02/21/2002 03:23 PM House MLV
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ALASKA STATE LEGISLATURE
HOUSE SPECIAL COMMITTEE ON MILITARY AND
VETERANS' AFFAIRS
February 21, 2002
3:23 p.m.
MEMBERS PRESENT
Representative Mike Chenault, Chair
Representative Beverly Masek
Representative Lisa Murkowski
Representative Joe Green
Representative Pete Kott
MEMBERS ABSENT
Representative Sharon Cissna
Representative Joe Hayes
COMMITTEE CALENDAR
HOUSE BILL NO. 324
"An Act making supplemental and other appropriations for
homeland security; and providing for an effective date."
- HEARD AND HELD
PREVIOUS ACTION
BILL: HB 324
SHORT TITLE:HOMELAND SECURITY APPROPRIATIONS
SPONSOR(S): RLS BY REQUEST OF THE GOVERNOR
Jrn-Date Jrn-Page Action
01/16/02 1972 (H) READ THE FIRST TIME -
REFERRALS
01/16/02 1972 (H) MLV, STA, FIN
01/16/02 1972 (H) GOVERNOR'S TRANSMITTAL LETTER
01/16/02 1972 (H) SPREADSHEET BY DEPT. COST
02/12/02 (H) MLV AT 3:00 PM CAPITOL 124
02/12/02 (H) Heard & Held
02/12/02 (H) MINUTE(MLV)
02/19/02 (H) MLV AT 3:00 PM CAPITOL 124
02/19/02 (H) Heard & Held
MINUTE(MLV)
02/21/02 (H) MLV AT 3:00 PM CAPITOL 124
WITNESS REGISTER
JANET CLARKE, Director
Division of Administration Services
Department of Health and Social Services (DHSS)
P.O. Box 110650
Juneau, Alaska 99811-0650
POSITION STATEMENT: During hearing on HB 324, explained Items
43 and 51-55 and answered questions.
KAREN E. PEARSON, Director
Division of Public Health
Department of Health and Social Services
P.O. Box 110610
Juneau, Alaska 99811-0610
POSITION STATEMENT: During hearing on HB 324, assisted with the
explanation of Items 43 and 51-55 and answered questions.
ACTION NARRATIVE
TAPE 02-12, SIDE A
Number 0001
CHAIR MIKE CHENAULT called the House Special Committee on
Military and Veterans' Affairs meeting to order at 3:23 p.m.
Representatives Chenault, Masek, Green, and Kott were present at
the call to order. Representative Murkowski arrived as the
meeting was in progress.
HB 324-HOMELAND SECURITY APPROPRIATIONS
CHAIR CHENAULT announced that the committee would continue to
consider HOUSE BILL NO. 324, "An Act making supplemental and
other appropriations for homeland security; and providing for an
effective date."
Number 0134
CHAIR CHENAULT brought attention to Item 43 [of the document
titled "Terrorism Disaster Policy Cabinet: Cost Estimates for
Highest Priority Recommendations," dated 1/14/02]. He informed
the committee that Wayne Rush was online to answer questions.
Number 0181
JANET CLARKE, Director, Division of Administration Services,
Department of Health and Social Services (DHSS), came forward to
testify along with Karen Pearson. Before addressing Item 43,
she offered a handout related to federal funding, titled
"Bioterrorism Preparedness & Response: Supplemental Funding
Summary." Ms. Clarke informed members that Washington, D.C.,
has recognized the problems in public health and in not having
enough support and infrastructure capacity for public health
throughout the country.
MS. CLARKE pointed out that the federal government has dealt
with anthrax issues since the previous fall, and to her belief
has already appropriated, through the President, over a billion
dollars nationwide; a certain amount allocated to the State of
Alaska can go for many items proposed in [HB 324]. Emphasizing
that a lot of requests might be converted to federal funding at
some point, she asked Ms. Pearson to discuss that before delving
into the individual items. In response to Chair Chenault, Ms.
Clarke clarified, "We already know Alaska is going to get $6.9
million for public health-related items for bioterrorism, and
the money has already been appropriated at the federal level."
Number 0375
KAREN E. PEARSON, Director, Division of Public Health,
Department of Health and Social Services, pointed out that many
components relate not just to the Division of Public Health, but
also to the existing public health system through the
municipalities, tribal health organizations, and so forth. The
federal money will go into that whole, broad system, which is
why [DHSS] couldn't say right now what items could be removed
from the list [of requested appropriations]. She said a group
of partners, including some just mentioned, need to come
together with [DHSS], within the constraints and framework of
funds being made available, to decide where to best invest that
money to achieve the specific benchmarks required by Congress
with regard to the money, "and how that fits in our particular
system."
MS. PEARSON reported that within her division are four areas
relating to the figures [she and Ms. Clarke] had been asked to
address today: the sections of epidemiology, laboratories,
public health nursing, and community health and emergency
medical services. All would be "playing ... into our partners
in public safety when there is some kind of an event." She
cited recent anthrax issues as an example, noting that just
yesterday a sample was received in the laboratory for testing.
Indicating people are still concerned and vigilant about [the
possibility that anthrax or other substances will be sent
through the mail], Ms. Pearson said that is good because the
threat is no less today than last fall, even though it is less
visible.
MS. PEARSON explained that the epidemiologists [in her division]
do disease surveillance and that if there were a covert
biological attack - unannounced, but with people just becoming
ill - it is that system which would pick it up as quickly as
possible. The lab would do testing and then provide
confirmation and results. The public health nursing [section]
would do a mass dissemination of antibiotics or follow-up, for
example. And the emergency medical services people are there
whatever the disaster or [emergency] is.
Number 0639
REPRESENTATIVE GREEN requested clarification about the partners
mentioned by Ms. Pearson.
MS. PEARSON highlighted the last half of the paragraph titled
"Summary" under "Public Health Preparedness & Response Program"
on the first page of the department's handout. She pointed out
that it talks about who needs to come together at the table
"with us" to determine where the money will go and what will
actually be done with it. Entities listed are state and local
health departments [and governments]; [emergency management]
agencies [and emergency medical services]; [the Office of Rural
Health]; law enforcement, fire, emergency rescue [workers], and
occupational health [workers]; other healthcare providers
[including] university, academic, medical, and public health];
community health [centers]; [Red Cross and other volunteer
organizations]; [hospital community including military and
Veterans Administration (VA) hospitals; and [tribal health
organizations].
MS. PEARSON indicated the foregoing would be mandatory
participants, according to Congress, but that there may be
others who aren't listed. All would "sit down" regarding the
$6.4 million of "bigger public health money" and would ask what
benchmarks must be achieved, such as assuring 90-percent
coverage within [Alaska] for the Health Alert Network, an
electronic system of communication. Then they would ask where
the money needs to be spent in order to achieve those things.
Number 0754
REPRESENTATIVE GREEN, noting that the document says the plan
must be submitted by April 15, surmised that the "coming
together" would be imminent.
MS. PEARSON agreed, pointing out that conference calls are set
up for the next week; that there will be mandatory training,
which all states send people to, on March 5; and that there will
be face-to-face meetings when those people return.
MS. CLARKE noted that "public health" in the current bill has a
total of $4.4 million. She said there would be a pretty good
idea, in the next week or two, of which items will likely
qualify for federal money; the planning process will help flesh
that out.
Number 0834
MS. PEARSON began specific discussion of Item 43, which read,
"Do a feasibility study for a Biosafety Level III lab facility
at the Fairbanks Public Health Lab to provide in-state redundant
capability." Noting that it is a capital item, she deferred to
Ms. Pearson for details.
MS. PEARSON said [Item 43] is in response to concerns, in all
states and at the federal level, about what would happen if the
only lab with the capacity to respond were in the location of a
major event. For example, perhaps the building wouldn't be
harmed, but staff would be rendered incapable of working. The
recommendation of Congress is to critically look at what it
would take to do redundant capacity, she noted, including the
pros and cons, cost-effectiveness, and so forth.
MS. PEARSON explained that currently there is a virology lab in
Fairbanks, for which the department wants to look at whether
there is a need to build in capacity to do some bacteriological
work - the kind of testing currently done in Anchorage. That
money [in Item 43] would assist with [thoroughly] analyzing the
cost to have some level of redundant capacity and what the
tradeoffs would be if Alaska did or did not have that capacity.
In response to questions, she clarified that the department
would look at the need to be able to do a bit of virology [work]
in Anchorage as well. Thus if one lab "went down" or there were
"big numbers," both labs could work on the same problem at the
same time.
Number 0999
CHAIR CHENAULT asked why it hasn't been done in the past or
isn't being done currently.
MS. PEARSON responded that nothing has been that time-sensitive.
It has been fine to have one set of expertise [in Anchorage] and
another [in Fairbanks], and to direct specimens to whichever lab
is appropriate. Originally there were three regional labs in
Alaska, including one in Juneau. However, the expense of
technology and equipment precluded maintaining that level [of
regional labs]; thus the decision was made to have the majority
of work done in Anchorage and to maintain the virology lab in
Fairbanks.
Number 1062
REPRESENTATIVE GREEN asked why the study would require $100,000.
MS. PEARSON replied that currently Fairbanks doesn't have
"Biosafety Level III," the ability to appropriately protect
workers against what the lab director calls "the really nasty
bugs." [The study] would look at configurations and how the
physical space would have to be modified, which are "architect-
design" issues, as well as cost-effectiveness. A certain amount
of technical work would be needed, along with the assessment of
the cost of operations, for example.
Number 1151
CHAIR CHENAULT suggested operating costs at the Anchorage
facility could be used as a base amount to determine some of the
costs without spending more money.
MS. PEARSON agreed, if it were simply a feasibility study,
rather than involving design issues. She added that it is an
"outside number."
Number 1244
MS. CLARKE began addressing Item 51, relating to the public
health lab, which read, "On-going bioterrorism response capacity
including training, travel to training, lab supplies, and
salary/[overtime] costs/vacancy reduction." She explained that
[the department] had learned in the fall of 2001 [during the
time of anthrax-caused deaths elsewhere and related testing
nationwide] that the laboratory was really impacted in an event.
The lab was turned into a 24-hour facility, which it hadn't been
before. She mentioned the need to be "staffed up" and the need
for reagent testing and so forth.
MS. PEARSON joined in, indicating that during the anthrax
response, approximately a 50-percent vacancy rate was found in
the Anchorage lab, a rate that had been growing over several
years because salaries weren't competitive. A fairly
significant part of the request therefore relates to the fact
that the department had used personal-services money [intended]
for vacant positions in order to cover supplies and operations.
Personal services is more than $400,000 of that request, she
noted; it is to be able to fully staff the facility [and
includes] the higher-level salaries necessary to recruit and
keep staff. Most of the rest is in supplies, including reagents
and so forth.
MS. CLARKE, in regard to the 50-percent vacancy discovered in
the microbiologist staffing, noted that people had said they
could make [an additional] $700 or more a month working in other
hospital labs; the lab was losing people to the private sector.
Furthermore, the lab director was working 18-hour days trying to
keep the tests timely. It was a strain on the lab's capability.
Ms. Clarke emphasized that this is a specialized area in which
the state needs to be competitive in order to [hire and retain]
appropriate people who can perform the tests and have fast
turnaround times; the bulk of the money would go for that.
Number 1440
CHAIR CHENAULT asked how many people work at the facility now.
MS. CLARKE or MS. PEARSON said fifteen.
MS. PEARSON said a majority are either microbiologists or
"techs," with about three administrative staff. In response to
questions, she said this portion is to pay the people who are on
staff; another request [in a separate item] would add two
microbiologists. She emphasized the need for money to fill the
existing positions and pay the appropriate salaries. She said
she thinks this clearly represents what Congress is responding
to with making this money available to states. It was
discovered in Washington, D.C., and the surrounding states that
the public health infrastructure in this country - not just in
Alaska - hasn't been adequately funded; when something happened,
therefore, all those "holes" in the system started showing up.
Ms. Pearson said this infrastructure is needed to do the day-to-
day work for Alaskans, to fight infectious diseases and so
forth, and would also be available if there were a terrorist-
related event.
Number 1571
MS. CLARKE added that the requested funds in personal services
will do two things. Approximately half is to replenish money
that was used, because there were vacancies, for supplies; that
has been yearly, she indicated, "just to keep things going."
The other half is to deal with the vacancy problems.
Number 1603
REPRESENTATIVE GREEN remarked that Items 51, 54, and 55 add up
to about $1.75 million, "with a little training and a little
travel," for personnel. He said it is a lot of people.
MS. CLARKE concurred.
CHAIR CHENAULT noted that it doesn't include the [two]
microbiologists [requested in Item 33].
Number 1648
MS. PEARSON emphasized the belief that a certain amount will be
covered by money from the federal government, which understands
that the infrastructure needs support. However, it is unknown
exactly what that [amount will be].
CHAIR CHENAULT acknowledged that it isn't the [exact] amount
needed from the general fund (GF), but said it is proposed in
[HB 324] that way and that the committee therefore needs to at
least look at it.
Number 1699
MS. CLARKE reported that Alaska has had difficulty keeping up
with necessary work on infectious diseases, including
tuberculosis (TB) outbreaks. This proposal is similar to one
[DHSS] had last year called "Back to Basics." Ms. Clarke agreed
with Ms. Pearson that it requires the same kind of
infrastructure to deal with infectious diseases as is needed to
investigate a major bioterrorism event. She suggested these
funds therefore would offer double duty, and again emphasized
the belief that much of the request will be able to be funded
with federal money.
Number 1774
MS. PEARSON added that it is a GF request because when [the
department] prepared this [appropriation request], Congress
hadn't yet passed the bioterrorism bill. [The department]
hadn't known, therefore, that potentially there would be federal
money to support some of these activities.
Number 1822
MS. CLARKE began addressing Item 53, which read, "Provide Simple
Triage and Rapid Treatment (START) Triage kits for EMS service
providers statewide." She said it is a capital request for
$20,000 to purchase START kits for EMS [emergency medical
services] providers throughout the state. She deferred to Ms.
Pearson.
MS. PEARSON explained that these are the kits used by EMS
personnel in order to triage. [The department's] EMS personnel
have said this would be very helpful in assessing what to do
next with a particular person, for example. She said she could
get information on the exact products in the kits.
CHAIR CHENAULT said he'd be curious as to whether those are
related to a bioterrorism threat, but questioned that. He said
he understood that [EMS personnel] should have such a supply,
however, without a borough or city government having to bear the
burden of providing them.
Number 1919
MS. CLARKE offered her understanding that the kits focus on
multiple or mass casualties, although she didn't know what was
in the kits either.
MS. PEARSON explained that "triage" refers to making decisions
about who needs to be treated first, who might need to be
evacuated, and so forth. However, she didn't know exactly what
these kits were designed to triage.
CHAIR CHENAULT said although he'd be curious to know what is in
the kits, it wasn't important [to know].
Number 1984
MS. CLARKE began discussion of Item 54, which read, "Public
Health and Epidemiology increases needed to address bioterrorism
cases." She noted that it has two pieces. First, $450,000 is
for additional staff and appropriate travel and contractual
funds for the epidemiology section; these are the people who are
disease investigators, which requires a lot of work and
expertise, particularly with some of the emerging diseases or
bioterrorism events. She reiterated that these people can
investigate either infectious diseases or bioterrorism events,
which is how they've been used nationwide.
MS. PEARSON added that these are the nurse-epidemiologists who,
when there is an outbreak, actually go out and direct the
investigation, which includes deciding who needs to be tested
or, in the case of a food-borne outbreak, whom the nurses need
to contact and maybe get specimens or samples from. They do the
directing, consultation, and, in many cases, the actual "nurse
work" out in the field. Noting that [the division] has
investigations on a [continual] basis, she cited a current food-
borne outbreak in Anchorage as an example and pointed out how
labor-intensive the process is; she provided details.
Number 2113
MS. CLARKE reported that the second portion, $240,000, is for
additional staff and test kits for the lab.
MS. PEARSON called this a "capacity issue of being able to do
the tests." She reiterated that part of this was requested the
previous year in the "Back to Basics" request for the lab,
[epidemiology], and nursing. She cited a new urine test for
chlamydia and gonorrhea as an example of a test that costs more
- $10 versus $4 or $5 for the earlier version - but is more
acceptable [to the public]; the hope is that many more people
who have been exposed to these diseases will be discovered
because more [sexual] partners will be tested, but each test
will cost twice as much as before. She said this is a very big
area for public health: the Alaskan community doesn't want
people to go untreated for sexually transmitted diseases because
the diseases will then spread and affect fertility and cause
other problems. She emphasized the desire to not have cost be a
barrier to getting a test done if people need that test.
MS. CLARKE remarked that chlamydia is a serious disease that can
cause infertility in women if untreated.
MS. PEARSON noted that CDC [Centers for Disease Control and
Prevention] has said Alaska has the second-highest chlamydia
rate in the country. She mentioned pilot projects in Anchorage
for routine testing of women coming in for early pregnancy care,
and she offered the belief that there is more disease out there
than people are actually aware of.
Number 2245
CHAIR CHENAULT offered his understanding, then, that [$450,000]
is for staff and travel.
MS. CLARKE agreed, saying it is for the epidemiologists. In
further response, she said the $240,000 is for one additional
position in the labs and additional contractual money.
Number 2278
MS. CLARKE began addressing Item 55, which read, "Public Health
nursing positions." She noted that this is for six positions,
the "front-line first responders" out in the field who help
vaccinate if there is a mass bioterrorism event or a mass-
infection problem, for instance.
MS. PEARSON, in response to Representative Green, explained that
identification of an outbreak or problem can come from any
source, including a [private] physician. The nurse-
epidemiologists all operate out of Anchorage and are "our core
team," with special knowledge in tracking and finding things
out; they have special expertise in infectious disease and how
to do epidemiological investigations and follow-up. The public
health nurses, by contrast, are generalists serving the
community and would give the immunizations that would prevent
the outbreaks that would cause the nurse team to be activated.
The nurse-epidemiologist would be the lead person who would go
to a community where there was an outbreak, would mobilize the
local public health nurses, and would serve as the day-to-day
technical person whom the public health nurses would call when
they had questions relating to infectious disease.
MS. PEARSON, in response to Chair Chenault regarding the six
requested positions, noted that these would be public health
nurses who would be out in the communities doing all the public
health work such as immunizing children, doing follow-up on
sexually transmitted diseases, and so forth. In further
response, she said the likely places "where we're really short
of staff or we have particularly strong need" are Saint Mary's,
Dillingham, Valdez, Wasilla, Seward, and the Bethel area.
Number 2465
CHAIR CHENAULT asked whether there were further questions; none
were offered. He thanked Ms. Clarke and Ms. Pearson and
announced that the rest of the issues in [DHSS] would most
probably be looked at some other time.
MS. CLARKE offered to provide information as soon as the
department knows more about the federal funding.
MS. PEARSON, in response to a question from Chair Chenault
[relating to the department's handout provided that day],
explained that the 6.9 [million dollars] is the total for public
health. The first section, which is for the general public
health infrastructure, is 6.4 [million dollars], and then
[approximately] $500,000 is for hospital [preparedness].
CHAIR CHENAULT indicated understanding. [HB 324 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Special Committee on Military and Veterans' Affairs meeting was
adjourned at 4:01 p.m.
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