Legislature(1997 - 1998)

02/16/1998 09:00 AM Senate HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                        February 16, 1998                                      
                            9:00 a.m.                                          
MEMBERS PRESENT                                                                
Senator Gary Wilken, Chairman                                                  
Senator Loren Leman, Vice-Chairman                                             
Senator Lyda Green                                                             
MEMBERS ABSENT                                                                 
Senator Jerry Ward                                                             
Senator Johnny Ellis                                                           
COMMITTEE CALENDAR                                                             
ALASKA PUBLIC HEALTH IMPROVEMENT PLAN - Update by Dr. Peter                    
SENATE CONCURRENT RESOLUTION NO. 14                                            
Establishing the Alaska Task Force on Parity for Mental Health.                
     MOVED CSSCR 14(HES) OUT OF COMMITTEE                                      
PREVIOUS SENATE COMMITTEE ACTION                                               
SCR 14 - See HESS minutes dated 4/30/97, 1/30/98, 2/4/98 and                   
WITNESS REGISTER                                                               
Dr. Peter Nakamura                                                             
Division of Public Health                                                      
Department of Health and Social Services                                       
P.O. Box 110610                                                                
Juneau, Alaska  99811-0610                                                     
POSITION STATEMENT:  Gave the presentation on the Alaska Public                
Health Improvement Plan                                                        
Deborah Erickson                                                               
Division of Public Health                                                      
Department of Health and Social Services                                       
P.O. Box 110610                                                                
Juneau, Alaska  99811-0610                                                     
POSITION STATEMENT:  Provided information about the Alaska Public              
Health Improvement Plan                                                        
Delisa Culpepper                                                               
Alaska Public Health                                                           
1874 Wickersham Drive                                                          
Fairbanks, Alaska  99507                                                       
POSITION STATEMENT:  Provided information on the Alaska Public                 
Health Improvement Plan                                                        
Christine Huss                                                                 
Health Community                                                               
P.O. Box 587                                                                   
Kenai, Alaska  99611                                                           
POSITION STATEMENT:  Provided information on the Alaska Public                 
Health Improvement Plan                                                        
Jerry Near                                                                     
Health Community                                                               
Drawer 448                                                                     
Soldotna, Alaska  99669                                                        
POSITION STATEMENT:  Provided information on the Alaska Public                 
Health Improvement Plan                                                        
Walter Majoros                                                                 
Executive Director                                                             
Alaska Mental Health Board                                                     
431 N. Franklin St.                                                            
Juneau, Alaska  99801                                                          
POSITION STATEMENT:  Commented on SCR 14                                       
ACTION NARRATIVE                                                               
TAPE 98-11, SIDE A                                                             
Number 001                                                                     
CHAIRMAN WILKEN called the Senate Health, Education and Social                 
Services (HESS) Committee to order at 9:07 a.m.  Present were                  
Senators Wilken and Green.  The first order before the committee               
was the Alaska Public Health Improvement Plan update by Dr. Peter              
Nakamura.  CHAIRMAN WILKEN noted a Public Health Steering Committee            
was formed last interim.  The presentation will be an update on the            
Steering Committee's work to date.                                             
DR. NAKAMURA, Director of the Division of Public Health (DPH), made            
the following comments.  He came to Alaska to work as a                        
pediatrician in 1969, and then became the director of the Public               
Health Program in Bethel.  Many health related problems existed in             
Bethel at that time, and clinicians were able to diagnose and treat            
those health disorders.  The major strides made in the field of                
public health have been in the elimination of deaths from                      
tuberculosis, cholera, typhoid, and diphtheria.  Public health                 
officials made these strides in partnership with clinical                      
practices.  Despite that progress, Alaska still has a long way to              
go. Alaska was ranked number 48 out of 50 states in its                        
immunization status.  The population of children in the state                  
doubled between 1980 and 1996. The number of vaccines now required             
to immunize children by the age of 19 is over 3 million doses.                 
DR. NAKAMURA said no environmental health element existed within               
DPH when he became director in 1991.  Today DPH is more able to                
respond to community health concerns about radiation and cancer or             
toxic waste.  As a very young state, Alaska's public health system             
was developed by responding to crises, by using federal or oil                 
industry dollars when available, and by focusing on special                    
interests of individuals with influence.  The Alaska Public Health             
Improvement Process will eventually lead to a plan.  The Steering              
Committee needs to know what health services and systems are                   
available to respond to public health issues in Alaska, not only               
within the state infrastructure, but in private health care                    
systems, tribal corporations, and municipalities.                              
DR. NAKAMURA stated the Steering Committee will also determine what            
capacities are available.  With the assistance of federal agencies,            
some capacities to respond to environmental health issues were                 
developed in the state but they have never been evaluated.  Those              
systems and capacities need to be tied in with disease status to               
determine how Alaska fares relative to the rest of the nation.                 
Health outcomes also need to be identified to determine where we               
could be.  Once the systems, services, and capacities are                      
evaluated, and the health outcomes are identified, a plan will be              
developed.  The Steering Committee hopes to create a package that              
will allow policy makers to make decisions and pass legislation                
that will have the greatest impact based on health status, rather              
than on special interests, special opportunities, or prices.                   
DR. NAKAMURA said the Alaska Public Health Improvement Plan is a               
significant and important process that requires the involvement of             
people with power, influence and knowledge,  First, a Steering                 
Committee was established, comprised of 35 individuals, including              
legislators.  The process must be broad enough to identify the                 
needs of communities and individuals, not those of the Division of             
public Health.  The Steering Committee has formed partnerships with            
communities to ensure that true community needs are addressed.                 
That process should be completed within two years.  One community              
has health powers which allows that community to collect some                  
funding on a tax basis to support health issues.  No one knows                 
whether specific communities can assume health powers, and to what             
DEB ERICKSON, Health Program Manager in the Division of Public                 
Health, DHSS, stated she has been coordinating the Alaska Public               
Health Improvement Process.  The group received a $300,000 grant               
from the Robert Wood Johnson Foundation to fund staff support, and             
travel costs for the Steering Committee and a large workgroup who              
is conducting an assessment of the current system.                             
MS. ERICKSON explained the project is divided into two phases.                 
Assessment of the current system will occur during the first phase,            
which should be complete in six to eight months.  Information is               
being gathered on the resources in the system, the rules,                      
responsibilities and authorities, and the different players in the             
system.  The focus of the second phase will be to determine what               
capacities will be needed in the public health system in the                   
future, what the roles, responsibilities, and authorities of the               
different players should be, and identifying any necessary legal               
changes that need to be made to support that system.                           
MS. ERICKSON said the three communities that were funded by the                
Kellogg Foundation are Fairbanks, the communities on the Kenai                 
Peninsula, and Sitka.  Those communities are working through the               
two-phase process at the local level and that information will be              
integrated in the state level process.                                         
Number 250                                                                     
CHAIRMAN WILKEN asked who is involved from the Fairbanks community.            
MS. ERICKSON answered some of the key members are Rick Solie, Ellen            
Ganley, and Cheryl Kilgore.  CHAIRMAN WILKEN asked if they are                 
participating as representatives of groups.  MS. ERICKSON replied              
people from the hospitals and health care sector have been very                
involved, and that the Public Health Nursing Center has been                   
helping to coordinate the application process.  CHAIRMAN WILKEN                
questioned whether the group of people is part of an agency or the             
Borough.  MS. ERICKSON said there is a workgroup that is working               
with the Borough Assembly.  The Assembly is considering passing a              
resolution in support of the process and is looking at being the               
funding agency for the grant.                                                  
CHAIRMAN WILKEN asked if that same type of membership applies to               
Sitka and the communities in Kenai.  MS. ERICKSON said yes, they               
are community coalitions and not specific organizations.                       
CHAIRMAN WILKEN questioned whether the money flows directly to                 
those groups, or through the state.  MS. ERICKSON said the money is            
going directly to the communities from the Kellogg Foundation.                 
DR. NAKAMURA explained all communities were invited to express an              
interest in partnership in this process by the Kellogg Foundation.             
Originally 30 communities were interested, but the application                 
process was a year-long, time-intensive process, during which time             
a number of communities dropped out.  The Foundation determined who            
was eligible.                                                                  
CHAIRMAN WILKEN asked where, on the process chart, would                       
suggestions for new legislation be considered.  DR. NAKAMURA said              
that will occur at the end point of the process.  Throughout the               
process, public health law experts will be consulted to give                   
guidance as to what other states have established and what issues              
should be addressed.                                                           
SENATOR LEMAN noted that he has introduced SB 205 which pertains to            
the issue of health and safety self-audits.  The Legislature passed            
the environmental audit part of the program last year.  He believes            
the health and safety self-audits and environmental self-audits may            
have some affect on public health concerns.  He encouraged the                 
working group to look at that legislation and inform him of  any               
concerns it may have.                                                          
Number 335                                                                     
MS. ERICKSON asked if the bill will increase accountability in the             
system and identify performance and outcome measures.  SENATOR                 
LEMAN answered the bill provides two incentives, limited immunity              
and limited privilege, to individuals and companies who audit their            
own operations and make required changes based on the audit                    
DELISA CULPEPPER, representing the Alaska Public Health Association            
(APHA), made the following statements.  The APHA represents about              
200 public health professionals statewide, and has been working                
toward an organized public health plan for the past 11 years.  It              
is pleased to be engaged in a formal process that will lead to a               
more structured view of public health needs in the state.  It is               
increasingly important, during these times of increasing                       
accountability and downsizing, that the APHA be engaged in                     
determining the most effective public health activities.  A clear              
and prioritized public health policy needs to be determined, along             
with a way to track progress.  Some of the functions and activities            
that need to be addressed and prioritized are epidemic prevention,             
protecting the environment - housing, food, and water, promoting               
healthy behaviors and healthy public policy, monitoring the health             
conditions of the population, mobilizing communities to action                 
around health issues, and training specialists and investigating               
and preventing disease.  Alaska needs to create an infrastructure              
that will reflect those activities for the future.                             
Number 391                                                                     
CHRISTINE HUSS testified as a member of Healthy Communities in                 
Kenai.  Healthy Communities was a recipient of the Turning Point               
grant from the Kellogg Foundation.  In the early 1990's a group                
formed to find funding sources for health insurance for people in              
Kenai communities.  That goal did not carry through, so the group              
developed a program to look at all of the health needs of the                  
community.  One of the group's objectives is to develop new                    
indicators.  The group has promoted many new programs on the Kenai             
Peninsula.  One apparent problem is the need to expand the public              
health facilities in the area.  The current space is inadequate and            
prevents some services from being adequately provided.                         
Number 418                                                                     
JERRY NEAR, representing Healthy Communities, gave the following               
testimony.  All communities are beginning to foresee the need to               
take responsibility for the assumption of various community needs,             
in view of pending budget constraints.  A community foundation was             
recently formed and incorporated as a 501(c)(3) entity so that                 
individuals can donate to the community and designate what the                 
funds are to be used for.  He informed committee members that he               
and Representative Gary Davis have put together a preliminary draft            
of a bill that deals with intestacy.  Under this proposal, if heirs            
cannot be located, property will be held by the state for five                 
years and then distributed to the various communities with                     
foundations.  The intent is to turn estates back to communities to             
be used as a resource for programs.                                            
Number 453                                                                     
CHAIRMAN WILKEN asked how the money from the Turning Point grant               
will be used, and how it flows into the statewide effort.  MR. NEAR            
said Healthy Communities has prepared a budget time line that                  
encompasses a three year period.  The money will be used to hire               
consultants. to take care of meeting costs, to pay for travel, and             
to pay some direct office expenses.  The budget is still in the                
design phase.                                                                  
CHAIRMAN WILKEN asked what the end product will look like.  MS.                
HUSS answered that their goal for the next year is to do an                    
assessment of community needs which they hope to do by developing              
initiative teams to do the studies.  She added most of the people              
working on this project are volunteers.                                        
CHAIRMAN WILKEN asked if Health Communities will be interacting                
with those involved from Fairbanks and Sitka.  MR. NEAR said those             
people will meet with Healthy Communities, as well as with other               
community representatives around the nation.                                   
CHAIRMAN WILKEN asked what other states are undertaking such a                 
project.  DR. NAKAMURA said the State of Washington has been at                
this process for about eight years and is not quite finished.                  
Washington participants have offered guidance to Alaska but Alaska             
is approaching its public health project in a different manner.                
MS. ERICKSON pointed out that originally 47 states admitted                    
applications to the Foundation to fund similar projects; 14 were               
funded.  The Foundations are supporting these projects because the             
public health community nationwide is recognizing the changing                 
nature of health problems that affect communities, other health                
care systems, welfare reform, political climates, and increased                
recognition of the need for more local control and personal                    
responsibility.  This process will allow everyone to review what               
steps the public health system has taken over the last 50 years and            
what improvements need to be made for the next century.  She                   
thought Alaska will review parts of other states' models for the               
purpose of comparison, but believed that other states will                     
eventually look to Alaska's redeveloped system as a model.                     
CHAIRMAN WILKEN asked if the State of Washington has developed                 
standards of measurement to determine whether any progress has                 
occurred, and whether Alaska's group has discussed using similar               
standards.  DR. NAKAMURA said he wants the state to know what is               
available by way of health systems and services and to feel                    
comfortable in knowing what the capacity of those systems are and              
how they impact the things we read about in the newspaper: the                 
number of accidental deaths, homicides, suicides, environmental                
issues, etc.  He noted this process is energy intensive. He is                 
concerned that if the goals are not achieved at this go-around, it             
will take a lot of convincing to get people to re-enter this                   
process for a second time.  Throughout this process the group needs            
the continued commitment and participation of the Legislature.                 
CHAIRMAN WILKEN indicated he would like to see the development of              
standards of measurement in Box 5 on the process chart.  He also               
suggested including the word "legislation" in Box 5.                           
Number 520                                                                     
CHAIRMAN WILKEN asked if Alaska's birth rate is increasing or                  
decreasing.  DR. NAKAMURA answered it is decreasing, as it is                  
nationwide.   CHAIRMAN WILKEN asked how Alaska compares nationwide.            
DR. NAKAMURA offered to provide that information at a later date.              
CHAIRMAN WILKEN inquired about the status of the new laboratory in             
Anchorage.  DR. NAKAMURA stated DHSS is still in the process of                
determining the scope of the laboratory and taking into account the            
services the state will need over the next 50 years.  He believes              
the laboratory will be a focal point of excellence for Alaska.                 
CHAIRMAN WILKEN asked about the Life Alaska group.  DR. NAKAMURA               
explained that Life Alaska provides human tissue services.  DHSS               
recognizes the value of offering such a service in conjunction with            
its medical examiner lab.  DHSS is reviewing Life Alaska's needs in            
conjunction with the other services as the priorities for the                  
laboratory are being developed.                                                
SENATOR LEMAN noted that he has been very impressed with the Crime             
Lab.  He encouraged Dr. Nakamura to think about designing the new              
facility with the understanding that it may need to be expanded in             
the future to consolidate all laboratory services in one location.             
DR. NAKAMURA maintained that possibility is being considered, and              
not only in the event that state services are consolidated, but                
also so that duplication with non-state services does not occur.               
CHAIRMAN WILKEN thanked Dr. Nakamura for updating the committee.               
          SCR 14 - PARITY FOR MENTAL HEALTH TASK FORCE                         
SENATOR LEMAN moved to adopt CSSCR 14(HES), version K.  There being            
no objection, the motion carried.                                              
TAPE 98-11, SIDE B                                                             
CHAIRMAN WILKEN explained version K incorporates the five                      
amendments adopted at the previous meeting.                                    
SENATOR LEMAN referred to item #1 on page 2, lines 7-8, and                    
expressed concern that the current phrase presumes that                        
discrimination against people with mental disorders is occurring in            
health insurance policies.  He maintained that if the word                     
"discrimination" is understood to mean differences in policies then            
its use is legitimate.                                                         
CHAIRMAN WILKEN asked Senator Leman if his concern is taken care of            
in the paragraph above which charges the Task Force with defining              
the four different classifications.  SENATOR LEMAN maintained that             
insurance policies are designed to discriminate among users because            
certain classes of users are higher risks, such as teenage drivers,            
therefore such discrimination is appropriate.                                  
SENATOR GREEN suggested using the phrase "review health insurance              
coverage of persons with mental disorders," because the concern is             
coverage rather than policies.                                                 
SENATOR LEMAN thought the existing language is acceptable as long              
as the intent is clear.                                                        
CHAIRMAN WILKEN suggested deleting lines 7-8 altogether to                     
eliminate the suggestion of discrimination.                                    
WALTER MAJOROS, Executive Director of the Alaska Mental Health                 
Board, stated his interpretation of the word "discrimination" would            
mean the Task Force is to study differential treatment of people               
with mental illnesses versus people with physical disorders, which             
is the heart of the issue.                                                     
CHAIRMAN WILKEN asked if that is taken care of on line 10, with the            
phrase, "special emphasis on parity, ...."  SENATOR GREEN thought              
the first "WHEREAS" clause contains that intent.                               
SENATOR GREEN moved to delete lines 7-8 on page 2.                             
MR. MAJOROS stated the issue is one of clarity, and that if the                
Legislature wants the Task Force to look at the issue of                       
differential treatment, lines 7-8 provide that mandate.  CHAIRMAN              
WILKEN suggested adding the words "differential treatment" to lines            
SENATOR LEMAN suggested using the language, "differential treatment            
in health insurance policies between coverage for mental and                   
physical disorders" because it will clarify the heart of the issue.            
MR. MAJOROS felt that language would be acceptable.                            
CHAIRMAN WILKEN announced the motion to delete lines 7-8 on page 2             
carried with no objection.                                                     
SENATOR LEMAN moved to create a new item #1, beginning on line 7,              
to read, "differential treatment in health insurance policies                  
between coverage for physical and mental disorders;".  There being             
no objection, the motion carried.                                              
SENATOR LEMAN moved to pass CSSCR 14(HES) as amended out of                    
committee with individual recommendations and its accompanying zero            
fiscal note.  There being no objection, the motion carried.                    
CHAIRMAN WILKEN announced a Joint House and Senate HESS committee              
meeting is scheduled at 8:15 a.m. on Wednesday to hear about the               
Education Week "Report Card for Alaska" and the Traumatic Brain                
Injury Act.  At 9:00 a.m. on Friday, the committee will hear a                 
brief presentation from President Kelly of the University of Alaska            
Board of Regents, and at 10:00 will discuss SB 203.  He adjourned              
the meeting at 10:10 a.m.                                                      

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