Legislature(1997 - 1998)

04/16/1997 09:07 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
      SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE                     
                         April 16, 1997                                        
                           9:07 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                                                           
                                                                               
 SENATE BILL NO. 164                                                           
 "An Act relating to the authority of an emergency medical                     
 technician at the scene of an accident or emergency."                         
                                                                               
  - HEARD AND HELD                                                             
                                                                               
 SENATE BILL NO. 122                                                           
 "An Act relating to unfair discrimination under a group health                
 insurance policy for services provided by marital and family                  
 therapists; and providing for an effective date."                             
                                                                               
  - MOVED CSSB 122(L&C) OUT OF COMMITTEE                                       
                                                                               
 SENATE BILL NO. 132                                                           
 "An Act relating to registration of sex offenders and central                 
 registry of sex offenders; relating to access to, release of, and             
 use of criminal justice information and systems; relating to                  
 notices concerning sex offender registrants; and providing for an             
 effective date."                                                              
                                                                               
  - MOVED SB 132 OUT OF COMMITTEE                                              
                                                                               
  PREVIOUS SENATE COMMITTEE ACTION                                             
                                                                               
 SB 164 - No previous Senate action to record.                                 
                                                                               
 SB 122 - See Labor and Commerce Committee minutes dated 4/8/97.               
                                                                               
 SB 132 - See Senate Health, Education & Social Services Committee             
           minutes dated 3/24/97.                                              
                                                                               
  WITNESS REGISTER                                                             
                                                                               
 Beth Hagevig, Staff                                                           
 Senator Wilken                                                                
 State Capitol                                                                 
 Juneau, Alaska 99801-1182                                                     
  POSITION STATEMENT:   Read the Sponsor Statement.                            
                                                                               
 Craig Lewis                                                                   
 Alaska EMS Association                                                        
 Interior Region Emergency Medical Services Council                            
 3522 Industrial Avenue                                                        
 Fairbanks, Alaska 99701                                                       
  POSITION STATEMENT:   Urged support of SB 164.                               
                                                                               
 Ellen Wofford, EMT-III                                                        
 Delta Rescue Squad                                                            
 PO Box 52                                                                     
 Delta Junction, Alaska 99737                                                  
  POSITION STATEMENT:   Supported SB 164.                                      
                                                                               
 Tom Dean, Chief                                                               
 Tok EMS                                                                       
 PO Box 811                                                                    
 Tok, Alaska 99780                                                             
  POSITION STATEMENT:   Encouraged passage of SB 164.                          
                                                                               
 Mark Johnson, Chief                                                           
 Section of Community Health & Emergency Medical Services                      
 Department of Health & Social Services                                        
 PO Box 110616                                                                 
 Juneau, Alaska 99811-0616                                                     
  POSITION STATEMENT:   Supported SB 164.                                      
                                                                               
 Rachael Moreland, Staff                                                       
 Senator Leman                                                                 
 State Capitol                                                                 
 Juneau, Alaska 99801-1182                                                     
  POSITION STATEMENT:   Read the Sponsor Statement.                            
                                                                               
 Catherine Reardon, Director                                                   
 Division of Occupational Licensing                                            
 Department of Commerce & Economic Development                                 
 PO Box 110806                                                                 
 Juneau, Alaska 99811-0806                                                     
  POSITION STATEMENT:   Supported SB 122.                                      
                                                                               
 Beverly Lindell, President                                                    
 Alaska Association of Marriage & Family Therapists                            
 PO Box 32481                                                                  
 Juneau, Alaska 99803                                                          
  POSITION STATEMENT:   Supported SB 122.                                      
                                                                               
 Marianne Burke, Director                                                      
 Division of Insurance                                                         
 Department of Commerce & Economic Development                                 
 PO Box 110805                                                                 
 Juneau, Alaska 99811-0805                                                     
  POSITION STATEMENT:   Discussed SB 122.                                      
                                                                               
  ACTION NARRATIVE                                                             
                                                                               
  TAPE 97-40, SIDE A                                                           
                                                                               
                                                                               
            SB 164 AUTHORITY OF EMERGENCY MED TECHS                            
                                                                             
                                                                              
 Number 001                                                                    
                                                                               
  CHAIRMAN WILKEN  called the Senate Health, Education & Social                
 Services Committee (HES) to order at 9:07 a.m. and introduced                 
 SB 164  as the first order of business before the committee.                  
                                                                               
  BETH HAGEVIG , Staff to Senator Wilken, read the following Sponsor           
 Statement into the record:                                                    
                                                                               
 Senate Bill 164 repairs a long overdue shortcoming in our public              
 safety network.  Specifically, it provides EMTs with appropriate              
 and relevant authority at the scene of an accident as well as                 
 during responses to medical emergencies in homes, without creating            
 potential conflict between emergency personnel.  SB 164 is intended           
 to protect EMTs who arrive first on the scene of an accident or               
 medical emergency, or who are the only emergency responders to                
 arrive for some time, as is the case in many rural areas.                     
                                                                               
 Currently, we ask emergency medical technicians to perform actions            
 necessary to their duties such as:                                            
                                                                               
 *controlling and directing activities at the scene of an accident;            
 *temporarily blocking or redirecting traffic to avoid the scene of            
  an accident;                                                                 
 *trespassing upon property in order to respond to an emergency                
  call;                                                                        
 *entering a building, including a private residence, or premises              
  where report of an injury or illness has taken place; and                    
 *directing the removal or destruction of a motor vehicle or other             
  thing in order to prevent further harm to injured or ill                     
  individuals;                                                                 
                                                                               
 without giving them the proper legal authority to do so.  By taking           
 for granted that EMTs are expected to perform these duties in the             
 absence of any legal authority, we leave hundreds of men and women            
 vulnerable to the lack of cooperation on the part of the public and           
 potential liable suits.                                                       
 Alaska relies heavily on its emergency medical personnel,                     
 especially in rural areas where law enforcement and fire personnel            
 are relatively few in numbers.  Just as we expect EMTs to protect             
 our safety in an emergency situation, we should reciprocate this              
 service, and give EMTs the proper legal authority to do their jobs            
 without compromising their personal safety.                                   
                                                                               
  CHAIRMAN WILKEN  referred the committee to the information in the            
 packet which detailed the levels of EMTs in Alaska.   BETH HAGEVIG            
 noted that ETTs although listed with the levels of EMTs, are not              
 technically EMTs.                                                             
                                                                               
 Number 094                                                                    
                                                                               
  CRAIG LEWIS , Alaska EMS Association and Interior Region Emergency           
 Medical Services Council Inc., urged the support of SB 164.  Mr.              
 Lewis believed that the committee packet included documents                   
 regarding cases in other states where EMTs without this authority             
 were injured and held liable after the fact.  The EMTs in rural               
 settings perform those duties listed.  Mr. Lewis noted that                   
 customarily there is a responsible person in charge, sometimes                
 called the Chief Medic.  SB 164 does not compromise nor conflict              
 with any existing law enforcement or fire fighting authority.                 
 SB 164 provides legal protection for EMTs responding in locations             
 where the trooper response is delayed or there are no volunteer               
 fire fighters to assume the role.                                             
                                                                               
  SENATOR GREEN  referred to line 14 on page 1 when noting that during         
 the Millers Reach fire lots of people began directing traffic                 
 without consistent identification that resulted in fist to cuffs              
 and later arrests.  In SB 164, what provides consistent                       
 identification of those in authority?   CRAIG LEWIS  pointed out that         
 SB 164 is not designed to deal with a wild land fire circumstance             
 as in Millers Reach.  Mr. Lewis believed the bill to address motor            
 vehicle accidents or illnesses in homes.  The majority of EMTs are            
 in uniform or wear some sort of patch.                                        
                                                                               
  CHAIRMAN WILKEN  did not want just anyone to claim to be an EMT and          
 end up directing traffic.  Should SB 164 contain language                     
 indicating the need for EMTs to carry identification or wear a                
 uniform in order to know that the person is truly an EMT if                   
 challenged?   CRAIG LEWIS  acknowledged that the involvement of               
 bystanders and the question of challenging of the EMTs is                     
 complicated.  The EMTs have credentials and cards which explain the           
 certification as well as uniforms.  EMTs are trained in dealing               
 with the public.  The definitions and standards defining an EMT               
 seem to already address the issue of identification.                          
                                                                               
 Number 213                                                                    
                                                                               
  ELLEN WOFFORD , EMT-III with Delta Rescue Squad, supported SB 164.           
 Many EMTs are volunteers and therefore may come upon a scene and              
 not be in the uniform, but do carry badges and perhaps have a hat             
 indicating the person's EMT status.                                           
                                                                               
  TOM DEAN , Chief of the Tok EMS, believed he was sort of responsible         
 for this legislation because he questioned whether Alaskan EMTs had           
 authority after reading an article discussing a similar situation             
 in another state.  SB 164 addresses what is done on a regular basis           
 by EMTs.  Mr. Dean noted that in his area, EMTs often arrive 30               
 minutes to an hour before troopers at motor vehicle accidents.                
 SB 164 merely gives authority to EMTs to do what they are already             
 doing.  Mr. Dean encouraged the passage of SB 164.                            
                                                                               
  MARK JOHNSON , Chief of the Section of Community Health & Emergency          
 Medical Services in DHSS, informed the committee that the Section             
 of Community Health & Emergency Medical Services was responsible              
 for planning, coordinating, and implementing a statewide emergency            
 medical services system which includes the certification of all               
 EMTs and ambulance services.  With regard to ETTs, those persons              
 are not equivalent to EMTs.  ETTs, first responders, would not be             
 covered under this statute.  Mr. Johnson explained that if someone            
 is certified by his section then, that person would receive a                 
 certificate, a wallet card, and patches.  Mr. Johnson supported               
 SB 164.                                                                       
                                                                               
  CHAIRMAN WILKEN  inquired as to the number of people involved from           
 the EMT-I level to MICP.   MARK JOHNSON  stated that approximately            
 4,000 people are certified statewide.                                         
                                                                               
 Number 295                                                                    
                                                                               
  SENATOR WARD  asked if SB 164 was enacted, would Martin Buser be             
 sent to jail if during an emergency situation an EMT told him not             
 to go home and he did.   BETH HAGEVIG  said that she would have to            
 confer with legal on that issue.  Placing EMTs as enforcers was not           
 the intent of this legislation; the intent was to give EMTs the               
 authority to do what they are already doing.  In general when EMTs            
 arrive on the scene, the EMTs rely on law enforcement to perform              
 enforcement duties.                                                           
                                                                               
  SENATOR WARD  restated his question.   BETH HAGEVIG  noted that SB 16        
 was modeled after the fire fighter authority legislation in which             
 there is a penalty if a fire fighter's instructions are disobeyed.            
 Ms. Hagevig reiterated that she would need to confer with an                  
 attorney on this matter.                                                      
                                                                               
  MARK JOHNSON  believed that there was no enforcement authority with          
 SB 164.  The reason for SB 164 is to protect EMTs; most EMTs do not           
 want enforcement authority.  Mr. Johnson also deferred to legal               
 advice.                                                                       
                                                                               
  SENATOR GREEN  believed Mr. Johnson, but noted that during an                
 ongoing emergency the functions between the various responding                
 groups can become blurred.  This legislation may not be the proper            
 place to address this issue, the ability to deputize.  Senator                
 Green referred to lines 3 and 4 on page 2; is that a typical                  
 standard?   MARK JOHNSON  believed that if EMS receives a call then           
 that gives EMS reasonable authority to enter on the basis of that             
 call.  This simply clarifies that.   BETH HAGEVIG  reiterated that            
 SB 164 was drafted almost verbatim from the fire fighter authority            
 legislation.                                                                  
                                                                               
 In response to Senator Ward,  CRAIG LEWIS  reiterated that the intent         
 of SB 164 was to provide authority not enforcement.  In general,              
 persons who violate statutes are penalized and if SB 164 becomes              
 law then the penalties relevant to that would apply.  There is a              
 $1,000 fine for failing to comply with a fire fighter's                       
 instructions which is specifically stated in that legislation.                
 That is not stated in SB 164.                                                 
                                                                               
 Number 383                                                                    
                                                                               
  SENATOR WARD  asked if all persons covered under SB 164 were                 
 required to carry photo identification.   CRAIG LEWIS  said no,               
 although most have a card issued by the state which identifies the            
 person and level of skill.   MARK JOHNSON  also replied no to Senator         
 Ward's inquiry.                                                               
                                                                               
  SENATOR WARD  noted that police officers are not always in uniform,          
 but do have identification beyond a badge, a cap, or a patch.   TOM           
 DEAN  reiterated that in the Millers Reach fire, EMTs would not be            
 in control in such a major fire.   SENATOR WARD  informed everyone of         
 another situation in which a person with identification took                  
 control of an emergency situation and instructed those present to             
 move away from the victim.  Unbeknownst to the EMT person, one of             
 the bystanders was a relative.  Without the proper identification,            
 the situation could have been very difficult.   TOM DEAN  assumed             
 that there was a reason that there were instructions to separate              
 the people from the victim.                                                   
                                                                               
  CHAIRMAN WILKEN  redirected the conversation to the question of              
 identification.   MARK JOHNSON  reiterated that all the certified             
 EMTs are issued a wallet card, patches and a certificate.                     
                                                                               
  CHAIRMAN WILKEN  asked if adding language requiring that the EMT             
 certification card be carried, which is not a photo identification,           
 would address the identification concerns.   SENATOR WARD  suggested          
 that a specific background or designation on the person's drivers             
 license could be utilized to signify their EMT status.   MARK                 
 JOHNSON  deferred to the DMV, but did note that SB 38 would require,          
 in addition to the organ donor specification, a Do Not Resuscitate            
 order as well.  If SB 38 passes, that is a lot of information on              
 the drivers license.                                                          
                                                                               
  CHAIRMAN WILKEN  suggested that SB 164 be held to work on this               
 matter.  SB 164 was held to Friday's agenda.                                  
                                                                               
                                                                               
        SB 122 INS.COVERAGE:MARRIAGE & FAMILY THERAPIST                       
                                                                              
 Number 459                                                                    
                                                                               
  CHAIRMAN WILKEN  introduced  SB 122  as the next order of business.          
 He noted that there was a CS from the Labor & Commerce Committee,             
 when saying that he would entertain a motion to place it before the           
 committee.                                                                    
                                                                               
  SENATOR WARD  moved to adopt CSSB 122(L&C) for discussion purposes.          
 Without objection, CSSB 122(L&C) was adopted.                                 
                                                                               
  RACHEAL MORELAND , Staff to Senator Leman, read the following                
 Sponsor statement into the record:                                            
                                                                               
 Senate Bill 122 was introduced by the Labor and Commerce Committee            
 at the request of the Alaska Association for Marriage and Family              
 Therapy (AAMFT).  SB 122 will add marital and family therapists to            
 the list of providers against whom insurers may not discriminate.             
                                                                               
 This bill does not require insurers to add coverage of marital and            
 family therapists where the coverage currently is not provided.  It           
 merely requires that insurers treat marital and family therapists             
 on equal footing with other licensed providers and extend the same            
 opportunities for coverage that the insurer offers others providing           
 the same services.  The definition of unfair discrimination is                
 clarified by this bill and codifies existing practice.                        
                                                                               
 Section 1, paragraph 1 adds marital and family therapists to the              
 unfair discrimination list under group health insurance policies              
 with an effective date of July 1, 1997.  Paragraph 2 defines unfair           
 discrimination.                                                               
                                                                               
 Legislation (Section 4, ch. 39, SLA 1993) affecting the unfair                
 discrimination clause was passed in 1993 with an effective date of            
 1998.  Section 2 repeals and reenacts this section to reflect the             
 addition of marital and family therapists and the definition of               
 unfair discrimination.                                                        
                                                                               
 Currently, health insurers offering mental health services may not            
 discriminate against licensed psychologists, psychological                    
 associates or clinical social workers.  SB 122 would allow those              
 insured with mental health coverage to choose treatment from a                
 licensed marital and family therapist.                                        
                                                                               
 AAMFT is a division of the American Association for Marriage and              
 Family Therapy, Inc.  Marriage and family therapists (MFTs) are a             
 group of mental health professionals with background in a variety             
 of disciplines, including psychology, social work, and family                 
 social science.  MFTs are licensed or certified in 37 states and              
 are recognized by the U.S. Department of Health and Human Services            
 as one of the five core mental health disciplines in the U.S.                 
                                                                               
  CATHERINE REARDON , Director of the Division of Occupational                 
 Licensing in the Department of Commerce & Economic Development,               
 informed the committee that the Board of Marital and Family                   
 Therapists works in association with this division.  The board                
 supports the inclusion of MFTs in this nondiscrimination clause.              
                                                                               
  SENATOR LEMAN  inquired as to how many people are licensed by the            
 board in this category.   CATHERINE REARDON  said that at the                 
 beginning of this fiscal year, there were 181 persons licensed in             
 this category.                                                                
                                                                               
 Number 515                                                                    
                                                                               
  BEVERLY LINDELL , President of AAMFT, requested the committee's              
 support for SB 122.  Ms. Lindell noted that SB 122 does not mandate           
 coverage nor increase the scope of service nor does the bill                  
 include any willing provider language.  This legislation is                   
 important for fairness.  Ms. Lindell noted that MFTs have been                
 licensed in this state since 1992 and pay fees to provide that                
 service.  MFTs are also one of the five core mental health groups             
 identified by the National Institute of Mental Health.                        
                                                                               
 With regard to the concern of cost, Ms. Lindell informed the                  
 committee that the Division of Insurance reported that there is no            
 evidence that costs would increase due to the increase in the pool            
 of providers.  In fact, the effect of competition may actually                
 decrease the costs.  Ms. Lindell explained that MFTs tend to be               
 solution focused which results in achieving a job efficiently and             
 quickly which could result in reduced costs to insurers.  Ms.                 
 Lindell also noted that a survey in the American Psychologist               
 reported that consumers refer to MFTs more often than other mental            
 health professionals.  Further there has been much information                
 about family problems across the nation and in Alaska which has the           
 highest rate of teen suicide and sexual abuse.  MFTs are the groups           
 that have expertise in that area and would like to practice that              
 with reimbursement.                                                           
                                                                               
  CHAIRMAN WILKEN  asked Ms. Burke to explain the term "unfair                 
 discrimination" to the committee.                                             
                                                                               
  MARIANNE BURKE , Director of the Division of Insurance for DCED,             
 explained that "unfair discrimination" does not include the purpose           
 of utilization review for standards of clinical appropriate health            
 care which Ms. Burke could support.  With regard to cost                      
 containment, Ms. Burke was a bit concerned that it could be used to           
 force an individual to seek the cheapest service available.  Ms.              
 Burke pointed out that the process of utilization review is a cost            
 containment measure.  Clinically appropriate health care services             
 have elements of cost containment.  Ms. Burke believed that the               
 amendment helps clarify this section of Title 21.                             
                                                                               
  SENATOR LEMAN  did not intend for "cost containment" to mean that            
 the lowest cost provider must be utilized, but rather that the                
 appropriate provider be utilized.  Senator Leman pointed out that             
 there may be appropriate measures to contain cost which would not             
 be an unfair discrimination practice.                                         
                                                                               
  CHAIRMAN WILKEN  asked if Ms. Burke had heard from insurance                 
 companies in Alaska with regard to the amendment.   MARIANNE BURKE            
 had only heard from one writer of health insurance in the state who           
 favored the amendment.                                                        
                                                                               
  SENATOR LEMAN  moved to report CSSB 122(L&C) out of committee with           
 individual recommendations and the accompanying zero fiscal note.             
 Without objection, it was so ordered.                                         
                                                                               
                                                                               
        SB 132 CRIMINAL JUSTICE INFO, INCL. SEX OFFENDER                      
                                                                              
 Number 581                                                                    
                                                                               
  CHAIRMAN WILKEN  announced  SB 132  as the final order of business           
 before the committee.                                                         
                                                                               
  SENATOR WARD  moved to report SB 132 out of committee with                   
 individual recommendations and accompanying fiscal notes.                     
                                                                               
  CHAIRMAN WILKEN  asked if there was anyone to testify or any                 
 questions on SB 132.  Hearing none, Chairman Wilken asked if there            
 was any objection to the motion.  Hearing no objection, SB 132 was            
 reported out of committee.                                                    
                                                                               
 There being no further business before the committee, the meeting             
 was adjourned at 9:55 a.m.                                                    
                                                                               

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