placing numerous centers throughout the state is
low. Nonetheless, he said this type of legislation would help
implement better policy, procedure, education, and training for
processing patients and helping to keep them in their
communities. In response to a follow up question, he confirmed
that telehealth is a large component of triaging patients and
highlighted the opportunity to leverage technology going
forward.
4:26:09 PM
REPRESENTATIVE SADDLER asked how many Alaska hospitals would
likely be designated as major emergency centers.
DR. LEVY did not know the answer. He shared an anecdotal
analogy involving the trauma centers.
REPRESENTATIVE SADDLER repeated his question, asking how many
Alaska hospitals would likely be designated as major emergency
centers.
DR. LEVY surmised that each hospital would receive separate
designations for stroke, heart attack, or trauma care rather
than one, all-encompassing "major emergency" designation.
REPRESENTATIVE MINA, in response to Representative Saddler, said
she did not know how many hospitals would receive each
designation.
4:32:15 PM
MR. WISEMAN reported that there are currently 14 trauma centers
in Alaska; two of which are level 2 in Anchorage, with
additional level 4 centers in hub communities. He added that
two more facilities, [the Wrangell Medical Center] and Kuskokwim
Health Corporation, are looking to be re-designated as trauma
centers, putting the total number at 16. He imagined that
depending on the level of care, the additional designations
would be similar in number. In response to a follow up
question, he said the stroke and heart attack centers would be
state designations and applied for voluntarily.
CHAIR PRAX asked how the system would be built.
MR. WISEMAN said the process would parallel that of the trauma
centers. In response to a follow up question, he confirmed that
hospitals would be certified as the point of definitive care.
4:37:18 PM
CHAIR PRAX asked whether thought had been given to the efficient
utilization of resources in terms of trauma center designations
and the overall problem of EMS in Alaska.
MR. WISEMAN answered yes, along with designations, there is a
focus on training and tying systems of care to help patients
meet the windows of intervention that come with system
development as it pertains to EMS. He added that protocols for
triaging patients and rapid recognition would come secondarily.
In response to a follow up question, he explained that he
oversees the Trauma Systems Unit that works with each facility
in coordinating the accreditation process. In addition, the
Office of EMS supports these services through curriculum,
licensure, and system design and development.
CHAIR PRAX said he was unclear on the benefit of this program
given the current state of Alaska's EMS system. He estimated
that implementing such a program would cost the state tens of
millions of dollars and questioned whether it would make more
sense to increase the level of care in hub cities or increase
the level of response in rural areas. He asked Mr. Wiseman to
share a cost estimate.
MR. WISEMAN said the current cost estimate accounts for one
additional staff member within the Trauma Systems Unit to
measure, monitor, and facilitate the conversation with partners
and help design the system. He shared a hypothetical example of
triaging a patient in Nuiqsut, Alaska.
DR. LEVY explained that currently, Alaska has no criteria for
assessing the standard of EMS care at various facilities, which
the bill would provide. He further described the benefits of
having a defined system and oversight for triaging patients in
rural areas.
4:50:20 PM
REPRESENTATIVE SADDLER referred to page 1, lines 7-9, and asked
whether the term "emergency medical services" includes trauma
and major emergencies.
DR. LEVY answered yes.
REPRESENTATIVE SADDLER asked how many designations other than
trauma are offered by the state for healthcare facilities.
DR. LEVY said he is only aware of trauma designations.
MR. WISEMAN agreed, as the inclusion of trauma in statute gives
DOH the authority to build trauma designations specifically.
REPRESENTATIVE SADDLER asked whether anything prohibits trauma
and major medical care from being included in the state's
medical services system.
MR. WISEMAN offered to follow up with the requested information.
4:53:51 PM
REPRESENTATIVE MINA, in response to prior questions and comments
from members and testifiers, said creating a fund similar to the
trauma fund is not within the scope of the bill; the bill aims
to reduce the burden on providers to improve workflow; the bill
is intended to expand the scope of Alaska's EMS system; the
fiscal note reflects one [full-time position] in addition to the
existing unit of $148,500; and she encouraged Alaska's hospitals
that are already providing good care for strokes and heart
attacks to coordinate with each other and share knowledge and
education to improve the system of care, especially in rural
areas. She said she wants to ensure that the department can
continue to progress and have the authority to work on heart
attacks and strokes, in addition to trauma.
4:57:46 PM
CHAIR PRAX announced that HB 191 was held over.
4:58:10 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:58 p.m.