Legislature(1997 - 1998)
04/07/1997 09:09 AM Senate HES
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SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE April 7, 1997 9:09 a.m. MEMBERS PRESENT Senator Gary Wilken, Chairman Senator Loren Leman, Vice Chairman Senator Lyda Green Senator Jerry Ward Senator Johnny Ellis MEMBERS ABSENT All members present. COMMITTEE CALENDAR CONFIRMATIONS Board of Clinical Social Work Examiners - Diane DiSanto Board of Dispensing Opticians - Mary Seutter Board of Education - Roy Nageak, Marilyn Webb State Medical Board - Beverly Fletcher, Donald Hudson, Sarah Isto, Suzanne Lombardi, Donald Olson Board of Professional Teaching Practices Commission - Mary Lou Madden, Thomas Matheson, Christine Miller SENATE BILL NO. 96 "An Act regulating hospice care." PREVIOUS SENATE COMMITTEE ACTION SB 96 - See Senate Health, Education & Social Services Committee minutes dated 2/24/97 and 3/21/97. WITNESS REGISTER Ritchie Sonner Hospice & Home Care of Juneau 3200 Hospital Drive, #100 Juneau, Alaska POSITION STATEMENT: Supported SB 96. Charles Quarre, President Central Peninsula Hospice HC1 Box 3336 Sterling, Alaska 99672 POSITION STATEMENT: Expressed concerns with SB 96. Barbara Rich Hospice of the Tanana Valley PO Box 80482 Fairbanks, Alaska 99708 POSITION STATEMENT: Indicated support for SB 96. Joy Janssen Petersburg Hospice Petersburg, Alaska POSITION STATEMENT: Discussed how this would apply to neighbor to neighbor care. Maxine Worhatch Petersburg Hospice Petersburg, Alaska POSITION STATEMENT: Discussed the need for insurance for volunteer hospices. Erica Worhatch Petersburg Hospice Petersburg, Alaska POSITION STATEMENT: Discussed liability for volunteer hospices. Shelbert Larsen, Administrator Health Facilities Licensing & Certification Department of Health & Social Services 4730 Business Park Boulevard, Suite 18 Anchorage, Alaska 99503-7117 POSITION STATEMENT: Stated that SB 96 was a good bill. ACTION NARRATIVE TAPE 97-36, SIDE A Number 001 CHAIRMAN WILKEN called the Senate Health, Education & Social Services Committee (HES) to order at 9:09 a.m. and announced that the committee would hear from appointees to the Board of Clinical Social Work Examiners, the Board of Dispensing Opticians, the Board of Education, the State Medical Board, and the Board of Professional Teaching Practices Commission. Chairman Wilken invited the State Board of Education appointees to begin. MARILYN WEBB , State Board of Education appointee, informed the committee that she currently resides in Juneau. Ms. Webb has two children who graduated from the Anchorage School District. Ms. Webb and her husband arrived in Alaska many years ago to work in a BIA school in Savoonga where Ms. Webb coordinated the bilingual program and worked with the kindergarten, first and second grade programs. Ms. Webb, a certified teacher, noted that she currently works in the Head Start program in Alaska. Ms. Webb felt that it is a privilege to work on the State Board of Education. SENATOR GREEN noted that in Alaska, Head Start goes through a department other than the Department of Education. Is Head Start located in the Department of Education in other states? MARILYN WEBB said that it depended on the state. Head Start is a federal program and the funding goes directly to the grantee. Number 102 SENATOR GREEN asked Ms. Webb if she had an opinion on child care/daycare grants. There is more than one type of assistance; one type of assistance goes to the licensed care provider and the other goes to the user. Therefore an individual could choose his/her own provider. Senator Green noted the debate revolving around whether the assistance should only be used for licensed providers. MARILYN WEBB said that quality of care is of concern. There is much research about the importance of what occurs with home care. Ms. Webb expressed the need to ensure that funding supports quality care for children whether in licensed or exempt homes. SENATOR LEMAN inquired as to Ms. Webb's possible role in encouraging local school districts to cooperate with home school and private school students who want to participate in school district activities. Senator Leman acknowledged that some school districts have been cooperative in this area and others have not. MARILYN WEBB noted that she had just had a presentation from Representative Dyson and the board voted to unanimously support his bill. SENATOR LEMAN noted that the Anchorage School District has been reluctant in this matter. CHAIRMAN WILKEN noted that Ms. Fletcher had a time constraint and her testimony would be taken next. Number 180 BEVERLY FLETCHER , appointee to the State Medical Board, pointed out that most of her work in Alaska has been in the arena of domestic violence and sexual assault. She began in that field in Dillingham in 1982. Ms. Fletcher has been in Juneau since early 1991 to the present and has been working for the Coast Guard as Family Programs Administrator. As a Family Programs Administrator, Ms. Fletcher primarily works in the domestic violence and sexual assault field as well as the Special Needs Program. Ms. Fletcher felt that her experience afforded her the understanding of rural health care issues as well as issues effecting urban Alaska. ROY NAGEAK , appointee to the State Board of Education, informed the committee that he had four children in the North Slope Borough School District. Mr. Nageak began in the school district when the state took over the BIA schools. When Mr. Nageak began with the school district the Iowa Test of Basic Skills (ITBS) scores were in the lower end of the national curve, below 10 percent. In the last 10 years, those scores in the North Slope have moved into the 40 and 50 percentiles which Mr. Nageak attributed to the involvement in hiring the teachers and the increased parental involvement. The North Slope has a belief that all children can learn. Mr. Nageak noted his involvement with the Alaska Association of School Boards which has provided him with a good state perspective. Mr. Nageak informed the committee that he was a whaling captain. He learned a value lesson from his father and uncle who were strict with him due to the dangers involved. Mr. Nageak emphasized the need to do the same with today's children; children need to realize that what they learn or do not learn early on effects them later. Number 260 SENATOR LEMAN noted that Mr. Nageak had attended a boarding school. There have been results from schools, such as Mt. Edgecombe, that are better than results in rural school districts. What can be taken from the boarding school experience that could be applied to other schools to better the results? ROY NAGEAK recalled his parents commitment to education; his parents sent him to boarding school about the time, age 14 or so, when the return from subsistence education would surface. Many people in leadership positions today attended boarding schools. No matter where students attend school, parental involvement is very important. Mr. Nageak said that a learning curve of the transition from a BIA operated system to a locally operated system is occurring, but that has not yet occurred in some of the more isolated areas. Mr. Nageak believed that educational scores would be higher once the problem areas in Alaska are identified and a training process begins. With regards to boarding schools, Mr. Nageak pointed out that he missed the support of his parents during his time in an Oregon boarding school. SENATOR LEMAN clarified that he was not suggesting that all children attend boarding schools rather what successes from boarding schools can be utilized in local schools in order to improve performance. ROY NAGEAK said that it was a matter of communication, sharing successes between school districts. SENATOR GREEN inquired as to Mr. Nageak's opinion on charter schools. ROY NAGEAK informed the committee that the North Slope Borough School District just reviewed a charter school proposal. There were many unanswered questions during the application process. Mr Nageak emphasized the need for a process to review charter school proposals. SENATOR GREEN was not sure that statute clearly specifies the role of the local school district versus that of the State Board of Education. Senator Green asked if anything was necessary at the state level to ensure that the review processes were not duplicated. ROY NAGEAK noted that it takes time to determine the responsibilities of a new law. If local school districts have an intensive process for a charter school, the state board should reflect that process. Number 319 DIANE DISANTO , appointee for the Board of Clinical Social Work Examiners, informed the committee that she was a licensed clinical social worker professionally trained in the bachelor and masters level of social work. Ms. DiSanto was the statewide Social Worker of the Year. Ms. DiSanto has worked in the direct practice and with advocacy in the management of social work. Ms. DiSanto is an Anchorage resident. SENATOR LEMAN commented that Ms. DiSanto had given him a tour of the South Central Foundation which is quite impressive. Senator Leman thanked Ms. DiSanto for those services and, in many cases, for less money than under traditional models. DIANE DISANTO noted that an addendum had been sent which specified that she had left the South Central Foundation last January. MARY CATHY SEUTTER , appointee for the Board of Dispensing Opticians, informed the committee that she was licensed as an optician in Virginia in 1978. Ms. Seutter moved to Alaska in 1983 and received her license in Alaska. She reviewed her employment history since moving to Alaska. Ms. Seutter believed in continuing education for all professionals and informed the committee of her efforts in that vein. CHAIRMAN WILKEN then moved to the Professional Teaching Practices Commission appointees. Number 428 CHRISTINE MILLER , appointee to the Professional Teaching Practices Commission, informed the committee that she was born, raised and graduated from high school in Fairbanks. Ms. Miller has a Bachelors degree from Western Washington State College in Speech Pathology & Audiology and a Masters degree in Speech Pathology from the University of Washington. She also holds a Type A certificate in Alaska with a K-12 special education, speech and hearing endorsement. Ms. Miller specified that she had taught 18 years in the Fairbanks schools, eight years as a classroom teacher and 10 as support to the class in the area of speech and language. Ms. Miller believed that Alaska has a highly educated and dedicated teaching staff and in order to maintain that level, as professionals, teachers should police themselves. In response to Chairman Wilken, Ms. Miller said she had taught at North Pole Elementary for 12 years and Ticasuk Brown Elementary for six years. SUZANNE LOMBARDI , appointee to the State Medical Board, noted that she was the current chair of the State Medical Board. Ms. Lombardi informed the committee that she was instrumental in forming the shelter in the Mat-Su Valley. At that time, Ms. Lombardi worked with the legislative delegation in order to obtain funding for the shelter. Ms. Lombardi then went to Law School and upon her return to Alaska Ms. Lombardi was a clerk for the Honorable James K. Singleton, Jr. Then Ms. Lombardi was appointed by Governor Hickel to the Prosecutor's Office. Currently, Ms. Lombardi is in private practice with Faulkner, Banfield. Last session a sexual misconduct statute was passed which left the promulgation of regulations regarding the definition of sexual misconduct to the State Medical Board. The board accomplished that and hoped that by the next meeting the Department of Law would have passed those regulations. The board has also passed regulations regarding record keeping and prescriptions. SENATOR LEMAN said that the Legislature is poised to pass SB 24 which creates a judicial by-pass for a minor seeking an abortion, enabling the parental consent provision to be enforced. Senator Leman asked if Ms. Lombardi would, as a member of the State Medical Board, enforce that law. SUZANNE LOMBARDI stated that the board is obligated to enforce any statute passed by the Legislature. SENATOR LEMAN noted the unfortunate dismissal of some qualified people from the State Medical Board. Senator Leman asked if the board was in a position so as not to suffer such a blow again? Senator Leman said that he would take this matter up in a later conversation. Senator Leman understood that the previous board did not have all the information on James McGuire which lead to the dismissal of the previous board. That action indicated that the Governor was held responsible for information that the board did not have. Senator Leman wanted to ensure that the board was not placed in that position again, that there is a provision in place to obtain such information. SUZANNE LOMBARDI did not believe it unusual for a governor to change boards. Ms. Lombardi did not know the reasons why the former board is not in tact. Ms. Lombardi believed that the Legislature would be proud of the work of those on this board. SENATOR GREEN indicated that she needed to converse with Ms. Lombardi about a complaint the Senator had received regarding a matter before the board. Senator Green expressed concern with the style of the board. SUZANNE LOMBARDI noted that she had been in frequent contact with Senator Green's staff and would be happy to discuss any matter with Senator Green. Number 522 DON HUDSON , appointee to the State Medical Board, informed the committee that he was board certified in Emergency Medicine and specialized in Emergency Medicine and Aerospace Medicine. Dr. Hudson noted that he had been involved with mid-level practitioners, using them in a variety of remote situations. Dr. Hudson had been involved in the training and sponsoring of paramedics. Dr. Hudson said that his expertise lies in rural Alaska. In response to Chairman Wilken, Dr. Hudson specified that he was discharged from the U.S. Airforce in 1981 as Major. In response to Senator Green, Dr. Hudson said that part of his love was the safety of snowmobilers. Dr. Hudson has encouraged marked and safe trails around Alaska in order to encourage tourism. SENATOR LEMAN noted that Dr. Hudson was the Director of the Iliuliak Family Clinic in Unalaska which the Legislature worked on several years ago. DON HUDSON said that the clinic has had its ups and downs, but almost always consistently on a positive note. Dr. Hudson discussed the interaction with the fishing industry. The Iliuliak Family Clinic is a great rural clinic with 60 weeks of physician coverage and tremendous community involvement. DON OLSON , appointee to the State Medical Board, commented that influence of his high school teachers in Unalakleet lead him to medical school. Dr. Olson discussed his college education. Since 1984, Dr. Olson has been practicing medicine in Nome and focusing on rural Alaska. Dr. Olson went to law school in the early 1990s. CHAIRMAN WILKEN pointed out that Dr. Olson and Dr. Hudson were both pilots. Chairman Wilken informed the committee that Dr. Sarah Isto is not present today, she is on a long planned family vacation. TAPE 97-36, SIDE B MARY LOUISE MADDEN , appointee to the Professional Teaching Practices Commission, informed the committee that she was completing her first year on the PTPC. Ms. Madden has been in Alaska since 1971 and has been involved in education most of that time at various levels. Currently, Ms. Madden is an adjunct teacher at the University of Alaska. Ms. Madden believed that PTPC was a valuable commission and she was pleased to serve. Number 588 SENATOR LEMAN noted that in 1990 a bill dealing with the sexual misconduct of teachers passed; has that bill been effective? MARY LOUISE MADDEN said that such incidents were rare, but not nil which is preferred. Such incidents are vigorously pursued as the profession has better information. Now perpetrators cannot come to Alaska and receive certification without Alaska knowing his/her background. In further response to Senator Leman, Ms. Madden said that there are ways to identify inappropriate behavior and everyone is becoming more aware of those indicators. SENATOR GREEN commented on the problems surrounding a student that turns 18 before graduation. Senator Green also noted the loophole for persons hired through consultants who do not adhere to the same level of scrutiny as persons hired through the regular personnel process. Senator Green requested that Ms. Madden notify her of any way she may attack that problem. In response to Chairman Wilken, MARY LOUISE MADDEN said that she was a Juneau resident and was teaching her class at the University which is why she could not be present at the hearing. LOU MATHESON , appointee to the Professional Teaching Practices Commission, informed the committee that he had been in Alaska for 18 years as an administrator in rural Alaska. Currently, Mr. Matheson represents the Secondary School Principals Association on the PTPC. Mr. Matheson said that he was appointed by Governor Hickel and served a three year term which expired June 6, 1996. Upon that expiration, the Secondary School Principals Association nominated Mr. Matheson for another term, 1996-1997 school year. Mr. Matheson endorsed the previous comments regarding the importance of the PTPC. CHAIRMAN WILKEN asked the committee to review the resumes. If any additional information is necessary that should be requested by Wednesday's hearing otherwise, Chairman Wilken assumed that he could report the names back to the Senate. SB 96 REGULATION OF HOSPICE CARE Number 530 CHAIRMAN WILKEN announced that SB 96 would be the next order of business before the committee. Chairman Wilken noted that the K version of the bill was before the committee. BEN BROWN , Staff to Senator Kelly, discussed the changes that version K includes. On page 8, line 21 after "which" the word "including" was deleted and "may include" was inserted. That language was inserted because sometimes a volunteer hospice would not include all the items listed for bereavement services. Page 9, line 14 the reference to 24 hour, seven days a week was deleted because in a volunteer context that would not occur. That language is on page 5 under the definition of nursing services as provided by nonvolunteer hospice programs. CHAIRMAN WILKEN asked Ms. Sonner to provide her testimony and noted that the packet included her letter. RITCHIE SONNER , Hospice & Home Care of Juneau, supported SB 96 as written. With the changes to SB 96, Ms. Sonner did not believe it to be burdensome administratively or financially. Hospice & Home Care of Juneau is a small volunteer hospice with few funds. SB 96 is written to protect the consumer. Ms. Sonner noted that she was not a supporter of regulation, but in this situation she recommended the passage of SB 96. SENATOR LEMAN asked Ms. Sonner if her notion that SB 96 was not burdensome was the general consensus among volunteer hospices. RITCHIE SONNER believed so, but noted there were folks on line who could speak to that. SENATOR LEMAN did not want to burden such organizations unnecessarily. CHARLES QUARRE , President of the Central Peninsula Hospice, stated that he maintained his previous testimony regarding concerns of the administrative and financial burdens of SB 96. Mr. Quarre noted that many industries are regulated by market forces. The volunteer hospices adhere to the guidelines of the National Hospice Organization which are almost identical to those specified in the bill. Mr. Quarre suggested reviewing the advisability of incurring additional expense and regulations in this area. Mr. Quarre questioned if there are current statutes that address abuses in this system. In response to Chairman Wilken, Mr. Quarre agreed that he was speaking in opposition to SB 96. Mr. Quarre requested that the volunteer hospice may be noted in the bill, but be excluded from the provisions if not entirely. CHAIRMAN WILKEN asked Mr. Quarre if he had any suggestions regarding how to accomplish that within SB 96. CHARLES QUARRE suggested that if the bill is to pass, the volunteer hospice could be recognized but excluded from the provisions of the bill. Number 427 BEN BROWN explained that if hospices are to be regulated, there must be a standard that applies to any organization using the term hospice. In the Commonwealth of Virginia, a bill excluding the volunteer hospices was passed which resulted in volunteer hospices being unable to use the term hospice in their name. Mr. Brown acknowledged that language could be used to avoid that problem. However, that would result in regulating only a portion of the industry providing hospice services. Mr. Brown recognized that the volunteer hospices in Alaska are exceeding the standards specified in the bill, but that may not continue as time passes. Eliminating the reference to the volunteer programs in SB 96 would not accomplish the primary goal and the remainder of the hospice community may not want that to go forward. RITCHIE SONNER noted that there are shams, although not in Alaska currently. Thirty-eight states have had to regulate hospices in even a more restrictive manner. SB 96 is a proactive bill to protect consumers who are in a vulnerable state. Ms. Sonner feared the possibility of an opportunist. Ms. Sonner pointed out that eliminating the reference to volunteer hospices would allow anyone to refer to themselves as a hospice. SB 96 should be passed as is or not at all. SENATOR WARD inquired as to the number of cases of abuse in Alaska this year. BEN BROWN did not believe there was a situation of abuse in Alaska currently. SENATOR WARD suggested that regulation could harm the process that is currently working. BEN BROWN referred to Article 2 when saying that the Administrator of Health Facilities Licensing & Certification will be reviewing mainly nonvolunteer hospices a couple days a year. The volunteer programs have a lower standard to adhere and the department has no intention of charging volunteer hospices. Mr. Brown reiterated that the volunteer hospices are already exceeding the standards in SB 96. Mr. Brown noted that nurses and doctors have associations that regulate them, only attorneys regulate themselves. Mr. Brown did not know what more could be done to lighten the burden without making the legislation meaningless. Number 366 SENATOR WARD agreed that there was no middle ground. Senator Ward inquired as to the public safety reasons for SB 96 within Alaska. BEN BROWN could not give an example within the hospice community. There was a problem in an assisted living home which lead to changes in law. Mr. Brown noted that an assisted living home was a comparable field. BARBARA RICH , Hospice of the Tanana Valley, said that she was speaking for the Board of Directors. Ms. Rich noted that all of the concerns regarding the bill initially speaking only to volunteer hospices when relevant were addressed. Ms. Rich noted that she was concerned with the administrative and financial costs of SB 96. Mr. Shelby of the Department of Health & Social Services assured Ms. Rich that it would be very minimal: a yearly on-site inspection would occur with a report following. The standards in the bill are minimal. SB 96 would protect vulnerable patients and families. Ms. Rich said that there has never been a problem in this area and the impetus is to continue that record. In response to Senator Ward, Ms. Rich said that the Hospice of the Tanana Valley has not experienced any problems. Ms. Rich was concerned that others may not do so. With regard to the expansion of the regulations, Ms. Rich did not believe there could be expansion. Ms. Rich said that she had heard of others who have lower standards as well as problems with this in other states. SENATOR WARD was not sure that regulation was necessary for a problem that does not exist. BARBARA RICH believed that the certified hospices would be regulated due to the presence of nursing staff and such. JOY JANSSEN , representing the forming Petersburg Hospice, informed the committee that Petersburg was in the process of forming a hospice beginning with neighbor to neighbor care. Ms. Janssen asked if neighbor to neighbor care was given without using the name hospice, would the organization still be regulated under this bill. BEN BROWN replied no. SB 96 applies only to groups representing themselves as hospices. Mr. Brown said that it would be a judgement call for the Department of Law upon the request of the Department of Health & Social Services. Mr. Brown pointed out the definition of "hospice services" when noting that providing only one service at home or not meeting all the needs listed could possibly eliminate Ms. Janssen's concerns. Identifying an organization as a hospice is the triggering mechanism and the secondary definition is providing hospice services. Number 251 MAXINE WORHATCH , testifying from Petersburg, asked if insurance, personal or group, would be necessary if a group fell under this bill as a volunteer. BEN BROWN said that was not covered by SB 96. Mr. Brown believed that most volunteer hospices carried insurance. SB 96 does not mandate liability insurance. Mr. Brown referred Ms. Worhatch to Ms. Sonner or Ms. Rich. MAXINE WORHATCH commented that it does not seem necessary to regulate volunteer hospices. Why would someone volunteer and then take advantage of a patient? ERICA WORHATCH asked if a hospice became licensed would the hospice be liable if a neighbor who was not a hospice volunteer wanted to help. BEN BROWN said that if a person wanted to help a dying neighbor, of course that can be done. As long as that neighbor did not say he/she was affiliated with a particular hospice, that hospice would not be liable for his/her actions. CHAIRMAN WILKEN suggested that those in Petersburg could consult the many successful volunteer hospices such as those represented by Ms. Sonner and Ms. Rich. SHELBERT LARSEN , Administrator of Health Facilities Licensing & Certification for DHSS, said that his agency would probably develop and enforce the regulations if this statute were to pass. Mr. Larsen believed that SB 96 was a good bill, providing minimum standards for hospice programs. Mr. Larsen did not believe SB 96 would be burdensome for either the for profit or volunteer hospices. CHAIRMAN WILKEN referred to Article 2, page 7, line 18 when asking if other volunteer organizations were required to show proof of auto insurance and valid drivers license. BEN BROWN said that he had asked Terri Lauterbach about that matter. Ms. Lauterbach was unaware of other volunteer organizations requiring such. That requirement was included because it was in the main statute and seemed appropriate to put in SB 96. This has not been a concern for anyone. Mr. Brown said that it would not be appropriate for an individual to be driving around a terminally ill patient without auto insurance and a valid drivers license. This is one reason for a hospice to have liability insurance. Liability would be increased if the two requirements were not met. SENATOR GREEN informed everyone that her husband was employed by the Auto Insurance Provider. Senator Green recalled that when she drove for Scouts or her church, she was required to have proof of insurance. Senator Green did not believe that those requirements were unique to hospices. SENATOR WARD requested that SB 96 be held until Kenai could provide an amendment to eliminate the volunteers from the bill. Senator Ward did not know when the amendment would be ready. Senator Ward said that he did not want to move SB 96 out of committee; people should not be regulated for a problem that does not exist. CHAIRMAN WILKEN said that he would prefer not to hold SB 96 beyond Wednesday. There being no further business before the committee, the meeting was adjourned at 10:35 a.m.
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